Department of Medicine, Dalhousie University, Halifax, NS, Canada B3H 2Y9.
Division of Anatomical Pathology, Dalhousie University, Halifax, NS, Canada B3H 2Y9.
Can J Gastroenterol Hepatol. 2016;2016:6091571. doi: 10.1155/2016/6091571. Epub 2016 Apr 14.
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.
奥美沙坦，一种用于治疗高血压的血管紧张素 II 受体拮抗剂，其副作用较少。在此，我们报告了一例 68 岁男性患者在服用奥美沙坦 3-4 年后发生严重的类脂性腹泻病和急性肾损伤。该患者因腹泻、呕吐和体重减轻 20 磅就诊，病史为 5 周。抗组织转谷氨酰胺酶（anti-TTG）阴性，IgA 正常。对远端十二指肠和十二指肠帽进行活检显示绒毛明显变钝，活检显示从球部开始几乎完全绒毛萎缩。上皮内淋巴细胞和表面上皮中的中性粒细胞增多。停用奥美沙坦后，患者腹泻症状改善，体重恢复到原来水平。四个月后再次进行内镜检查，发现炎症改变完全消退，绒毛结构正常。奥美沙坦的长期使用与严重的类脂性腹泻病有关。肠道损伤的机制尚不清楚。十二指肠活检结果可能类似于其他肠病，如乳糜泻。医生应考虑将药物作为肠病的潜在病因。
