Angiotensin-Ⅱ inhibitor(olmesartan)-induced collagenous sprue with resolution following discontinuation of drug  

作　　者：Jennifer A Nielsen Anita Steephen Matthew Lewin 

机构地区：[1]Division of Research,ProPath Laboratory,Dallas,TX 75247,United States [2]Texas Digestive Disease Consultants,Southlake,TX 76092,United States [3]Division of Gastrointestinal Pathology,ProPath Laboratory,Dallas,TX 75247,United States

出　　处：《World Journal of Gastroenterology》2013年第40期6928-6930,共3页世界胃肠病学杂志（英文版）

摘　　要：Collagenous sprue(CS) is a pattern of small-bowel injury characterized histologically by marked villous blunting,intraepithelial lymphocytes,and thickened sub-epithelial collagen table. Clinically,patients present with diarrhea,abdominal pain,malabsorption,and weight loss. Gluten intolerance is the most common cause of villous blunting in the duodenum; however,in a recent case series by the Mayo Clinic,it has been reported that olmesartan can have a similar effect. In this case report,a 62-year-old female with a history of hypothyroidism and hypertension managed for several years with olmesartan presented with abdominal pain,weight loss,and nausea. Despite compliance to a gluten-free diet,the patient's symptoms worsened,losing 20 pounds in 3 wk. Endoscopy showed thickening,scalloping,and mosaiform changes of the duodenal mucosa. The biopsy showed CS characterized by complete villous atrophy,lymphocytosis,and thickened sub-epithelial collagen table. After 2 mo cessation of olmesartan,the patient's symptoms improved,and follow-up endoscopy was normal with complete villous regeneration. These findings suggest that olmesartan was a contributing factor in the etiology of this patient's CS.Clinicians should be aware of the possibility of druginduced CS and potential reversibility after discontinuation of medication.Collagenous sprue(CS) is a pattern of small-bowel injury characterized histologically by marked villous blunting,intraepithelial lymphocytes,and thickened sub-epithelial collagen table. Clinically,patients present with diarrhea,abdominal pain,malabsorption,and weight loss. Gluten intolerance is the most common cause of villous blunting in the duodenum; however,in a recent case series by the Mayo Clinic,it has been reported that olmesartan can have a similar effect. In this case report,a 62-year-old female with a history of hypothyroidism and hypertension managed for several years with olmesartan presented with abdominal pain,weight loss,and nausea. Despite compliance to a gluten-free diet,the patient's symptoms worsened,losing 20 pounds in 3 wk. Endoscopy showed thickening,scalloping,and mosaiform changes of the duodenal mucosa. The biopsy showed CS characterized by complete villous atrophy,lymphocytosis,and thickened sub-epithelial collagen table. After 2 mo cessation of olmesartan,the patient's symptoms improved,and follow-up endoscopy was normal with complete villous regeneration. These findings suggest that olmesartan was a contributing factor in the etiology of this patient's CS.Clinicians should be aware of the possibility of druginduced CS and potential reversibility after discontinuation of medication.

关 键 词：COLLAGENOUS SPRUE CELIAC disease OLMESARTAN Patient-drug interaction DUODENUM 

分 类 号：R656.7[医药卫生—外科学]