Korean J Gastroenterol.  2022 Mar;79(3):130-134. 10.4166/kjg.2022.007.

Olmesartan-associated Enteropathy with Acute Kidney Injury

• Kang MJ
• Min KH
• Kim HW
• Park SB
• Kang DH
• Choi CW
• Kim SJ
• Nam HS
• Ryu DG

• KMID: 2527481
• DOI: http://doi.org/10.4166/kjg.2022.007

Abstract

Olmesartan, a recently introduced angiotensin II receptor blocker for hypertension, has been reported to cause drug-induced small bowel enteropathy. The diagnosis of olmesartan-associated enteropathy (OAE) needs clinical suspicion and the exclusion of coeliac disease, as it mimics coeliac sprue. Once diagnosed, it can be completely cured with the discontinuation of olmesartan. However, due to the extremely low incidence of OAE in Korea, clinical suspicion and diagnosis may be a challenge. The authors report the first case of OAE presenting with chronic diarrhea and acute kidney injury in Korea.

Keyword

Olmesartan; Enteropathy; Diarrhea; Acute kidney injury

Figure

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  Fig. 1 Endoscopic retrograde choangiopancreatography (ERCP) at the time of initial diagnosis. ERCP reveals (A) major papilla and (B) minor papilla.

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  Fig. 2 Pathologic findings of the duodenum. (A) Loss of villi structures and erosion (hematoxylin and eosin [H&E], ×100) and (B) chronic active inflammation of gland structures (H&E, ×200).

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  Fig. 3 Hospital course of the patient’s stool amount and the number of diarrhea episodes per day.

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  Fig. 4 Images of video capsule endoscopy showing recovered villi and the disappearance of edema on the (A) distal duodenum and (B) upper jejunum.

Reference

1. Ianiro G, Bibbò S, Montalto M, Ricci R, Gasbarrini A, Cammarota G. 2014; Systematic review: sprue-like enteropathy associated with olmesartan. Aliment Pharmacol Ther. 40:16–23. DOI: 10.1111/apt.12780. PMID: 24805127.

2. Rubio-Tapia A, Herman ML, Ludvigsson JF, et al. 2012; Severe spruelike enteropathy associated with olmesartan. Mayo Clin Proc. 87:732–738. DOI: 10.1016/j.mayocp.2012.06.003. PMID: 22728033. PMCID: PMC3538487.

3. Menne J, Haller H. 2012; Olmesartan and intestinal adverse effects in the ROADMAP study. Mayo Clin Proc. 87:1230–1232. DOI: 10.1016/j.mayocp.2012.10.005. PMID: 23218089. PMCID: PMC3547579.

4. Carneiro L, Moreira A, Pereira A, Andrade C, Soares J, Silva A. 2016; Olmesartan-induced sprue like enteropathy. GE Port J Gastroenterol. 23:101–105. DOI: 10.1016/j.jpge.2015.12.003. PMID: 28868441. PMCID: PMC5580175.

5. Kamal A, Fain C, Park A, et al. 2019; Angiotensin II receptor blockers and gastrointestinal adverse events of resembling sprue-like enteropathy: a systematic review. Gastroenterol Rep (Oxf). 7:162–167. DOI: 10.1093/gastro/goz019. PMID: 31217979. PMCID: PMC6573796.

6. You SC, Park H, Yoon D, Park S, Joung B, Park RW. 2019; Olmesartan is not associated with the risk of enteropathy: a Korean nationwide observational cohort study. Korean J Intern Med. 34:90–98. DOI: 10.3904/kjim.2017.002. PMID: 29172402. PMCID: PMC6325440.

7. Adike A, Corral J, Rybnicek D, Sussman D, Shah S, Quigley E. 2016; Olmesartan-induced enteropathy. Methodist Debakey Cardiovasc J. 12:230–232. DOI: 10.14797/mdcj-12-4-230. PMID: 28289500. PMCID: PMC5344475.

8. Roca-Argente L, Diaz-Jaime FC, López-Romero LC, et al. 2017; Acute kidney injury secondary to diarrhea caused by "sprue-like" enteropathy associated with olmesartan. Nefrologia. 37:548–550. DOI: 10.1016/j.nefro.2016.10.005. PMID: 28027786.

9. Esteve M, Temiño R, Carrasco A, et al. 2016; Potential coeliac disease markers and autoimmunity in olmesartan induced enteropathy: a population-based study. Dig Liver Dis. 48:154–161. DOI: 10.1016/j.dld.2015.09.014. PMID: 26699826.

10. Marthey L, Cadiot G, Seksik P, et al. 2014; Olmesartan-associated enteropathy: results of a national survey. Aliment Pharmacol Ther. 40:1103–1109. DOI: 10.1111/apt.12937. PMID: 25199794.

11. Scialom S, Malamut G, Meresse B, et al. 2015; Gastrointestinal disorder associated with olmesartan mimics autoimmune enteropathy. PLoS One. 10:e0125024. DOI: 10.1371/journal.pone.0125024. PMID: 26101883. PMCID: PMC4477936.

12. Hujoel IA, Rubio-Tapia A. 2016; Sprue-like enteropathy associated with olmesartan: a new kid on the enteropathy block. GE Port J Gastroenterol. 23:61–65. DOI: 10.1016/j.jpge.2016.02.005. PMID: 28868435. PMCID: PMC5580180.

13. Gonakoti S, Khullar S, Rajkumar A. 2019; Olmesartan associated enteropathy: a rare underdiagnosed cause of diarrhea and weight loss. Am J Case Rep. 20:111–116. DOI: 10.12659/AJCR.913207. PMID: 30683835. PMCID: PMC6364444.

14. Dias E, Morais R, Gullo I, Lopes P, Teixeira M, Macedo G. 2020; Olmesartan-associated enteropathy: heterogeneity of involvement along gastrointestinal tract. Porto Biomed J. 5:e079. DOI: 10.1097/j.pbj.0000000000000079. PMID: 33195870. PMCID: PMC7657573.