Stoeckli Luisa, Koster Markus, Tuerkmen-Uthayanan Tugce, Cogliatti Sergio, Brand Stephan
Department of General Internal Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland.
Division of Endocrinology and Diabetology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
Case Rep Gastroenterol. 2025 Jun 6;19(1):403-411. doi: 10.1159/000545217. eCollection 2025 Jan-Dec.
Sartan-induced enteropathy is an uncommon side effect of treatment with angiotensin II receptor antagonists (ARBs), which has predominantly been described for olmesartan.
For the first time, we describe sartan-induced enteropathy as an adverse drug reaction associated with azilsartan in a 74-year-old male patient who was admitted to the hospital twice within 5 months because of excessive non-bloody diarrhea and weight loss. In this case, histopathological findings of intraepithelial lymphocytosis and intestinal villous atrophy resembled celiac disease; however, celiac disease-specific antibodies remained negative, and a gluten-free diet did not result in significant clinical recovery, while symptoms stopped rapidly after stopping azilsartan. When the patient was seen 5 months later, he was free of clinical symptoms, and histological changes disappeared after stopping azilsartan.
This case illustrates sprue-like enteropathy as a potential side effect of azilsartan, emphasizing to consider this differential diagnosis in ARB-treated patients with chronic diarrhea. The causality of our findings was confirmed by drug de-challenge and re-challenge resulting in typical histological changes.
沙坦类药物所致肠病是血管紧张素II受体拮抗剂（ARB）治疗中一种不常见的副作用，主要见于奥美沙坦。
我们首次描述了一名74岁男性患者中，沙坦类药物所致肠病作为与阿齐沙坦相关的药物不良反应。该患者在5个月内两次因大量非血性腹泻和体重减轻入院。在本病例中，上皮内淋巴细胞增多和肠绒毛萎缩的组织病理学表现类似于乳糜泻；然而，乳糜泻特异性抗体仍为阴性，无麸质饮食并未导致显著的临床恢复，而停用阿齐沙坦后症状迅速缓解。5个月后复诊时，患者无临床症状，停用阿齐沙坦后组织学改变消失。
本病例说明了类口炎性腹泻样肠病是阿齐沙坦的一种潜在副作用，强调在接受ARB治疗的慢性腹泻患者中应考虑这种鉴别诊断。通过药物撤药和再激发导致典型的组织学改变，证实了我们研究结果的因果关系。
