Aims Olmesartan-associated enteropathy (OAE) has been described since a decade and only
case reports and case series have been documented. According to published studies,
in patients receiving olmesartan and present celiac-like symptoms, upper GI endoscopy
with duodenal biopsy should be performed. Aim of our study was to present our experience
in OAE.
Methods All patients (pts) under antihypertensive treatment with sartans, who hospitalized
in our department between February and August 2022 due to gastrointestinal symptoms
or anemia were included. They underwent upper and/or lower GI endoscopy and small
bowel capsule endoscopy. Epidemiological, endoscopic and histologic data were analyzed.
Results Totally 141 pts (M/F: 76/65, mean age 72 years[43-95]) included. Olmesartan were
receiving 87(61.7%), valsartan 30(21.3%), irbesartan 16(11.3%) and losartan 8(5.7%).
Only 17 pts were suffering from chronic non-infectious diarrhea (average 54 days [15-90]),
44 from anemia, while 13 presented both diarrhea and anemia. Biopsy samples were taken
by 49 pts. Endoscopic and histologic abnormalities indicative of celiac-like enteropathy
(flattening of villi, scalloping of Kerckring folds) were reported in 2 pts (4.16%)
under olmesartan treatment. Clinical improvement was observed 10 days after discontinuation
of the drug. Anti-tissue transglutaminase antibodies were negative for all 49 pts.
Pts who received other sartans, had no endoscopic or histologic findings of celiac-like
enteropathy.
Conclusions Endoscopic and histological findings of the duodenum combined with history of olmesartan
intake and a negative celiac test, strongly suggest OAE. This diagnosis is reinforced
by the clinical improvement after drug withdrawal.
