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

作     者：Jennifer A Nielsen Anita Steephen Matthew Lewin 

作者机构：Division of ResearchProPath LaboratoryDallasTX 75247United States Texas Digestive Disease ConsultantsSouthlakeTX 76092United States Division of Gastrointestinal PathologyProPath LaboratoryDallasTX 75247United States 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2013年第19卷第40期

页      面：6928-6930页

核心收录：

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

主　　题：Collagenous sprue Celiac disease Olmesartan Patient-drug interaction Duodenum 

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 *** should be aware of the possibility of druginduced CS and potential reversibility after discontinuation of medication.