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Blood Pressure Drug Side Effects Mimic Celiac Disease

Celiac.com 06/25/2012 - If you have received a celiac disease diagnosis while taking heart pressure medication, it turns out you might not actually have celiac disease. An investigation led by Dr. Joseph Murray has shown that certain blood pressure medication can cause symptoms not unlike those commonly attributed to celiac disease, and going off the drug can stop the symptoms.

CC_Jesse_AlwinBetween 2008 and 2011, 22 patients on the blood pressure medication olmesartan (sold as Benicar) exhibited clear symptoms of celiac disease: intestinal inflammation and abnormalities, chronic diarrhea and weight loss (median weight loss of 39 pounds). One of the patients lost an astounding 125 pounds, and fourteen of the patients exhibited symptoms so severe as to require hospitalization.

All of the patients were diagnosed with celiac disease based on symptoms and intestinal biopsy results, but gluten-free diet caused no improvement in any of the patients. Furthermore, their blood tests came back with results that did not match up with a celiac disease diagnosis.

After taking the patients off olmesartan, all of their symptoms showed dramatic improvement. Eighteen of the 22 had subsequent intestinal biopsies, which revealed improvement in that area as well. It would seem then, that the medication causes celiac-like symptoms.

Some in the medical community have questioned the causal relationship of olmesartan to the symptoms though. As Dr. Franz Messerli of St. Luke's-Roosevelt Hospital, New York argues, “Only re-exposure [to the drug] can confirm the GI side effects were indeed due to olmesartan.”

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The sample size has also been called into question by Dr. Henry Black of NYU-Langone Medical Center, who claims that the side effects are highly uncommon and that he uses the drug all the time with no adverse effects. Some have even proposed that the reaction is the result of a drug allergy rather than symptoms related to the mechanism of the drug itself.

The conclusion one can draw from Dr. Murray's findings and subsequent criticisms, is that it is highly likely that olmesartan can cause celiac-like symptoms, but it is not entirely clear how often or why. Those who take it and experience such symptoms (or have gotten a celiac diagnosis while on the drug) should discuss switching to another medication with their doctors. It is still unclear if these symptoms are specific to olmesartan, or can be caused by the entire ARB family of drugs.

As Dr. Murray says, "it's really an awareness issue. We want doctors to be aware of this issue, so if they see a patient who is having this type of syndrome — they think about medications as a possible association."

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2 Responses:

 
dappycharlie
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said this on
02 Jul 2012 2:00:53 PM PDT
Can anyone say if beta blockers were part of this investigation?

 
Sharon
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said this on
03 Jul 2012 6:55:11 AM PDT
I started to respond to the original release of this information in Physician's First Watch (June 22) - entitled "Case Series Associates Olmesartan with Spruelike Disease." I was disappointed that the Mayo Clinic physicians Murray et al. made no mention of looking at the inactive ingredients in Olmesartan as a cause, as well as two other antihypertensive medications that also seem to cause celiac-like symptom. Two if not three of these have more than one form of cellulose and even talc (which should not be an issue); however Olmesartan, as well as at least one of the other contain lactose in as few forms. Seems like lactose intolerance would have been looked at as well - and this is often associated with celiac disease (or celiac-like response) from the damage to the epithelial cells that can't produce the lactase - though there is not mention of this in the full publication. Perhaps this is the reason there was no response to a gluten-free diet - perhaps dairy needed to be removed as well. You would have thought the patients would be aware of any lactose intolerance issue. In one of the medications I believe the lactose was 5x the amount of the active ingredient.




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Dang! If I lived that close to Chicago, I would definitely go to the University of Chicago's celiac center even just to hang out with some celiacs or celiac-savvy folk! (Maybe visit Aunt Mary too....) Consider a second opinion. Some people spend more on their Friday night bar tab instead of paying for a second opinion (cash) if they went out-of-network (insurance). Your current GI must suspect something (e.g. parasite). Maybe he is hoping it will resolve on its own (frankly sometime this approach works), but that side pain for over a year is not normal. Keep advocating. ?

Cycling Lady, LMAO at IBeStumped! So true. Yes, he is trying the band aid approach it seems. That's probably the most frustrating thing of all. So yesterday I get a call back from his office and they say to stop taking the Viberzi and switch back to Imodium! I reminded them that Imodium didn't work, I had already used it 8 days with no changes. His assistant informed me that that is all he can recommend at this time until he sees me at my next appointment which is 5/24! I live near Chicago and I am about to make an appointment to go to the University of Chicago hospital which is the top celiac research hospital in the country. Hopefully they can give me better answers.

