Duodenal Villous Atrophy and Diarrhea Associated with Chronic Olmesartan Intake

Giulia Colombo; Raffaella Rossio; Barbara Ferrari; Letterio Runza; Peyvandi Flora

doi:doi:10.11648/j.ijpc.20190506.12

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Duodenal Villous Atrophy and Diarrhea Associated with Chronic Olmesartan Intake

Giulia Colombo, Raffaella Rossio, Barbara Ferrari, Letterio Runza, Peyvandi Flora

Published in International Journal of Pharmacy and Chemistry (Volume 5, Issue 6)

Received: 8 November 2019 Accepted: 29 November 2019 Published: 6 December 2019

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Abstract

Olmesartan is an angiotensin II receptor blocker (ARB) approved for the treatment of hypertension since 2002. Olmesartan-associated enteropathy (OAE), first described in 2012 by Rubio-Tapia, has seldom been considered as a diagnosis in patients with villous atrophy and negative serology for celiac disease. The clinical presentation could be extremely heterogenous. In contrast to celiac disease, there is no response to a gluten-free diet. The exact mechanism of intestinal injury still remains unknown. The histological pattern, at the upper gastrointestinal endoscopy, usually reveals a variable degree of villous atrophy and a moderate infiltration of lymphocytes at mucosal level. Symptoms usually improve upon olmesartan discontinuation and the repeat endoscopy could demonstrate complete resolution of inflammatory change with normal villous architecture. The differential diagnosis for this kind of clinical and pathological features include celiac disease, tropical sprue, autoimmune enteropathy, inflammatory bowel disease, and drug induced enteropathy. With this background, we report the case of a patient with a clinical picture compatible with seronegative celiac disease and symptoms that rapidly improved clinically and histologically after olmesartan discontinuation. In conclusion, although this condition is rare, physicians should be consider this medication in the differential diagnosis of this enteropathy.

Published in	International Journal of Pharmacy and Chemistry (Volume 5, Issue 6)
DOI	10.11648/j.ijpc.20190506.12
Page(s)	72-74
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2019. Published by Science Publishing Group

Keywords

Olmesartan, Celiac Disease, Enteropathy, Diarrhea, Weight Loss, Nausea

References

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[2]	Ludvigsson JF, Ludvigsson J, Ekbom A, Montgomery SM. Celiac Disease and Risk of Subsequent Type 1 Diabetes: A general population cohort study of children and adolescents. Diabetes Care. 2006; 29: 2483–2488.
[3]	Ludvigsson JF, Reutfors J, Osby U, Ekbom A, Montgomery SM. Coeliac disease and risk of mood disorders–a general population-based cohort study. J Affect Disord. 2007; 99: 117–126.
[4]	T. R. Ziegler, C. Fernández-Estívariz, L. H. Gu, M. W. Fried, L. M. LeaderSevere villus atrophy and chronic malabsorption induced by azathioprine Gastroenterology, 2003, pp. 1950-1957.
[5]	N. Kamar, P. Faure, E. Dupuis, et al. Villous atrophy induced by mycophenolate mofetil in renal-transplant patients Transpl Int, 2004, 463-467.
[6]	H. Weclawiak, A. Ould-Mohamed, B. Bournet, et al. Duodenal villous atrophy: a cause of chronic diarrhea after solid-organ transplantation Am J Transplant, 2011, pp. 575-582.
[7]	Burbure N, Lebwohl B, Arguelles-Grande C et al: Olmesartan-associated sprue-like enteropathy: A systematic review with emphasis on histopathology. Hum Pathol, 2016; 50: 127–34.
[8]	Zhao D, Liu H, Dong P. A meta-analysis of antihypertensive effect of telmisartan versus candesartan in patients with essential hypertension. Clin Exp Hypertens 2019; 41: 75–9.
[9]	The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Bethesda, MD: National Institutes of Health, National Heart, Lung, and Blood Institute, US Department of Health and Human Services; 2004. NIH Publication No. 04-5230.
[10]	Rubio-Tapia A, Herman ML, Ludvigsson JF, et al. Severe spruelike enteropathy associated with olmesartan. Mayo Clin Proc 2012; 87: 732–8.
[11]	Choi E-YK, McKenna BJ: Olmesartan-associated enteropathy: A review of clinical and histologic findings. Arch Pathol Lab Med, 2015; 139: 1242–47 15.
[12]	Fuchs FD, DiNicolantonio JJ. Angiotensin receptor blockers for prevention of cardiovascular disease: where does the evidence stand? Open Heart 2015; 2: e000236.
[13]	Abdelghany M, Gonzalez L 3rd, Slater J, Begley C: Olmesartan associated sprue-like enteropathy and colon perforation. Case Rep Gastrointest Med, 2014; 2014: 494098 16.
[14]	Adike A, Corral J, Rybnicek D, et al. Olmesartan-induced enteropathy. Methodist DeBakey Cardiovasc J. 2016; 12: 230–3.
[15]	Marthey L, Cadiot G, Seksik P et al: Olmesartan–associated enteropathy: Results of a national survey. Aliment Pharmacol Ther, 2014; 40: 1103-9.
[16]	Zeino Z, Sisson G, Bjarnason I. Adverse effects of drugs on small intestine and colon. Best Pract Res Clin Gastroenterol. 2010; 24: 133–41.

