International Journal of Celiac Disease
ISSN (Print): 2334-3427 ISSN (Online): 2334-3486 Website: http://www.sciepub.com/journal/ijcd Editor-in-chief: Samasca Gabriel
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International Journal of Celiac Disease. 2021, 9(2), 35-37
DOI: 10.12691/ijcd-9-2-6
Open AccessArticle

Drug-induced Collagenous Sprue: A Reversible Small Bowel Mucosal Disorder

Hugh James Freeman1,

1Department of Medicine (Gastroenterology), University of British Columbia, Vancouver, BC, Canada

Pub. Date: May 18, 2021

Cite this paper:
Hugh James Freeman. Drug-induced Collagenous Sprue: A Reversible Small Bowel Mucosal Disorder. International Journal of Celiac Disease. 2021; 9(2):35-37. doi: 10.12691/ijcd-9-2-6

Abstract

Collagenous sprue is an unusual small intestinal mucosal disorder characterized by flattened small intestinal mucosa, unusual sub-epithelial collagen deposits, increased intra-epithelial lymphocytes, often denuded epithelial cells and resistance to therapy, including a gluten-free diet. The disorder is heterogeneous with several potential causes now identified. Similar to sprue-like intestinal disease, collagenous sprue may be caused or precipitated by different pharmaceutical agents. Olmesartan, an angiotensin II inhibitor, often employed in treatment of hypertension, may cause a drug-induced form of sprue-like small intestinal disease with the pathological features of untreated celiac disease refractory to gluten-free diet treatment. In addition, collagenous sprue may be precipitated by olmesartan. Recognition and cessation of the medication has led to resolution of the small intestinal mucosal disorder without steroids or other treatment.

Keywords:
collagenous sprue sprue-like intestinal disease drug-induced small bowel disease malabsorption olmesartan

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References:

[1]  Freeman HJ. Collagenous mucosal inflammatory diseases of the gastrointestinal tract. Gastroenterology 2005: 129: 338-350.
 
[2]  Weinstein WM, Saunders DR, Tytgat GN, Rubin CE. Collagenous sprue—-an unrecognized type of malabsorption. N Engl J Med 1970; 283: 1297-1301.
 
[3]  Schein J. Syndrome of nontropical sprue with hitherto undescribed lesions of the small intestine. Gastroenterology 1947; 8: 438-460.
 
[4]  Hourihane DO. Diarrhea of small bowel origin. The histology of intestinal biopsies. Proc R Soc Med 1963; 56: 1073-1077.
 
[5]  Freeman HJ, Webber DO. Free perforation of the small intestine in collagenous sprue. World J Gastroenterol 2009; 15: 4446-4448.
 
[6]  Medlicott SA, Beck PL, Loken S, Crabtree T. Synchronous collagenous sprue and enteropathy-type T-cell lymphoma: variants of the same disease. Can J Gastroenterol 2004; 18: 329-332.
 
[7]  Freeman HJ. Collagenous sprue associated with an extensive T-cell lymphoma. J Clin Gastroenterol 2003; 36: 144-146.
 
[8]  Freeman HJ, Davis JE, Myers DM. Complete histological resolution of collagenous sprue. Can J Gastroenterol 2004; 18: 333-336.
 
[9]  Freeman HJ, Berean KW. Resolution of paraneoplastic collagenous enterocolitis after resection of colon cancer. Can J Gastroenterol 2006; 20: 357-360.
 
[10]  Rubio-Tapia A, Talley NJ, Gurudu SR, Wu T-T, Murray JA. Gluten-free diet and steroid treatment are effective therapy for most patients with collagenous sprue. Clin Gastroenterol Hepatic 2010; 8: 344-349.
 
[11]  Rubio-Tapia A, Herman ML, Ludvigsson JF, Kelly DG, Mangan TF, Wu T-T, Murray JA. Severe sprue-like enteropathy associated with olmesartan. Mayo Clinic Proc 2012; 87: 732-738.
 
[12]  Freeman HJ. Olmesartan enteropathy, Inter J Celiac Dis 2016; 4: 24-26.
 
[13]  de Fonseka A, Turkey A, Moskalul C. A case of olmesartan-induced enteropathy. Inflamm Bowel Dis 2012; 18: S17.
 
[14]  Talbot GH Small bowel histopathologic findings suggestive of celiac disease in an asymptomatic patient receiving olmesartan. Mayo Clin Proc 2012; 87: 1231-1232.
 
[15]  Freeman HJ. Drug-induced sprue-like intestinal disease. Inter J Celiac Dis 2014; 2: 49-53.
 
[16]  Rubin CE, Eidelman S, Weinstein WM. Sprue by any other name. Gastroenterology 1970; 58: 409-413.
 
[17]  Freeman HJ. Sprue-like intestinal disease. Int J Celiac Dis 2014; 2: 6-10.
 
[18]  Freeman HJ, Weinstein WM, Shnitka TK, Wensel RH, Sartor VE. Watery diarrhea syndrome associated with a lesion of the colonic basement membrane (BM)—lamina propriety (LP) interface. Ann Royal Coll Phys Surg Can 1976; 9: 45.
 
[19]  Hilman N, Kraag G. NSAID-induced collagenous colitis. J Rheumatol 2010; 37: 2432-2433.
 
[20]  Riddell RH, Tanaka M, Mazzoleni G. Non-steroidal anti-inflammatory drugs as a possible cause of collagenous colitis: a case-control study. Gut 1992; 33: 683-686.
 
[21]  Vasant DH, Hayes S, Bucknall R, Lai S. Clinical and histological resolution of collagenous sprue following gluten-free diet and discontinuation of non-steroidal anti-inflammatory drugs (NSAIDS). BMJ Case Rep 2013; 200097: 1-3.
 
[22]  Nielsen JA, Steephen A, Lewin M. Angiotensin-II inhibitor (olmesartan)-induced collagenous sprue with resolution following discontinuation of drug. World J Gastroenterol 2013; 19: 6928-6930.
 
[23]  Desruisseaux C, Bensoussan M, Desilets E, Tran H-K, Arcand R, Poirier G, Wisniewski A, Maniere T. Adding water to the mill: olmesartan-induced collagenous sprue—a case report and brief literature review. Can J Gastroenterol Hepatol 2016: 1-2.
 
[24]  Freeman HJ. Olmesartan-induced collagenous sprue. Inter J Celiac Dis 2020; 8: 32-34.
 
[25]  Ducloux D, Ottignon Y, Semhoun-Ducloux S, Labbe S, Saint-Hillier Y, Miguet J-P, Crayon P, Chalopin J-M. Mycophenolate mofetil-induced villous atrophy. Transplantation 1998; 66: 1115-11116.
 
[26]  Calmet FH, Yarur AJ, Pukazhendhi G, Ahmad J, Bhamidimam KR. Endoscopic and histologic features of mycophenolic mofetil colitis in patients after solid organ transplantation. Ann Gastroenterol 2015; 28: 366-373.
 
[27]  Freeman HJ, Nimmo M. Mycophenolate-associated sprue-like intestinal disease involving into collagenous sprue. Inter J Celiac Dis 2021; In press.