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- Title
Olmesartan-associated enteropathy: results of a national survey.
- Authors
Marthey, L.; Cadiot, G.; Seksik, P.; Pouderoux, P.; Lacroute, J.; Skinazi, F.; Mesnard, B.; Chayvialle, J. A.; Savoye, G.; Druez, A.; Parlier, D.; Abitbol, V.; Gompel, M.; Eoche, M.; Poncin, E.; Bobichon, R.; Colardelle, P.; Wils, P.; Salloum, H.; Peschard, S.
- Abstract
Background Recently, a new enteropathy has been described: olmesartan-associated enteropathy. However, the association has been questioned: a phase 3 trial and a cohort study found no association between gastrointestinal events and olmesartan. Aim To collect French cases of sartan-associated enteropathy to describe further this entity, confirm or refute causality, and determine if the association exists with other sartans. Methods French gastroenterologists were invited to report cases of sartan-associated enteropathy and collect clinical, biological and histological data. Patients with diarrhoea and histological duodenal abnormalities were included. Results Thirty-six patients with olmesartan-associated enteropathy were reported, including 32 with villous atrophy and four without. There was only one patient with irbesartan-associated enteropathy. None of the patients died. Patients with villous atrophy had diarrhoea, vomiting, renal failure, hypokalaemia, body weight loss and hypoalbuminaemia. Thirty-one patients were hospitalised; four required intensive care. Anti-transglutaminase and anti-enterocyte antibodies were negative; anti-nuclear antibodies were positive (9/11). Endoscopic duodenal biopsies showed villous atrophy (32/32) and polyclonal intra-epithelial CD3+CD8+ lymphocytosis (11/11). Exactly, 14/15 patients responded to steroids and/or immunosuppressants, prescribed because of suspected autoimmune enteropathy. Ten olmesartan interruptions were followed by reintroductions before steroids or immunosuppressants. Interruptions were followed by remissions (9/10), but reintroductions were followed by relapses (9/9). Twenty-nine patients were in remission since olmesartan interruption, including 26 without immunosuppressants. Patients with normal villi had similar clinical characteristics, but mild histological abnormalities (intra-epithelial lymphocytosis and lamina propria lymphocytic infiltration). Conclusions Olmesartan causes a severe and immune-mediated enteropathy, with or without villous atrophy. Enteropathy associated with other sartans seems to be very rare.
- Subjects
INTESTINAL diseases; GASTROENTEROLOGY; HISTOLOGICAL techniques; DIARRHEA; THERAPEUTICS; TRANSGLUTAMINASE regulation
- Publication
Alimentary Pharmacology & Therapeutics, 2014, Vol 40, Issue 9, p1103
- ISSN
0269-2813
- Publication type
Article
- DOI
10.1111/apt.12937