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APA Style

Giulia Colombo, Raffaella Rossio, Barbara Ferrari, Letterio Runza, Peyvandi Flora. (2019). Duodenal Villous Atrophy and Diarrhea Associated with Chronic Olmesartan Intake. International Journal of Pharmacy and Chemistry, 5(6), 72-74. https://doi.org/10.11648/j.ijpc.20190506.12

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ACS Style

Giulia Colombo; Raffaella Rossio; Barbara Ferrari; Letterio Runza; Peyvandi Flora. Duodenal Villous Atrophy and Diarrhea Associated with Chronic Olmesartan Intake. Int. J. Pharm. Chem. 2019, 5(6), 72-74. doi: 10.11648/j.ijpc.20190506.12

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AMA Style

Giulia Colombo, Raffaella Rossio, Barbara Ferrari, Letterio Runza, Peyvandi Flora. Duodenal Villous Atrophy and Diarrhea Associated with Chronic Olmesartan Intake. Int J Pharm Chem. 2019;5(6):72-74. doi: 10.11648/j.ijpc.20190506.12

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@article{10.11648/j.ijpc.20190506.12,
  author = {Giulia Colombo and Raffaella Rossio and Barbara Ferrari and Letterio Runza and Peyvandi Flora},
  title = {Duodenal Villous Atrophy and Diarrhea Associated with Chronic Olmesartan Intake},
  journal = {International Journal of Pharmacy and Chemistry},
  volume = {5},
  number = {6},
  pages = {72-74},
  doi = {10.11648/j.ijpc.20190506.12},
  url = {https://doi.org/10.11648/j.ijpc.20190506.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijpc.20190506.12},
  abstract = {Olmesartan is an angiotensin II receptor blocker (ARB) approved for the treatment of hypertension since 2002. Olmesartan-associated enteropathy (OAE), first described in 2012 by Rubio-Tapia, has seldom been considered as a diagnosis in patients with villous atrophy and negative serology for celiac disease. The clinical presentation could be extremely heterogenous. In contrast to celiac disease, there is no response to a gluten-free diet. The exact mechanism of intestinal injury still remains unknown. The histological pattern, at the upper gastrointestinal endoscopy, usually reveals a variable degree of villous atrophy and a moderate infiltration of lymphocytes at mucosal level. Symptoms usually improve upon olmesartan discontinuation and the repeat endoscopy could demonstrate complete resolution of inflammatory change with normal villous architecture. The differential diagnosis for this kind of clinical and pathological features include celiac disease, tropical sprue, autoimmune enteropathy, inflammatory bowel disease, and drug induced enteropathy. With this background, we report the case of a patient with a clinical picture compatible with seronegative celiac disease and symptoms that rapidly improved clinically and histologically after olmesartan discontinuation. In conclusion, although this condition is rare, physicians should be consider this medication in the differential diagnosis of this enteropathy.},
 year = {2019}
}

