Celiac.com 12/16/2024 - Angiotensin receptor blockers (ARBs) are commonly prescribed to manage high blood pressure, heart failure, and kidney disease. They work by blocking the action of angiotensin II, a hormone that causes blood vessels to constrict, which helps reduce blood pressure and ease strain on the cardiovascular system. Some well-known ARBs include losartan, valsartan, and irbesartan. While they provide significant benefits for many patients, a recent study suggests that for people with celiac disease, ARBs may worsen symptoms and lead to other health complications.
New Study Highlights Risks of ARBs for Celiac Disease Patients
At the 2024 American College of Gastroenterology (ACG) Annual Scientific Meeting, Dr. Isabel Hujoel from the University of Washington presented findings that suggest ARBs may be linked to worse outcomes in people with celiac disease. The research focused on whether ARB use could exacerbate certain celiac symptoms or increase the likelihood of health issues commonly associated with the disease, such as iron deficiency, diarrhea, abdominal pain, and low hemoglobin.
How ARBs May Impact Celiac Disease Outcomes
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One potential reason for the adverse effects is that ARB-associated enteropathy may share underlying pathophysiological characteristics with celiac disease. Both conditions involve damage to the small intestine lining, which disrupts nutrient absorption and can lead to symptoms like diarrhea, abdominal discomfort, and malabsorption. In individuals with celiac disease, exposure to gluten triggers an immune response that inflames the small intestine, causing long-term complications if untreated. The study suggests that ARBs might compound these challenges, though further research is needed to confirm the link and understand the mechanisms involved.
Increased Hazard Ratios for Key Symptoms
Hujoel and her team analyzed data from the National Institutes of Health's All of Us project, a large dataset that included over 1,800 patients diagnosed with celiac disease. Among these patients, those who began taking ARBs after their celiac diagnosis had a significantly higher risk of experiencing iron deficiency, low hemoglobin, abdominal pain, and diarrhea compared to those who were not on ARB therapy. Importantly, the study controlled for various factors to ensure that the effects observed were likely due to ARB use rather than other conditions or treatments.
Highlighting Specific Outcomes: Iron Deficiency and Hemoglobin Levels
The study found particularly high hazard ratios for iron deficiency and low hemoglobin in celiac patients who used ARBs, suggesting that the drug may interfere with iron absorption. This is a crucial finding because people with celiac disease are already at risk for nutrient deficiencies due to small intestine damage, which can limit their ability to absorb essential vitamins and minerals. ARB use might compound these issues, resulting in persistent fatigue and weakness due to low iron levels.
Implications for Celiac Disease Management
The findings imply that healthcare providers should carefully consider alternatives to ARBs for managing hypertension in people with celiac disease. Other classes of antihypertensive drugs, such as ACE inhibitors, calcium channel blockers, or beta-blockers, could be explored as alternatives. While ARBs are generally well-tolerated and effective, the study underscores the importance of tailoring treatment to the specific needs and health status of each patient. For those with nonresponsive celiac disease, a trial period without ARBs could be beneficial to see if symptoms improve.
Monitoring for Nonresponsive Celiac Symptoms
One of the major challenges in managing celiac disease is "nonresponsive celiac disease," a condition where symptoms persist even with strict adherence to a gluten-free diet. For patients who continue to experience gastrointestinal issues, reviewing their medication list may help identify whether ARBs or other medications could be contributing to the problem. If symptoms improve after discontinuing ARBs, it may indicate that the medication was exacerbating their condition.
Recommendations for Patients and Providers
Given the prevalence of ARBs in hypertension treatment, it’s crucial to raise awareness about the potential interactions between these medications and celiac disease symptoms. Dr. Patricia Jones from the University of Miami Miller School of Medicine, who co-moderated the session on small intestine and liver research, noted the importance of sharing these findings so that both patients and healthcare providers can make informed decisions. With this knowledge, patients can seek medical advice if they experience worsening symptoms after starting an ARB, allowing for timely adjustments to their treatment plans.
Future Research Directions
The research presented at ACG 2024 opens the door to further investigation into the relationship between ARB use and celiac disease outcomes. Future studies could examine specific ARBs, such as losartan, and focus on patient outcomes over longer periods. Researchers could also explore differences between patients on a gluten-free diet versus those who are not, looking at medication adherence, symptom recurrence, and other health markers. These studies would help solidify our understanding of ARB use in celiac patients and provide clearer guidelines for managing this group’s unique health needs.
Conclusion
The new research presented by Dr. Hujoel and her team sheds light on the potential risks of ARB use in people with celiac disease. While ARBs play an essential role in controlling blood pressure, patients with celiac disease may need alternative therapies to avoid exacerbating their symptoms. As awareness grows and further research is conducted, healthcare providers will be better equipped to make informed choices that prioritize the long-term health of celiac patients. For now, anyone with celiac disease on ARB therapy should consult their physician to assess whether alternative treatments might offer a safer, more effective solution.
Read more at: medscape.com
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