scholarly journals Severe spruelike enteropathy and collagenous colitis caused by olmesartan

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shiho Kaneko ◽  
Kana Matsuda ◽  
Yasuko Mizuta ◽  
Shoya Shiratori ◽  
Kazuma Kishi ◽  
...  
Keyword(s):  
Weight Loss ◽  
Clinical Symptoms ◽  
Villous Atrophy ◽  
Collagenous Colitis ◽  
Clinical History ◽  
Angiotensin Ii Receptor Blocker ◽  
Angiotensin Ii Receptor ◽  
Medication History ◽  
Severe Diarrhea ◽  
History Of

Abstract Background Olmesartan, which is an angiotensin II receptor blocker, reportedly causes spruelike enteropathy, with intestinal villous atrophy as its typical histopathological finding. Interestingly, collagenous and/or lymphocytic gastritis and colitis occur in some patients. We report the case of a 73-year-old Japanese man with a 2-month clinical history of severe diarrhea and weight loss. There were few reports in which spruelike enteropathy and collagenous colitis were both observed and could be followed up. Case presentation We report a case of a 73-year-old man with a 2-month clinical history of severe diarrhea and weight loss. He had taken olmesartan for hypertension treatment for 5 years. Endoscopic examination with biopsies revealed intestinal villous atrophy and collagenous colitis. Suspecting enteropathy caused by olmesartan, which was discontinued on admission because of hypotension, we continued to stop the drug. Within 3 weeks after olmesartan discontinuation, his clinical symptoms improved. After 3 months, follow-up endoscopy showed improvement of villous atrophy but not of the thickened collagen band of the colon. However, the mucosa normalized after 6 months, histologically confirming that the preexistent pathology was finally resolved. Conclusions This report presents a case in which spruelike enteropathy and collagenous colitis were both observed and could be followed up. In unexplained cases of diarrhea, medication history should be reconfirmed and this disease should be considered a differential diagnosis.

scholarly journals Olmesartan-induced enteropathy

2018 ◽  
pp. bcr-2018-224411 ◽  
Author(s):  
Nirmal K Onteddu ◽  
Venkata Siva Krishna Kumar Pulivarthi ◽  
Mihira Ginnavaram ◽  
Ramalinga Kedika
Keyword(s):  
Weight Loss ◽  
Primary Care Physicians ◽  
Hospital Admissions ◽  
Clinical Symptoms ◽  
Villous Atrophy ◽  
Signs And Symptoms ◽  
Chronic Diarrhoea ◽  
Caucasian Woman ◽  
Frequent Adverse Event ◽  
History Of

Olmesartan-induced enteropathy (OIE) typically presents with a constellation of signs and symptoms including chronic diarrhoea, weight loss and villous atrophy on biopsy. We describe a 68-year-old Caucasian woman with a history of hypothyroidism and hypertension who presented to our hospital with recurrent episodes of acute intermittent diarrhoea, nausea, vomiting, renal failure and 15 lbs weight loss. After an extensive workup, she was diagnosed with possible OIE. Cessation of the offending drug resulted in improvement of clinical symptoms and also hospital admissions for severe diarrhoea reinforcing the diagnosis of OIE. Among the adverse effects of drug therapy, diarrhoea is a relatively frequent adverse event accounting for about 7%. This report serves as an addition to existing literature and to increase the awareness of olmesartan-induced sprue-like enteropathy among the primary care physicians and gastroenterologists.

scholarly journals Urachal Adenocarcinoma: A Case Report with Key Imaging Findings and Radiologic-Pathologic Correlation

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Willian Schmitt ◽  
Marta Baptista ◽  
Marco Ferreira ◽  
António Gomes ◽  
Ana Germano
Keyword(s):  
Weight Loss ◽  
Differential Diagnosis ◽  
Clinical History ◽  
Imaging Findings ◽  
Lesion Location ◽  
Patient Demographics ◽  
Pathologic Correlation ◽  
Associated Symptoms ◽  
History Of ◽  
Urachal Adenocarcinoma

Urachal pathologies are rare and can mimic numerous abdominal and pelvic diseases. Differential diagnosis of urachal anomalies can be narrowed down by proper assessment of lesion location, morphology, imaging findings, patient demographics, and clinical history. We report a case of a 60-year-old male, with a history of unintentional weight loss without associated symptoms, who was diagnosed with locally invasive urachal adenocarcinoma. With this article, we pretend to emphasize urachal adenocarcinoma clinical features along with its key imaging findings with radiologic-pathologic correlation.

scholarly journals Bilateral Subdural Haematoma and CPAP Use: A Possible Association

