Association of sprue-like enteropathy and angiotensin receptor-1 antagonists

Summary

Over the past 5 years several case reports and cohort studies have been published that describe a sprue-like enteropathy (SLE) with abdominal pain, chronic diarrhea and weight loss, after taking angiotensin type 1 receptor blockers (ARB). The initial case series from the Mayo Clinic, which described 22 cases of olmesartan-induced SLE, was followed by numerous case descriptions for almost all ARBs. A total of 73 case reports have been described so far that show evidence of ARB-associated enteropathy with villous atrophy and full recovery 3–12 months after discontinuation of the sartan in question. Of these, 59 cases were olmesartan-associated cases of SLE, another 14 case reports have been published for telmisartan (4), valsartan (3), losartan (2), candesartan (1) and eprosartan (1). Based on the available cohort studies, ARB-associated intestinal malabsorption occurs in 9.8–14 cases per 100,000 patients treated with ARBs, the number treated to harm is over 31,000 patient-years. Although the majority of case reports have been published with olmesartan, in the cohort studies no clear difference within the ARBs can be ruled out. The SLE is rare but must be suspected and diagnostically investigated in every patient presenting with abdominal discomfort, chronic diarrhea and weight loss who is being treated with an ARB, after other causes have been ruled out. In such cases, discontinuing the ARB leads to a full recovery.

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Fig. 1

Abbreviations

α1:

Alpha-1-adrenoceptor

ARB:

Angiotensin receptor‑1 antagonist

AT1:

Angiotension-receptor‑1

AT2:

Angiotension-receptor‑2

CL−:

Chloride

ECV:

Extracellular fluid volume

K+:

Potassium

NA+:

Sodium

PG:

Prostaglandins

SLE:

Sprue-like enteropathy

TGF beta:

Transforming growth factor beta

TNF-alpha:

Tumor necrosis factor alpha

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Correspondence to Univ.-Doz. Dr. René R. Wenzel M.D..

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R.R. Wenzel: For the following companies there is a conflict of interest with the presented data due to consultancy fees or sponsoring: Actelion, Astra-Zeneca, Abbott, Bayer, Daichii-Sankyo, Gepamed, Medtronic, Menarini, Novartis, Speedel Pharma, St Jude Medical and Takeda. C. Datz declares that he has no competing interests.

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Wenzel, R.R., Datz, C. Association of sprue-like enteropathy and angiotensin receptor-1 antagonists. Wien Klin Wochenschr 131, 493–501 (2019). https://doi.org/10.1007/s00508-019-01539-2

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Keywords

  • Malabsorption
  • Hypertension
  • Renin-Angiotensin-System
  • Diarrhea
  • AT1-receptor-antagonist