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TY  - JOUR
T1  - Duodenal Villous Atrophy and Diarrhea Associated with Chronic Olmesartan Intake
AU  - Giulia Colombo
AU  - Raffaella Rossio
AU  - Barbara Ferrari
AU  - Letterio Runza
AU  - Peyvandi Flora
Y1  - 2019/12/06
PY  - 2019
N1  - https://doi.org/10.11648/j.ijpc.20190506.12
DO  - 10.11648/j.ijpc.20190506.12
T2  - International Journal of Pharmacy and Chemistry
JF  - International Journal of Pharmacy and Chemistry
JO  - International Journal of Pharmacy and Chemistry
SP  - 72
EP  - 74
PB  - Science Publishing Group
SN  - 2575-5749
UR  - https://doi.org/10.11648/j.ijpc.20190506.12
AB  - Olmesartan is an angiotensin II receptor blocker (ARB) approved for the treatment of hypertension since 2002. Olmesartan-associated enteropathy (OAE), first described in 2012 by Rubio-Tapia, has seldom been considered as a diagnosis in patients with villous atrophy and negative serology for celiac disease. The clinical presentation could be extremely heterogenous. In contrast to celiac disease, there is no response to a gluten-free diet. The exact mechanism of intestinal injury still remains unknown. The histological pattern, at the upper gastrointestinal endoscopy, usually reveals a variable degree of villous atrophy and a moderate infiltration of lymphocytes at mucosal level. Symptoms usually improve upon olmesartan discontinuation and the repeat endoscopy could demonstrate complete resolution of inflammatory change with normal villous architecture. The differential diagnosis for this kind of clinical and pathological features include celiac disease, tropical sprue, autoimmune enteropathy, inflammatory bowel disease, and drug induced enteropathy. With this background, we report the case of a patient with a clinical picture compatible with seronegative celiac disease and symptoms that rapidly improved clinically and histologically after olmesartan discontinuation. In conclusion, although this condition is rare, physicians should be consider this medication in the differential diagnosis of this enteropathy.
VL  - 5
IS  - 6
ER  -

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Author Information

Giulia Colombo

Department of General Medicine Hemostasis and Thrombosis, Foundation IRCCS Ca' Granda Hospital Policlinic Maggiore, Milan, Italy
Raffaella Rossio

Department of General Medicine Hemostasis and Thrombosis, Foundation IRCCS Ca' Granda Hospital Policlinic Maggiore, Milan, Italy
Barbara Ferrari

Department of General Medicine Hemostasis and Thrombosis, Foundation IRCCS Ca' Granda Hospital Policlinic Maggiore, Milan, Italy
Letterio Runza

Department of Pathological Anatomy, Foundation IRCCS Ca’ Granda Hospital Policlinic Maggiore, Milan, Italy
Peyvandi Flora

Department of General Medicine Hemostasis and Thrombosis, Foundation IRCCS Ca' Granda Hospital Policlinic Maggiore, Milan, Italy

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APA Style

Giulia Colombo, Raffaella Rossio, Barbara Ferrari, Letterio Runza, Peyvandi Flora. (2019). Duodenal Villous Atrophy and Diarrhea Associated with Chronic Olmesartan Intake. International Journal of Pharmacy and Chemistry, 5(6), 72-74. https://doi.org/10.11648/j.ijpc.20190506.12

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ACS Style

Giulia Colombo; Raffaella Rossio; Barbara Ferrari; Letterio Runza; Peyvandi Flora. Duodenal Villous Atrophy and Diarrhea Associated with Chronic Olmesartan Intake. Int. J. Pharm. Chem. 2019, 5(6), 72-74. doi: 10.11648/j.ijpc.20190506.12

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AMA Style

Giulia Colombo, Raffaella Rossio, Barbara Ferrari, Letterio Runza, Peyvandi Flora. Duodenal Villous Atrophy and Diarrhea Associated with Chronic Olmesartan Intake. Int J Pharm Chem. 2019;5(6):72-74. doi: 10.11648/j.ijpc.20190506.12

