SHM Converge Scientific Abstract ePoster Gallery-Not a Sprue: Severe Diarrhea Caused by Olmesartan Enteropathy

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This case describes a 71-year-old man with abdominal pain, foul-smelling watery diarrhea, vomiting, and more than 20 pounds of weight loss over several months. He had a history of chronic ITP, CKD, SIBO, and hypertension, and was taking amlodipine-olmesartan among other medications. On presentation, he appeared cachectic and mildly tachycardic, with mild left upper quadrant tenderness but no peritoneal signs.<br /><br />Workup suggested a severe osmotic diarrhea: stool studies showed a high osmotic gap. Inflammatory testing was mildly elevated, and endoscopic evaluation revealed small bowel abnormalities. EGD with duodenal biopsy showed moderate acute and chronic duodenitis with surface erosion. Video capsule endoscopy demonstrated granularity, villous flattening throughout the small bowel, and distal mucosal denudation and fissuring, consistent with severe enteropathy.<br /><br />The case highlights olmesartan-associated enteropathy (OAE), a rare but important cause of chronic severe diarrhea and weight loss that occurs after long-term olmesartan use. Symptoms can include abdominal pain, bloating, diarrhea, nausea, and vomiting, and severe cases may require hospitalization, renal support, or nutritional supplementation. The exact mechanism is not fully understood, but it is thought to involve an immune-mediated reaction in the gastrointestinal tract.<br /><br />The key clinical lesson is to include medication-induced enteropathy in the differential diagnosis of unexplained chronic diarrhea and weight loss. Stopping olmesartan usually leads to rapid improvement, and steroids or other anti-inflammatory treatments may be added in severe cases. Recognizing OAE early can reduce morbidity and avoid unnecessary testing and prolonged hospitalization.

Asset Subtitle

Ann Marie Kumfer

Meta Tag

Author List Ann Marie Kumfer, Jessica Saganowich

Category Clinical Vignettes

Concept Severe Diarrhea

Concept Olmesartan

Concept Enteropathy

Concept Weight Loss

Concept Medication-Related Cause

Distinguished Non-Finalist

Presenter Organization University of North Carolina Hospital

Presenting Author Ann Marie Kumfer

Track Adult

Keywords

olmesartan-associated enteropathy

chronic diarrhea

weight loss

villous flattening

osmotic diarrhea

duodenitis

small bowel enteropathy

olmesartan

abdominal pain

medication-induced enteropathy

Severe Diarrhea

Olmesartan

Enteropathy

Weight Loss

Medication-Related Cause