Navigating Non-Celiac Enteropathy: Understanding Olmesartan-Induced Enteropathy

Celiac.com 03/21/2024 - For people with celiac disease, managing symptoms and maintaining a gluten-free lifestyle are essential for overall health. However, recent research has uncovered another potential cause of enteropathy that presents a diagnostic challenge for both patients and healthcare providers: olmesartan-induced enteropathy.

Olmesartan, an angiotensin II receptor antagonist commonly prescribed for hypertension, has been linked to enteropathy in rare cases, and another brand name for it is Benicar. This side effect, while uncommon, can manifest as chronic diarrhea, weight loss, and signs of malabsorption, mirroring the symptoms of celiac disease. A team of researchers set out to study the diagnostic challenges related to non-celiac enteropathy, specifically focusing on olmesartan-induced enteropathy. Here's what they found. 
 
The research team included Doukas S G, Doukas P G, and Velpari S. They are variously affiliated with the Department of Medicine, Saint Peter's University Hospital in New Brunswick, NJ, USA; the Department of Forensic Sciences and Laboratory of Toxicology, University of Crete, Medical School in Heraklion, GRC; and the department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School/Saint Peter's University Hospital in New Brunswick, USA.

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Their recent study focused on a 73-year-old woman who presented to the emergency department with watery diarrhea, weight loss, and electrolyte imbalances. Despite extensive testing, including celiac disease panels and imaging studies, the cause of her symptoms remained elusive until duodenal biopsies revealed moderate to severe villi blunting and intraepithelial lymphocytosis—a hallmark of olmesartan-induced enteropathy.

History of Taking Olmesartan

The patient's history of olmesartan use prompted the discontinuation of the medication, leading to a remarkable improvement in her symptoms and duodenal biopsy results within one month.

This case underscores the importance of considering medication history and ruling out other potential causes of enteropathy in patients with symptoms suggestive of malabsorption. Olmesartan-induced enteropathy can mimic celiac disease both clinically and histopathologically, often leading to unnecessary diagnostic investigations and delays in appropriate treatment.

Greater awareness of medication-related diarrheal syndromes, such as olmesartan-induced enteropathy, is crucial for prompt diagnosis and management. Healthcare providers should be vigilant in recognizing the potential link between olmesartan use and enteropathy, as simple discontinuation of the medication can lead to significant clinical improvement.

For people with celiac disease and other gastrointestinal conditions, understanding the potential causes of enteropathy beyond gluten exposure is essential for effectively managing symptoms, and optimizing health outcomes. By staying informed and working closely with healthcare providers, patients can navigate the complexities of non-celiac enteropathy, and advocate for their well-being.

Read more at Cureus 16(2): e54373. doi:10.7759/cureus.54373