Marietta Eric V, Cartee Amanda, Rishi Abdul, Murray Joseph A
Dig Dis. 2015;33(2):215-220. doi: 10.1159/000370205. Epub 2015 Apr 22.
BACKGROUND/AIMS: Many medications can cause diarrhea by increasing motility, inflammation or enteropathy. Olmesartan and mycophenolic acid (CellCept) are drugs that are capable of increasing inflammation and enteropathy in some individuals and, if not recognized, can lead to chronic diarrhea. It is this type of drug-induced diarrhea that is the focus of this review.
A summary of our findings (recent and earlier published) as well as a review of published works from other centers were conducted.
There is increasing evidence that olmesartan use is associated with enteropathy in a small number of individuals who use angiotensin receptor II blockers, and that this enteropathy is characterized by severe diarrhea capable of inducing severe dehydration and, in some instances, failure of organs such as the kidney. Typical patient demographics are Caucasian individuals who are older (>50 years old) and obese or overweight prior to weight loss. Prolonged exposure to olmesartan use for 1-2 years is typical, although case reports of irbesartan and valsartan have been reported as well. Discontinuing olmesartan leads to improvement of symptoms; however, the period for healing is variable, with some patients requiring steroid therapy and even prolonged parental nutrition support. In addition, many histological features of olmesartan-associated enteropathy are also present in celiac disease, including villi shortening and lymphocyte infiltration. Other drug-associated enteropathies have also been reported with mycophenolate mofetil used in transplantation.
Of the drug-associated enteropathies discussed in this review, olmesartan can generate the most severe symptoms, albeit quite rare. Therefore, with patients who present with severe diarrhea and weight loss, one should consider olmesartan-associated enteropathy. In addition, many of the features associated with olmesartan-associated enteropathy are also found in celiac disease enteropathy; as such, one should review any celiac disease diagnosis for any use of olmesartan at the time of diagnosis.
背景/目的：许多药物可通过增加肠道蠕动、引发炎症或肠病来导致腹泻。奥美沙坦和霉酚酸（骁悉）是能够在某些个体中增加炎症和引发肠病的药物，若未被识别，可导致慢性腹泻。此类药物性腹泻正是本综述的重点。
对我们的研究结果（近期及早期发表的）进行了总结，并对其他中心发表的研究进行了综述。
越来越多的证据表明，在少数使用血管紧张素II受体阻滞剂的个体中，使用奥美沙坦与肠病有关，且这种肠病的特征是严重腹泻，可导致严重脱水，在某些情况下还会导致肾脏等器官功能衰竭。典型的患者特征是白种人，年龄较大（>50岁），在体重减轻之前肥胖或超重。通常长期使用奥美沙坦1至2年，不过也有关于厄贝沙坦和缬沙坦的病例报告。停用奥美沙坦可使症状改善；然而，愈合时间因人而异，一些患者需要类固醇治疗，甚至需要长期的肠外营养支持。此外，奥美沙坦相关肠病的许多组织学特征在乳糜泻中也存在，包括绒毛缩短和淋巴细胞浸润。移植中使用霉酚酸酯也报告了其他药物相关的肠病。
在本综述讨论的药物相关肠病中，奥美沙坦可引发最严重的症状，尽管相当罕见。因此，对于出现严重腹泻和体重减轻的患者，应考虑奥美沙坦相关肠病。此外，与奥美沙坦相关肠病相关的许多特征在乳糜泻肠病中也有发现；因此，在诊断乳糜泻时，应复查是否曾使用过奥美沙坦。
