Olmesartan Associated Enteropathy: Usefulness of Video Capsule Endoscopy in a Case With Doubtful Upper Endoscopic/Histological Picture

Author(s): Francesco Abbruzzi, Ilaria Loconte, Sonia Carparelli, Enzo Ierardi, Alfredo Di Leo, Mariabeatrice Principi*.

Journal Name: Current Drug Safety

Volume 15 , Issue 1 , 2020

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Abstract:

Background: Olmesartan, an antihypertensive drug, may be associated with a severe “sprue-like enteropathy”.

Objectives: To report a case of Olmesartan enteropathy demonstrated by video capsule endoscopy distally from the second duodenum along with the whole small bowel before and after drug withdrawal.

Case Presentation: A 81-years-old man was referred for asthenia, chronic watery diarrhea and anasarca (ascites, pleural effusion and edemas of superior and inferior limb). The only comorbidity was hypertension treated with Olmesartan. All causes of infective and inflammatory chronic diarrhea were investigated and excluded. Upper endoscopy was normal; histological examination of the second portion of the duodenum showed moderate and patchy infiltration of lymphocytes at mucosal and intra-epithelial level with intermittent partial villous atrophy. The possibility of adverse drug reaction, estimated by Naranjo scale, showed a score of 7, indicating a strong probability. Olmesartan was then withdrawn. However, because of severe clinical general condition, we preferred to corroborate our diagnostic work-up by a non-invasive investigation, i.e. video capsule endoscopy, which showed jejunal and ileal mucosal alterations (mosaic pattern, diffuse hyperemia, severe edema, consequent apparent reduced lumen, diffuse thickening of intestinal folds, multiple erosions, patchy lymphangectasia). After 14 days, the resolution of anasarcatic state and hydroelectrolytic imbalances was observed. Nine months later, small-bowel video-capsule demonstrated mild mucosal hyperaemia and mosaic pattern.

Conclusion: Our case could give new insights in the field of Olmesartan associated enteropathy by highlighting the possibility of distally main lesion location and, therefore, the usefulness of video capsule endoscopy in the presence of doubtful diagnostic features.

Keywords: Olmesartan, malabsorption, sprue-like enteropathy, video capsule endoscopy, anasarca, diarrhea.

[1]
Rubio-Tapia A, Herman ML, Ludvigsson JF, et al. Severe spruelike enteropathy associated with olmesartan. Mayo Clin Proc 2012; 87(8): 732-8.
[http://dx.doi.org/10.1016/j.mayocp.2012.06.003] [PMID: 22728033]
[2]
Burbure N, Lebwohl B, Arguelles-Grande C, Green PHR, Bhagat G, Lagana S. Olmesartan-associated sprue-like enteropathy: A systematic review with emphasis on histopathology. Hum Pathol 2016; 50: 127-34.
[http://dx.doi.org/10.1016/j.humpath.2015.12.001] [PMID: 26997446]
[3]
Bhat N, Anupama NK, Yelsangikar A, Vizhi K. Olmesartan-related sprue-like enteropathy. Indian J Gastroenterol 2014; 33(6): 564-7.
[http://dx.doi.org/10.1007/s12664-014-0506-7] [PMID: 25303875]
[4]
Herman M, Rubio-Tapia A, Marietta E, Wu T, Murray J. Severe enteropathy in a patient on valsartan. Am J Gastroenterol 2013; 108(Suppl. 1): S302.
[5]
Cyrany J, Vasatko T, Machac J, Nova M, Szanyi J, Kopacova M. Letter: Telmisartan-associated enteropathy - is there any class effect? Aliment Pharmacol Ther 2014; 40(5): 569-70.
[http://dx.doi.org/10.1111/apt.12850] [PMID: 25103353]
[6]
Cammarota G, Ianiro G, Bibbò S, Gasbarrini A. Letter: Telmisartan associated enteropathy - is there any class effect? Authors’ reply. Aliment Pharmacol Ther 2014; 40(5): 569-70.
[http://dx.doi.org/10.1111/apt.12870] [PMID: 25103354]
[7]
Marthey L, Cadiot G, Seksik P, et al. Olmesartan-associated enteropathy: Results of a national survey. Aliment Pharmacol Ther 2014; 40(9): 1103-9.
[http://dx.doi.org/10.1111/apt.12937] [PMID: 25199794]
[8]
Kamal A, Fain C, Park A, et al. Angiotensin II receptor blockers and gastrointestinal adverse events of resembling sprue-like enteropathy: A systematic review. Gastroenterol Rep (Oxf) 2019; 7(3): 162-7.
[http://dx.doi.org/10.1093/gastro/goz019] [PMID: 31217979]
[9]
Marietta EV, Nadeau AM, Cartee AK, et al. Immunopathogenesis of olmesartan-associated enteropathy. Aliment Pharmacol Ther 2015; 42(11-12): 1303-14.
[http://dx.doi.org/10.1111/apt.13413] [PMID: 26423313]
[10]
Naranjo CA, Busto U, Sellers EM, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981; 30(2): 239-45.
[http://dx.doi.org/10.1038/clpt.1981.154] [PMID: 7249508]
[11]
Shenbagaraj L, Swift G. Olmesartan-associated severe gastritis and enteropathy. BMJ Case Rep 2018; 11(1): pii: e226133
[http://dx.doi.org/10.1136/bcr-2018-226133]
[12]
Mandavdhare HS, Sharma V, Prasad KK, Kumar A, Rathi M, Rana SS. Telmisartan-induced sprue-like enteropathy: A case report and a review of patients using non-olmesartan angiotensin receptor blockers. Intest Res 2017; 15(3): 419-21.
[http://dx.doi.org/10.5217/ir.2017.15.3.419] [PMID: 28670240]
[13]
Desruisseaux C, Bensoussan M, Désilets E, et al. Adding water to the mill: Olmesartan-induced collgenous sprue-A case report and brief literature review. Can J Gastroenterol Hepatol 2016; 2016: 4837270
[http://dx.doi.org/10.1155/2016/4837270] [PMID: 27446843]
[14]
Scott BB, Losowsky MS. Patchiness and duodenal-jejunal variation of the mucosal abnormality in coeliac disease and dermatitis herpetiformis. Gut 1976; 17(12): 984-92.
[http://dx.doi.org/10.1136/gut.17.12.984] [PMID: 1017719]
[15]
Alimetov AY, Poliakov PP, Onopriev AV, Avakimyan AV, Zanin SA, Kade AK. Capsule endoscopy for diagnosis of celiac disease. Ter Arkh 2019; 91(2): 91-6.
[PMID: 31094178]


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Article Details

VOLUME: 15
ISSUE: 1
Year: 2020
Page: [65 - 68]
Pages: 4
DOI: 10.2174/1574886314666190923161406

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