van Beurden Yvette H, Nijeboer Petula, Janssen Johan, Verbeek Wieke H M, Mulder Chris J J
VUmc, afd. Maag-, darm- en leverziekten, Amsterdam.
Ned Tijdschr Geneeskd. 2014;158:A7370.
The differential diagnosis of diarrhoea in combination with villous atrophy is broad. Coeliac disease heads the list but medication-induced villous atrophy should also be taken into consideration.
We report the case of a 63-year-old man presenting with recurrent secretory diarrhoea, acute renal failure and metabolic acidosis. Initial work-up revealed total villous atrophy (Marsh stage IIIC) with intraepithelial lymphocytosis. A gluten-free diet did not have any effect on the diarrhoea. During several periods of hospitalization antihypertensive medications were temporarily stopped due to dehydration; this resulted in reduction of his symptoms. Eventually an association between the enteropathy and the antihypertensive olmesartan was suspected. Indeed, permanent withdrawal of olmesartan resulted in permanent clinical improvement.
Olmesartan is frequently prescribed in the Netherlands and it should be included in the differential diagnosis of diarrhoea accompanying villous atrophy.
腹泻伴绒毛萎缩的鉴别诊断范围广泛。乳糜泻居首位，但药物性绒毛萎缩也应予以考虑。
我们报告一例63岁男性，表现为反复分泌性腹泻、急性肾衰竭和代谢性酸中毒。初步检查发现完全性绒毛萎缩（马什III C期）伴上皮内淋巴细胞增多。无麸质饮食对腹泻无任何效果。在几次住院期间，由于脱水，降压药被暂时停用；这使他的症状有所减轻。最终怀疑肠病与降压药奥美沙坦有关。事实上，永久停用奥美沙坦导致临床症状永久改善。
奥美沙坦在荷兰经常被处方使用，应将其纳入腹泻伴绒毛萎缩的鉴别诊断中。