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@article{10.11648/j.ijpc.20190506.12,
  author = {Giulia Colombo and Raffaella Rossio and Barbara Ferrari and Letterio Runza and Peyvandi Flora},
  title = {Duodenal Villous Atrophy and Diarrhea Associated with Chronic Olmesartan Intake},
  journal = {International Journal of Pharmacy and Chemistry},
  volume = {5},
  number = {6},
  pages = {72-74},
  doi = {10.11648/j.ijpc.20190506.12},
  url = {https://doi.org/10.11648/j.ijpc.20190506.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijpc.20190506.12},
  abstract = {Olmesartan is an angiotensin II receptor blocker (ARB) approved for the treatment of hypertension since 2002. Olmesartan-associated enteropathy (OAE), first described in 2012 by Rubio-Tapia, has seldom been considered as a diagnosis in patients with villous atrophy and negative serology for celiac disease. The clinical presentation could be extremely heterogenous. In contrast to celiac disease, there is no response to a gluten-free diet. The exact mechanism of intestinal injury still remains unknown. The histological pattern, at the upper gastrointestinal endoscopy, usually reveals a variable degree of villous atrophy and a moderate infiltration of lymphocytes at mucosal level. Symptoms usually improve upon olmesartan discontinuation and the repeat endoscopy could demonstrate complete resolution of inflammatory change with normal villous architecture. The differential diagnosis for this kind of clinical and pathological features include celiac disease, tropical sprue, autoimmune enteropathy, inflammatory bowel disease, and drug induced enteropathy. With this background, we report the case of a patient with a clinical picture compatible with seronegative celiac disease and symptoms that rapidly improved clinically and histologically after olmesartan discontinuation. In conclusion, although this condition is rare, physicians should be consider this medication in the differential diagnosis of this enteropathy.},
 year = {2019}
}

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TY  - JOUR
T1  - Duodenal Villous Atrophy and Diarrhea Associated with Chronic Olmesartan Intake
AU  - Giulia Colombo
AU  - Raffaella Rossio
AU  - Barbara Ferrari
AU  - Letterio Runza
AU  - Peyvandi Flora
Y1  - 2019/12/06
PY  - 2019
N1  - https://doi.org/10.11648/j.ijpc.20190506.12
DO  - 10.11648/j.ijpc.20190506.12
T2  - International Journal of Pharmacy and Chemistry
JF  - International Journal of Pharmacy and Chemistry
JO  - International Journal of Pharmacy and Chemistry
SP  - 72
EP  - 74
PB  - Science Publishing Group
SN  - 2575-5749
UR  - https://doi.org/10.11648/j.ijpc.20190506.12
AB  - Olmesartan is an angiotensin II receptor blocker (ARB) approved for the treatment of hypertension since 2002. Olmesartan-associated enteropathy (OAE), first described in 2012 by Rubio-Tapia, has seldom been considered as a diagnosis in patients with villous atrophy and negative serology for celiac disease. The clinical presentation could be extremely heterogenous. In contrast to celiac disease, there is no response to a gluten-free diet. The exact mechanism of intestinal injury still remains unknown. The histological pattern, at the upper gastrointestinal endoscopy, usually reveals a variable degree of villous atrophy and a moderate infiltration of lymphocytes at mucosal level. Symptoms usually improve upon olmesartan discontinuation and the repeat endoscopy could demonstrate complete resolution of inflammatory change with normal villous architecture. The differential diagnosis for this kind of clinical and pathological features include celiac disease, tropical sprue, autoimmune enteropathy, inflammatory bowel disease, and drug induced enteropathy. With this background, we report the case of a patient with a clinical picture compatible with seronegative celiac disease and symptoms that rapidly improved clinically and histologically after olmesartan discontinuation. In conclusion, although this condition is rare, physicians should be consider this medication in the differential diagnosis of this enteropathy.
VL  - 5
IS  - 6
ER  -

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