Depertment of Gastroenterology, Kitami Red Cross Hospital, Higashi-2, Kita-6, Kitami, 090-0026, Japan.
Department of Pathology, Asahikawa Medical University, 1-1 Midorigaoka Higashi-2 Hokkaido, Asahikawa, Japan.
BMC Gastroenterol. 2021 Sep 23;21(1):350. doi: 10.1186/s12876-021-01926-y.
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.
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.
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.
奥美沙坦是一种血管紧张素 II 受体阻滞剂，据报道可引起类淀粉样肠病，其典型的组织病理学表现为肠绒毛萎缩。有趣的是，一些患者还会出现胶原性和/或淋巴细胞性胃炎和结肠炎。我们报告了一例 73 岁日本男性，其临床病史为严重腹泻和体重减轻，持续 2 个月。同时观察到类淀粉样肠病和胶原性结肠炎并可进行随访的病例报告较少。
我们报告了一例 73 岁男性，其临床病史为严重腹泻和体重减轻，持续 2 个月。他因高血压接受奥美沙坦治疗已有 5 年。内镜检查和活检显示肠绒毛萎缩和胶原性结肠炎。由于低血压，入院时停用了导致该病的奥美沙坦，我们继续停用该药。奥美沙坦停药后 3 周内，患者的临床症状改善。3 个月后，随访内镜显示绒毛萎缩改善，但结肠增厚的胶原带无改善。然而，6 个月后黏膜恢复正常，组织学证实先前的病变最终得到解决。
本报告提供了一例同时观察到类淀粉样肠病和胶原性结肠炎并可进行随访的病例。在不明原因腹泻的情况下，应重新确认药物治疗史，并将该病视为鉴别诊断。
