Simas Diogo, Gonçalves André Ruge, Gomes Plácido, Russo Pedro, Amado Cristina M, Vasconcelos Helena
Serviço de Gastrenterologia, Unidade Local de Saúde da Região de Leiria, Leiria, Portugal.
Serviço de Anatomia Patológica, Unidade Local de Saúde da Região de Leiria, Leiria, Portugal.
GE Port J Gastroenterol. 2024 Dec 19;32(4):288-292. doi: 10.1159/000543202. eCollection 2025 Jul.
Angiotensin receptor blockers are a pharmacological class widely used as antihypertensive therapy. Recently, a relationship between these agents and gastrointestinal disease has been described, namely, enteropathy, gastropathy, and microscopic colitis. The mechanism is unknown, but it is thought that a cell-mediated immune reaction is involved and does not appear to be a class effect. Treatment consists of stopping the drug and rechallenge can confirm the diagnosis.
An 85-year-old man with a history of hypertension treated with olmesartan/hydrochlorothiazide for 12 years presented to the emergency department with months of epigastric pain, without vomiting, blood loss, diarrhea, or weight loss. A recent upper gastrointestinal endoscopy (UGE) showed congested mucosa, irregular erosions, and friability in the distal body, notch, and antrum. Histology revealed moderate chronic gastritis, severe inflammatory activity, abundant eosinophils, intestinal metaplasia with low-grade dysplasia, and marked atrophy, with no signs of malignancy or (Hp). The patient had previously been treated by his family doctor with lansoprazole and sucralfate, without improvement, and was subsequently discharged on esomeprazole with a referral for a gastroenterology consultation. Three months later, a follow-up UGE showed persistent erosions despite good adherence to esomeprazole. Hp serology was positive, and the patient was started on bismuth-based quadruple therapy. A post-treatment urea breath test confirmed Hp eradication. Six months later, UGE still showed multiple ulcers in the distal body and antrum. Olmesartan was switched to lisinopril, and after another 6 months, a follow-up UGE showed no ulcers or erosions. Biopsies revealed reduced inflammation and no dysplasia, indicating histological improvement. Olmesartan-induced gastropathy was diagnosed.
This case report illustrates olmesartan-induced gastropathy, an important diagnosis to consider in cases of non-Hp gastritis and refractory peptic ulcer disease.
血管紧张素受体阻滞剂是一类广泛用于抗高血压治疗的药物。最近，已描述了这些药物与胃肠道疾病之间的关系，即肠病、胃病和显微镜下结肠炎。其机制尚不清楚，但认为涉及细胞介导的免疫反应，且似乎不是类效应。治疗包括停用药物，再次用药可确诊。
一名85岁男性，有高血压病史，服用奥美沙坦/氢氯噻嗪治疗12年，因数月的上腹部疼痛就诊于急诊科，无呕吐、失血、腹泻或体重减轻。近期上消化道内镜检查（UGE）显示胃体远端、胃切迹和胃窦黏膜充血、不规则糜烂和脆弱。组织学检查显示中度慢性胃炎、严重炎症活动、大量嗜酸性粒细胞、伴有低度发育异常的肠化生和明显萎缩，无恶性肿瘤迹象或幽门螺杆菌（Hp）。患者此前由家庭医生用兰索拉唑和硫糖铝治疗，无改善，随后出院时服用埃索美拉唑，并转诊至胃肠病科会诊。三个月后，随访UGE显示尽管患者很好地坚持服用埃索美拉唑，但糜烂仍持续存在。Hp血清学检查呈阳性，患者开始接受铋剂四联疗法。治疗后尿素呼气试验证实Hp已根除。六个月后，UGE仍显示胃体远端和胃窦有多处溃疡。将奥美沙坦换为赖诺普利，又过了6个月，随访UGE显示无溃疡或糜烂。活检显示炎症减轻且无发育异常，表明组织学有改善。诊断为奥美沙坦所致胃病。
本病例报告说明了奥美沙坦所致胃病，这是在非Hp胃炎和难治性消化性溃疡病病例中需要考虑的重要诊断。
