International Journal of Celiac Disease
ISSN (Print): 2334-3427 ISSN (Online): 2334-3486 Website: Editor-in-chief: Samasca Gabriel
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International Journal of Celiac Disease. 2016, 4(1), 24-26
DOI: 10.12691/ijcd-4-1-6
Open AccessReview Article

Olmesartan Enteropathy

Hugh James Freeman1,

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

Pub. Date: February 16, 2016

Cite this paper:
Hugh James Freeman. Olmesartan Enteropathy. International Journal of Celiac Disease. 2016; 4(1):24-26. doi: 10.12691/ijcd-4-1-6


Celiac disease is an immune-mediated small intestinal mucosal disorder with characteristic, but non-specific histopathological changes. A number of heterogeneous disorders may produce similar changes in small bowel biopsies, but these fail to respond to a gluten-free diet. Recently, it has become increasingly appreciated that different medications may cause this sprue-like intestinal disease, including a specific angiotensin II receptor antagonist, olmesartan, an agent often used for treatment of hypertension. This enteropathy appears to occur as an apparently rare adverse event, often presenting with severe diarrhea, malabsorption and weight loss following chronic long-term use of the drug. Serological studies, particularly for tissue transglutaminase IgA antibodies, are negative and biopsies may show moderate to severe changes in mucosal architecture similar to celiac disease. Sub-epithelial collagen deposits may also occur. Clinical and biopsy changes fail to respond to a strict gluten-free diet, but cessation of olmesartan use appears to result in resolution.

celiac disease sprue-like intestinal disease drug-induced enteropathy refractory celiac disease collagenous sprue

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[1]  Freeman HJ. Refractory celiac disease and sprue-like intestinal disease. World J Gastroenterol 2008; 14: 828-830.
[2]  Freeman HJ. Drug-induced sprue-like intestinal disease. International J Celiac Dis 2014; 2: 49-53.
[3]  Freeman HJ. Collagenous mucosal inflammatory diseases of the gastrointestinal tract. Gastroenterology 2005; 129: 138-350.
[4]  Tran TH, Li H. Olmesartan and drug-induced enteropathy. P & T 2014; 39: 47-50.
[5]  de Fonseka A, Tuskey A, Moskalul C. A case of olmesartan-induced enteropathy. Inflamm Bowel Dis 2012; 18: S17.
[6]  Rubio-Tapia A, Hermann ML, Ludvigsson JF, Kelly DG, Mangan TF, Wu TT, Murray JA. Severe spruelike enteropathy associated with olmesartan. Mayo Clin Proc 2012; 87: 732-738.
[7]  Talbot GH. Small bowel histopathologic findings suggestive of celiac disease in an asymptomatic patient receiving olmesartan. Mayo Clin Proc 2012; 87: 1231-1232.
[8]  Rubio-Tapia A, Talley NJ, Gurudu SR, Wu TT, Murray JA. Gluten-free diet and steroid treatment are effective therapy for most patients with collagenous sprue. Clin Gastrointest Hepatol 2010; 8: 344-349.
[9]  Freeman HJ. Collagenous sprue. Canad J Gastroenterol 2011; 25: 189-192.
[10]  Scialom S, Malamut G, Meresse B, Guegan N, Brousse N, Verkarre V, Derrieux C, Macintyre E, Seksik P, Savoye G, Cadiot G, Vuitton L, Marthey L, Carbonnel F, Cerf-Bensussan N, Cellier C. Gastrointestinal disorder associated with omesartan mimics autoimmune enteropathy. PLoS One 2015; 10: e0125024.
[11]  Kagami S, Border WA, Miller DE, Noble NA. Angiotensin II stimulates extracellular matrix protein synthesis through induction of transforming growth factor-beta expression in rat glomerular mesangial cells. J Clin Invest 1994; 93: 2431-2437.
[12]  Narietta EV, Nadeau AM, Cartee AK, Singh I, Rishi A, Choung RS, Wu TT, Rubio-Tapia A, Murray JA. Immunopathogenesis of olmesartan-associated enteropathy. Aliment Pharmacol Ther 2015; 42: 1303-1314.
[13]  Schiepatti A, Biagi E, Cumetti D, Luinetti O, Sonzogni A, Mugellini A, Corrazza GR. Olmesartan-associated enteropathy: new insights on the natural history? Scand J Gastroenterol 2016; 51: 152-156.
[14]  Herman ML, Rubio-Tapia A, Wu TT, Murray JA. A case of severe sprue-like enteropathy associated with valsartan. ACG Case Rep J 2015; 2: 92-94.
[15]  Marietta EV, Cartee A, Rishi A, Murray JA. Drug-induced enteropathy. Dig Dis 2015; 33: 215-220.
[16]  Lagana SM, Braunstein ED, Arguelles-Grande C, Bhagat G, Green PHk, Lebwohl B. Sprue-like histology in patients with abdominal pain taking olmesartan compared with other angiotensin receptor blockers. J Clin Pathol 2015; 68: 29-32.
[17]  Abdelghany M, Gonzales L 3rd, Slater J, Begley C. Olmesartan associated sprue-like enteropathy and colon perforation. Case Rep Gastrointest Med 2014; 2014: 494098.
[18]  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.
[19]  Theophile H, David XR, Miremont-Salame G, Harambukru F. Five cases of sprue-like enteropathy in patients treated by olmesartan. Dig Liver Dis 2014; 46: 465-469.
[20]  Marthey L, Cadiot G, Seksik P, Pouderoux P, Lacroute J, Skinazi F, Mesnard B, Chayvialie JA, Savoye G, Druez A, Parlier D, Abitbol V, Gompel M, Eoche M, Poncin E, Bobichon R, Colardelle P, Wils P, Salloum H, Peschard S, Zerbib F, Meresse B, Cerf-Bensussan N, Malamut G, Carbonnel F. Omesartan-associated enteropathy: results of a national survey. Aliment Pharmacol Ther 2014; 40: 1103-1109.
[21]  Greywoode R, Braunstein ED, Arguelles-Grande C, Green PH, Lebwohl B. Olmesartan, other antihypertensives, and chronic diarrhea among patients undergoing endoscopic procedures: a case-control study. Mayo Clin Proc 2014; 89: 1239-1243.