Department of Gastroenterology, Galway University Hospital, Galway, Ireland.
Department of Gastroenterology, Mayo General Hospital, Castlebar, Ireland.
United European Gastroenterol J. 2021 Oct;9(8):973-979. doi: 10.1002/ueg2.12117. Epub 2021 Jun 29.
Angiotensin receptor blocker-associated enteropathy (ARB-e) is an increasingly recognised clinical entity with symptoms and histological findings identical to coeliac disease (CD). There is evidence to suggest immune-mediated mucosal injury in ARB-e with a high prevalence of DQ2/DQ8; however, as IgA anti-tissue transglutaminase (anti-TTG) is usually negative, an insult other than TTG-mediated injury is suspected. The impact of ARBs on disease activity in patients with CD is not known.
To assess the effect of ARB exposure on patients with established CD.
A patient record search of 1142 individual patients attending a dedicated coeliac clinic from 2010 to the present identified 59 patients treated with ARB. Those with CD confirmed by serology (TTG + ve/EMA + ve) and histopathology (Marsh criteria) were included (n = 40, 0.52%). Data collected included disease duration, compliance with gluten-free diet (GFD), reported symptoms (diarrhoea, weight loss and abdominal pain), surrogate markers of absorption (Vitamin D, Iron, Calcium and Haemoglobin), in addition to anti-TTG titre and histological grade at last follow up. Patients were age and sex-matched in a 1:2 ratio with CD patients not taking ARBs (controls), with comparable rates of disease duration and compliance with GFD.
The ARB and control groups were matched in terms of age (mean 66.2 years) and gender (female 63%). Strict compliance with GFD was reported in 55% and 56%, respectively. Persistent symptoms were reported in 10/40 (25%) of the ARB group compared with 7/82 (9%) of controls (p = 0.0181). There were lower rates of mucosal healing (Marsh grade 0) in the ARB group (36% n = 11) compared to controls (55%, n = 33). There was no significant difference in anti-TTG titres. Surrogate markers of absorption were comparable across the groups, except for Vitamin D which was lower in those taking olmesartan (p = 0.0015).
ARBs may aggravate the enteropathy and lead to increased symptoms in patients with bone fide diagnosed CD following a GFD.
血管紧张素受体阻滞剂相关性肠病（ARB-e）是一种日益被认识的临床实体，其症状和组织学表现与乳糜泻（CD）完全相同。有证据表明，ARB-e 存在免疫介导的黏膜损伤，且 DQ2/DQ8 阳性率较高；然而，由于 IgA 抗组织转谷氨酰胺酶（anti-TTG）通常为阴性，因此怀疑存在除 TTG 介导损伤以外的其他损伤。ARB 对 CD 患者疾病活动的影响尚不清楚。
评估 ARB 暴露对已确诊 CD 患者的影响。
对 2010 年至目前在专门的乳糜泻诊所就诊的 1142 名患者进行病历搜索，共发现 59 名服用 ARB 的患者。将通过血清学（TTG 阳性/EMA 阳性）和组织病理学（Marsh 标准）证实患有 CD 的患者纳入研究（n=40，0.52%）。收集的数据包括疾病持续时间、无麸质饮食（GFD）的依从性、报告的症状（腹泻、体重减轻和腹痛）、吸收的替代标志物（维生素 D、铁、钙和血红蛋白），以及最后一次随访时的抗 TTG 滴度和组织学分级。将 ARB 组和 CD 不服用 ARB（对照组）的患者按照年龄和性别以 1:2 比例匹配，两组的疾病持续时间和 GFD 依从性相当。
ARB 组和对照组在年龄（平均 66.2 岁）和性别（女性占 63%）方面匹配。严格遵守 GFD 的比例分别为 55%和 56%。ARB 组报告持续症状的比例为 10/40（25%），而对照组为 7/82（9%）（p=0.0181）。ARB 组黏膜愈合（Marsh 分级 0）的比例较低（36%，n=11），而对照组为 55%（n=33）（p=0.0003）。抗 TTG 滴度无显著差异。各组间吸收替代标志物无差异，但服用奥美沙坦的患者维生素 D 水平较低（p=0.0015）。
ARB 可能会加重乳糜泻患者的肠病，并导致遵循 GFD 治疗的患者出现更多症状。
