SHM Converge Scientific Abstract ePoster Gallery-A Rare Case of Olmesartan Induced Enteropathy

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This case report describes a rare but important adverse effect of olmesartan, an angiotensin receptor blocker (ARB) used to treat hypertension. The patient was a 66-year-old woman with repeated hospitalizations over three months for generalized abdominal pain, nausea, vomiting, and watery diarrhea. Initial evaluations, including labs and imaging, were largely unremarkable except for electrolyte abnormalities, and she had previously been misdiagnosed with chronic gastritis.<br /><br />During admission, colonoscopy and esophagogastroduodenoscopy showed non-erosive gastritis. Biopsies from the duodenum and colon revealed intraepithelial lymphocytosis, acute inflammation, crypt apoptosis, and villous blunting—findings that can resemble celiac disease. However, celiac serologies were negative. Pathology suggested the pattern was more consistent with olmesartan-induced enteropathy (OIE), a sprue-like syndrome caused by olmesartan.<br /><br />Olmesartan was permanently discontinued, and the patient completed a budesonide taper. Her symptoms fully resolved, and she remained symptom-free for two years after stopping the drug.<br /><br />The report highlights that medication-induced enteropathy is most commonly linked to immunosuppressants, but olmesartan is a well-recognized cause of severe chronic diarrhea and weight loss. The FDA issued a black box warning in 2013 for olmesartan-related intestinal injury. Similar reactions have been reported more rarely with other ARBs, including valsartan, telmisartan, irbesartan, and losartan.<br /><br />The authors emphasize that OIE is difficult to diagnose because it mimics celiac disease both clinically and histologically. Proposed mechanisms include a delayed immune-mediated injury, possibly involving HLA-DQ2/DQ8 predisposition and intestinal dysbiosis. The case underscores the importance of considering olmesartan as a cause of unexplained chronic diarrhea and villous atrophy, especially when celiac testing is negative.

Asset Subtitle

Mohammed O. Choudary

Meta Tag

Author List Martin Banks, Misbah Safdar, Mohammed O. Choudary, Sad F. Alquadan, Samantha Ginder

Category Clinical Vignettes

Concept Olmesartan

Concept Sprue-like Enteropathy

Concept Chronic Diarrhea

Concept Villous Blunting

Concept Discontinuation

Distinguished Non-Finalist

Presenter Organization Bayhealth Medical Center

Presenting Author Mohammed O. Choudary

Track Adult

Keywords

olmesartan

angiotensin receptor blocker

enteropathy

chronic diarrhea

villous atrophy

celiac disease mimic

budesonide

abdominal pain

crypt apoptosis

FDA black box warning

Olmesartan

Sprue-like Enteropathy

Chronic Diarrhea

Villous Blunting

Discontinuation