Olmesartan-Induced Collagenous Sprue

Hugh James Freeman^1,

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

Cite this paper:
Hugh James Freeman. Olmesartan-Induced Collagenous Sprue. International Journal of Celiac Disease. 2020; 8(1):32-34. doi: 10.12691/ijcd-8-1-6

Abstract

A 65-yr-old female with diarrhea for 3 months and weight loss was evaluated. There was no travel or family history, but she had been treated with olmesartan for an elevated blood pressure. Fecal studies for an infectious cause were negative and serological studies for celiac disease were negative. A small bowel biopsy showed changes of collagenous sprue. The drug was discontinued. Diarrhea ceased and she regained her weight. Repeat biopsies of the small bowel were normal. Except for cessation of the olmesartan, no other dietary (eg., gluten-free diet) or treatment medication (eg., steroids) was provided. Long-term follow-up revealed no recurrence of symptoms in patients with sprue-like intestinal disease or collagenous sprue, consideration should be given to a drug-induced cause. This may limit the need for further clinical studies, restrictive diets or powerful prescribed medications, including steroids and immunosuppressive agents.

Keywords:
collagenous sprue celiac disease drug-induced small bowel disease olmesartan sprue-like enteropathy angiotensin-II inhibitor

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

Figures

References:

[1]	Schein J. Syndrome of nontropical sprue with hitherto undescribed lesions of the small intestine. Gastroenterology 1947; 8: 438-460.
[2]	Hourihane DO. Diarrhea of small bowel origin. The histology of intestinal biopsies. Proc R Soc Med 1963; 56: 1073-1977.
[3]	Weinstein WM, Saunders DR, Tytgat GN, Rubin CE. Collagenous sprue-an unrecognized type of malabsorption. N Engl J Med 1970; 283: 1297-1301.
[4]	Freeman HJ, Davis JE, Myers DM. Complete histological resolution of collagenous sprue. Can J Gastroenterol 2004; 18: 333-336.
[5]	Freeman HJ, Berean KW. Resolution of paraneoplastic collagenous enterocolitis after resection of colon cancer. Can J Gastroenterol 2006; 20: 357-360.
[6]	Freeman HJ. Collagenous mucosal inflammatory diseases of the gastrointestinal tract. Gastroenterology 2005; 129: 338-350.
[7]	Freeman HJ. Hyposplenism, antiendomysial antibodies and lymphocytic colitis in collagenous sprue. Can J Gastroenterol 1999; 13: 347-350.
[8]	Freeman HJ, Webber DL. Free perforation of the small intestine in collagenous sprue. World J Gastroenterol 2009; 15: 4446-4448.
[9]	Freeman HJ. Collagenous sprue associated with an extensive T-cell lymphoma. J Clin Gastroenterol 2003; 36: 144-146.
[10]	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.
[11]	Freeman HJ. Sprue-like intestinal disease. Int J Celiac Dis 2014; 2: 6-10.
[12]	Vasant DH, Hayes S, Bucknall R, Lal S. Clinical and histological resolution of collagenous sprue following gluten-free diet and discountinuation of non-steroidal anti-inflammatory drugs. BMJ Case Rep 2013. Pie: bcr2013200097.
[13]	Freeman HJ. Olmesartan enteropathy. Int J Celiac Dis 2016; 4: 24-26.
[14]	Rubio-Tapia A, Herman ML, Ludvigsson JF, Kelly DG, Mangan TF, Wu TT, Murray JA. Severe spruelike enteropathy associated with olmesartan. Mayo Clin Proc 2012; 87: 732-738.
[15]	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.
[16]	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.