2020 ◽  
Author(s):  
Beatrice Khater ◽  
Vicky Kassouf ◽  
Georges Haddad ◽  
Roula Hourany
Keyword(s):  
Subdural Haematoma ◽  
Brain Mri ◽  
Sleep Apnoea ◽  
Neurological Deficits ◽  
Angiotensin Ii Receptor Blocker ◽  
Angiotensin Ii Receptor ◽  
Acute Subdural Haematoma ◽  
Obstructive Sleep ◽  
History Of ◽  
The Right

Obstructive sleep apnoea (OSA) is a common condition usually treated with continuous positive airway pressure (CPAP). No reports have linked it to an acute subdural haematoma. A 54-year-old white man who had hypertension well controlled with an angiotensin II receptor blocker, presented with a 2-week history of occipital headache with no other focal neurological symptoms. The headache began 12 days after he had started using CPAP for OSA. A brain MRI performed 2 weeks later showed bilateral subdural haematomas which were chronic on the left and sub-acute/acute on the right. Since the patient was clinically stable with no focal neurological deficits, he received prednisone for 3 weeks and was followed up with consecutive CT scans demonstrating gradual regression of the haematomas. This is the first report showing that subdural haematomas could be linked to CPAP use.

scholarly journals Nasal upregulation of CST1 in dog-sensitised children with severe allergic airway disease

2021 ◽  
Vol 7 (2) ◽  
pp. 00917-2020
Author(s):  
Ulrika Käck ◽  
Elisabet Einarsdottir ◽  
Marianne van Hage ◽  
Anna Asarnoj ◽  
Anna James ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Clinical History ◽  
Airway Disease ◽  
Forced Expiratory Volume ◽  
Allergic Airway Disease ◽  
Healthy Controls ◽  
Cell Counts ◽  
History Of ◽  
White Blood Cell Counts ◽  
Methacholine Provocation

BackgroundThe clinical presentation of children sensitised to dog dander varies from asymptomatic to severe allergic airway disease, but the genetic mechanisms underlying these differences are not clear. The objective of the present study was to investigate nasal transcriptomic profiles associated with dog dander sensitisation in school children and to reveal clinical symptoms related with these profiles.MethodsRNA was extracted from nasal epithelial cell brushings of children sensitised to dog dander and healthy controls. Blood sample analyses included IgE against dog dander, dog allergen molecules, other airborne and food allergens, basophil activation and white blood cell counts. Clinical history of asthma and rhinitis was recorded, and lung function was assessed (spirometry, methacholine provocation and exhaled nitric oxide fraction).ResultsThe most overexpressed gene in children sensitised to dog dander compared to healthy controls was CST1, coding for Cystatin 1. A cluster of these children with enhanced CST1 expression showed lower forced expiratory volume in 1 s, increased bronchial hyperreactivity, pronounced eosinophilia and higher basophil allergen threshold sensitivity compared with other children sensitised to dog dander. In addition, multi-sensitisation to lipocalins was more common in this group.ConclusionsOverexpression of CST1 is associated with more severe allergic airway disease in children sensitised to dog dander. CST1 is thus a possible biomarker of the severity of allergic airway disease and a possible therapeutic target for the future treatment of airborne allergy.

scholarly journals Olmesartan: A Little-Known Cause of Diarrhoea

2019 ◽  
Author(s):  
Joana Serôdio ◽  
Joana Carneiro ◽  
Manuel Veiga ◽  
António Ferreira
Keyword(s):  
Weight Loss ◽  
Coeliac Disease ◽  
Clinical Case ◽  
Villous Atrophy ◽  
Clinical Suspicion ◽  
Differential Diagnoses ◽  
Histological Evidence ◽  
History Of

Olmesartan's sprue-like enteropathy was first described in 2012 and typically presents with diarrhoea, weight loss, nausea, vomiting, low albumin and histological evidence of intestinal villous atrophy. Coeliac disease is one of the main differential diagnoses and should be excluded. We present the clinical case of a 63-year-old man treated with olmesartan for 10 years who presented with a 2-month history of diarrhoea and was diagnosed with olmesartan´s enteropathy. This case highlights the need for clinical suspicion of this new entity in order to reduce the associated morbidity and unnecessary costly investigations.

