Olmesartan-associated sprue-like enteropathy. EndoTODAY 이준행

[SmallTODAY 034 - Olmesartan/Valsartan-associated sprue-like enteropathy]

Olmesartan is an angiotensin receptor blocker (ARB) approved for the treatment of hypertension in 2002. FDA reported olmesartan associated sprue-like enteropathy via a MedWatch alert in July 2013 after a case series of 22 patients was reported by Mayo Clinic. The patients usually present with chronic diarrhea, vomiting, abdominal pain, bloating, and a median of a 40 pound weight loss. Dehydration and acute renal failure have also been reported.

자료 제공: 이선영 교수님

2021년 Intestinal Research에 valsartan-associated sprue-like enteropathy (VSE) 증례가 실렸습니다. 80세 일본 여성이었는데 복통, 구토, 설사로 내원했습니다. 처음에는 항생제, 다음에는 스테로이드를 사용하다가 결국 valsartan을 끊고 좋아졌다고 합니다.

A computed tomography scan revealed severe inflammation of the small intestine, especially in the upper small intestine (Fig. A). We did single balloon enteroscopy and observed the duodenum and almost all of the upper small intestine. It showed erythema, mucosal fragility and villous atrophy enhancing mucosal fissures, and they looked like scalloped mucosa of celiac disease (Fig. B). Indigo carmine clearly revealed villous atrophy as shown in Fig. C. A pathological test of the small intestine showed collagen deposition and intraepithelial lymphocytosis (Fig. D: left, H&E; right, Elastica-Masson staining).

대한장연구학회 부울경지회에서 발간한 '다양한 하부위장관 증례 (2023)'에서 angiotensin receptor blocker-induced enteropathy를 보았습니다. Olmesartan이 원인이었습니다.

[References]

1) EsoTODAY - 십이지장질환 증례토의

2) SmallTODAY - 소장질환 증례토의

3) ColonTODAY - 대장질환 증례토의

4) Dr. Sinn's LiverTODAY - 간질환 증례토의