7Hi jen and welcome No-one can diagnose remotely via nterwe posts but if there was such a game as celiac / gluten sensitive bingo, I would be calling 'House!' having read your account above... Lots of things fit the pattern as I'm sure your lurking has revealed. It's a tricky condition to diagnose however so you may have a little wait before you join the coolest club in town and get your funky celiac membership card For now it's really important that you stay on gluten. Keep eating it as accurate testing requires it. Ask your doctor to check the boxes for celiac testing alongside your liver blood tests. There should be enough in your history to get this without hassle but if they're reluctant INSIST and don't be afraid to assert your reasonable suspicion and wish to clarify and exclude. A good liver specialis will be aware of the possible links so you should be ok. If not gt second opinion. Ask for a full celiac panel as there are variety of tests. Find further info here There's a lot to take in, but be positive, I think you are on the right track and if so, you could soon be feeling better than you ever thought possible!

Hello, I am in a job that I travel every 3rd week...It gets challenging becuase many times I am doing audits of warehouses and they dont even have a cafeteria. I usually bring gluten-free protein bars as a back up if I have to miss a meal and then eat when I get back to the hotel. Just a suggestion because they certainly fill me up....Have a safe trip...Kelly

Hello all, I'm a new member here but have lurked for a while. I'm looking for some advice regarding my medical history, possible symptoms of celiac and next steps. General info: female, low level smoker, drink alcohol, aged 32. I started having bad gastro issues when I was around 17. Since then I've consistently suffered from chronic diarrhoea, frequent discomfort in the tummy area, feelings of dehydration despite drinking at least eight glasses a day and frequent fatigue for no real reason. In 2008/9 I visited the doctor as my diarrhoea was having an effect on my studies at the time. The doctor tested me for allergies; eggs, fish, gluten and lactose and did a "standard" blood test. Everything came back fine except my liver results, which were elevated to double (I did not the see the results for myself so can't say which enzymes etc). I was told to drink less and take Imodium. The doctor implied that perhaps I was stressed and / or anxious and, still being young plus a student who regularly went out drinking, I accepted this advice and carried on with my life. I would here add that I am not an unusually stressed person - in fact, learning to deal with my unpredictable bowels has forced me to be quite a laid-back person! Fast forward to 2016. I had been living with my partner for two years by this point who had noticed my bowel habits and informed me that this was definitely not normal. He encouraged me to try out a gluten free diet since I was apprehensive about visiting a doctor only to be fobbed off with Imodium again. I did the diet as strictly as a newbie can for around two months before we set off travelling. During the diet I noticed that after a couple of weeks of extreme tiredness I felt quite a lot better - I kept a food journal at the time which showed that I almost immediately had diarrhoea once after eating an ice-cream, i felt bloated and unwell after an attempt to make oat muffins (maybe i didn't cook them very well though!) and I felt bloated and had diarrhoea after eating some fish fried in flour (We made a mistake in ordering them but I didn't want to complain). My partner also reported that my mood swings (which I admit can be a little unpredictable) were much better. Once we started travelling I gave up and ate what I was given as we were staying with friends etc much of the time. Toward the end of our trip I started to feel extremely tired, to the point of having to stay in for "rest" days, and my guts were very unhappy. I chalked it up to irregular eating patterns, too many beers and late nights in general. During the trip I also had an extreme hangover after drinking wheat beer. And, while of course I accept that any overindulgence can make you ill, I really felt that that level of hangover was quite out of the ordinary. Finally, I developed a strange lump under my armpit during this period. Now back at home, I decided to go to the doc and check out the odd lump under my armpit. The doctor was pretty confident that it was nothing to worry about cancer-wise but she ordered a battery of blood tests just to be sure. The lump is fine (good news) but the results showed elevated GGT, high-ish ALT and normal AST liver enzymes plus signs of dehydration in red bloods / higher (but not concerning) levels of white bloods. I'm scheduled to go back for another blood test to double-check liver function and discuss results - if it is again high she will send me for a ultrasound. Does this history chime with anyone here? I know that the correct course in basic health terms is to stop drinking for some time (easily done) and stop smoking forever (easy to say...) but I cannot help but think that something else is going on here. I will discuss this with my doctor and make clear that my bowel issues have not been resolved and that the initial IBS diagnosis wasn't based on any thorough testing so to speak. In the meantime - does anyone have any advice for me in times of avenues to research or experience of similar symptoms? Gluten remains in my diet but in all other respects it could be regarded as very healthy, I think anyway... (pescatarian, plenty of fruit and veg, little to no sugar on a daily basis, not much dairy to speak of...) Thanks in advance and sorry for bending everyone's' ear about this... I guess it's just taken a long time for me to admit I might be sick and I need some help. Jen