Comparison of pharmacodynamics and celiac effects of olmesartan medoxomil formulations by using olmesartan-induced celiac-rat-model

2021 ◽  
Vol 18 ◽  
Author(s):  
Yelda Komesli ◽  
Bekir Ugur Ergur ◽  
Ercument Karasulu
Keyword(s):  
Weight Loss ◽  
Side Effects ◽  
Rat Model ◽  
Villous Atrophy ◽  
Case Reports ◽  
Olmesartan Medoxomil ◽  
Albino Rats ◽  
Pressure System ◽  
Severe Diarrhea ◽  
Clinical Changes

: Olmesartan Medoxomil (OM) is an angiotensin receptor blocker and has the adverse effect of celiac like enteropathy which was accepted by the FDA in 2013. This disease is characterized by severe diarrhea, weight loss and enteropathy. Although there are many case reports associated with olmesartan-related enteropathy in humans, it has not been described in a long-term animal model study so far. We developed a self-microemulsifying drug delivery system (OM-SMEDDS) in our previous study to reduce this side effect of drug and to enhance bioavailability. In this study, an artificial hypertension model was established with dose of 185 µmol /kg L-NAME (N ω-nitro-L-arginine methyl ester) twice in a day intraperitoneally in Wistar albino rats. To determine and compare side effects, the OM-Suspension and OM-SMEDDS were administered at 1.3 mg/kg therapeutic dose during one-month period to the rats. Tension of rats was recorded by measuring from their tails with non invasive blood pressure system. We observed celiac like enteropathy findings like villous atrophy and intraepithelial lymphocytosis and clinical changes like weight loss and severe diarrhea after the treatment with OM-Suspension during one-month experiment. It was also observed that the antihypertensive efficacy of the OM-SMEDDS formulation was higher than the suspension during the experiment and did not cause enteropathy, diarrhea and weight loss by reducing intestinal exposure. Hereby we evaluated the side effects of two different pharmaceutical forms by designing a sustainable and reproducible celiac rat model that can be induced with olmesartan medoxomil.

scholarly journals Spruelike Enteropathy Associated with Olmesartan: An Unusual Case of Severe Diarrhea

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Stephanie E. Dreifuss ◽  
Yutaka Tomizawa ◽  
Nicholas J. Farber ◽  
Jon M. Davison ◽  
Adam E. Sohnen
Keyword(s):  
Clinical Response ◽  
Unusual Case ◽  
Chronic Diarrhea ◽  
Villous Atrophy ◽  
Case Series ◽  
Screening Colonoscopy ◽  
Drug Induced ◽  
Severe Diarrhea ◽  
History Of ◽  
High Index Of Suspicion

A 64-year-old male with a history of hypertension presented with worsening diarrhea and 25-pound weight loss over the preceding three months. Prior screening colonoscopy was unremarkable, and the patient failed conservative management. On presentation, the patient had orthostatic hypotension associated with prerenal azotemia for which olmesartan (40 mg/day) was held. Initial workup for chronic diarrhea was essentially unremarkable. Then, EGD was performed with small bowel biopsy, which showed a moderate villous blunting and an intraepithelial lymphocyte infiltration. Celiac disease was excluded by negative conventional serology tests and the absence of clinical response to a gluten-free diet. In the interim, diarrhea became resolving without any other interventions, and clinical response was achieved even with gluten-containing diet. Two months later, he achieved a complete resolution of diarrhea and regained 20-pound weight. Spruelike enteropathy is a clinical entity manifested by chronic diarrhea and intestinal villous atrophy. Spruelike enteropathy associated with olmesartan as a cause of drug-induced diarrhea is rare, and it has been reported only in a case series to date. This case highlighted the importance for clinicians to maintain a high index of suspicion for olmesartan as a precipitant of spruelike enteropathy.

scholarly journals A gastro-colic fistula secondary to high-grade B-cell gastric lymphoma in a patient with AIDS: a case report

2021 ◽  
Vol 49 (4) ◽  
pp. 030006052110066
Author(s):  
Waiian Leong ◽  
Mingfeng Xu ◽  
Li Ni ◽  
Jiajun Su ◽  
Dongye Yang
Keyword(s):  
Weight Loss ◽  
Abdominal Pain ◽  
Hiv Infection ◽  
B Cell ◽  
Histopathological Examination ◽  
Gastric Lymphoma ◽  
High Grade ◽  
Severe Diarrhea ◽  
History Of ◽  
Immunodeficiency Syndrome

To the best of our knowledge, there are no previous reports of a gastro-colic fistula (GCF) secondary to primary high-grade B-cell gastric lymphoma associated with acquired immunodeficiency syndrome (AIDS). Here, we report a 37-year-old man who presented with paroxysmal abdominal pain for 4 months, diarrhea for 15 days and weight loss of 4 kg. He had a history of human immunodeficiency virus (HIV) infection and was diagnosed with AIDS in 2013. The patient was diagnosed with a GCF secondary to primary high-grade B-cell gastric lymphoma by gastroscopy and histopathological examination. Two weeks after diagnosis, he died in another hospital. This is an uncommon case in which the GCF occurred secondary to malignant gastric lymphoma in a patient with AIDS. Supported by the literature, patients with HIV infection who complain of abdominal pain or a mass, severe diarrhea, and weight loss should be assessed for a GCF secondary to lymphoma because of its worse prognosis.

