Olmesartan Enteropathy

Celiac disease is an immune-mediated small intestinal mucosal disorder with characteristic, but non-specific histopathological changes. A number of heterogeneous disorders may produce similar changes in small bowel biopsies, but these fail to respond to a gluten-free diet. Recently, it has become increasingly appreciated that different medications may cause this sprue-like intestinal disease, including a specific angiotensin II receptor antagonist, olmesartan, an agent often used for treatment of hypertension. This enteropathy appears to occur as an apparently rare adverse event, often presenting with severe diarrhea, malabsorption and weight loss following chronic long-term use of the drug. Serological studies, particularly for tissue transglutaminase IgA antibodies, are negative and biopsies may show moderate to severe changes in mucosal architecture similar to celiac disease. Sub-epithelial collagen deposits may also occur. Clinical and biopsy changes fail to respond to a strict gluten-free diet, but cessation of olmesartan use appears to result in resolution.