High-Output (HO) Ostomy With Histopathologic Abnormality: Examination of 78 Stoma Specimens

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S56-S57
Author(s):  
Fernanda Cordeiro-Rudnisky ◽  
Natallia Sheuka ◽  
Edward Lee ◽  
Hwajeong Lee
Keyword(s):  
Medical Records ◽  
Collagenous Colitis ◽  
Clinical History ◽  
Functional Abnormality ◽  
Skin Breakdown ◽  
Histologic Abnormality ◽  
History Of ◽  
Inflammatory Bowel ◽  
Histologic Changes ◽  
High Output

Abstract Background HO (>2,000 mL output/day) is a serious complication following ostomy procedure. HO may be associated with variable underlying conditions or idiopathic. We encountered an ileostomy case with diffuse subepithelial collagen deposits resembling collagenous colitis from a patient with history of HO without underlying cause. A subset of idiopathic HO may be associated with histopathologic abnormalities of the bowel. Methods Resected stomas from ostomy malfunction were searched using ICD-9 and CPT codes (2003-2018). Archived pathology materials were reviewed and activity, villous blunting, pyloric metaplasia (PM), and subepithelial collagen deposits were assessed. Trichrome stain was performed when necessary. Clinical history was obtained from medical records. Results Sixty-one ileostomies and 17 colostomies were retrieved from 69 patients. Types of ostomy malfunction were stricture/obstruction (n = 21), hernia (n = 10), ischemia/necrosis (n = 4), leak (n = 4), abscess/adhesion (n = 3), skin breakdown (n = 3), prolapse (n = 3), retraction (n = 2), reepithelialization (n = 1), and unclear/not specified (n = 15). Thirty-two patients had inflammatory bowel disease (IBD; 19 Crohn disease [CD], 13 ulcerative colitis [UC]). All HOs were from ileostomy, and 16 had risk factors for HO, including IBD (n = 9 [56%]; 7 CD, 2 UC), short bowel (n = 6, 3 with CD), pelvic/intra-abdominal abscess (n = 2), sepsis (n = 2), and prokinetic (n = 1). Five ileostomies from CD showed PM, while 11 lacked significant histologic abnormalities. Among 5 (24%) idiopathic HOs, 1 was the index case with diffuse subepithelial collagen deposits with subtotal villous blunting, 1 showed PM, and 1 had focal activity. Remaining 2 ileostomies from idiopathic HO were unremarkable. Stomas from patients with other types of ostomy malfunction showed compatible histologic changes. Fifteen cases without ostomy malfunction did not show histologic abnormality. Conclusion Most HO represents functional abnormality without histopathologic abnormality except in IBD. However, idiopathic HO may be associated with histopathologic abnormalities in the stoma suggestive of acute/chronic enteritis and scarring, which may be underrecognized and treatable.

scholarly journals Duodenal Villous Atrophy in a TTG-Negative Patient Taking Olmesartan: A Case Report and Review of the Literature

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Tasha Kulai ◽  
Thomas Arnason ◽  
Donald MacIntosh ◽  
John Igoe
Keyword(s):  
Villous Atrophy ◽  
Kidney Injury ◽  
Intraepithelial Lymphocytes ◽  
Surface Epithelium ◽  
Review Of The Literature ◽  
Angiotensin Ii Receptor ◽  
Angiotensin Ii Receptor Antagonist ◽  
Repeat Endoscopy ◽  
History Of

Olmesartan, an angiotensin II receptor antagonist used to treat hypertension, is associated with few adverse effects. Here, a case of severe sprue-like enteropathy and acute kidney injury is described in a 68-year-old male taking olmesartan for 3-4 years. He presented to hospital with a five-week history of diarrhea, vomiting, and a 20 lb weight loss. Anti-TTG was negative with a normal IgA. Biopsies of the distal duodenum and duodenal cap revealed marked blunting of the villi with near complete villous atrophy of the biopsies from the bulb. There was an increase in intraepithelial lymphocytes as well as neutrophils in the surface epithelium. The patient’s diarrhea improved upon discontinuation of olmesartan and he returned to his previous weight. Repeat endoscopy four months later demonstrated complete resolution of inflammatory change with normal villous architecture. Long-term olmesartan use is associated with severe sprue-like enteropathy. The mechanism of intestinal injury is unknown. Duodenal biopsy results may mimic other enteropathies such as celiac disease. Physicians should consider medications as potential etiologies of enteropathy.

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