SHM Converge Scientific Abstract ePoster Gallery-Olmesartan

Pdf Summary

This case describes a 70-year-old man with chronic profuse watery diarrhea and 40-pound weight loss that persisted despite treatment for presumed pancreatic insufficiency. His extensive workup was initially unrevealing, and endoscopy appeared grossly normal. However, duodenal biopsy showed crypt abscesses, increased intraepithelial lymphocytes, and complete villous atrophy, consistent with sprue-like enteropathy. Celiac serologies and anti-enterocyte antibodies were negative, supporting the diagnosis of olmesartan-associated enteropathy (OAE).<br /><br />OAE is a rare but important adverse effect of olmesartan, an angiotensin II receptor blocker used for hypertension. Symptoms may include non-bloody diarrhea, abdominal pain, vomiting, and severe weight loss, often appearing months to years after starting the medication. Because the endoscopic appearance can be normal, diagnosis is frequently delayed unless biopsies are obtained.<br /><br />In this patient, olmesartan was discontinued and he received a prolonged steroid taper, leading to complete symptom resolution and early weight regain. The case highlights the need for clinicians to consider OAE in patients with unexplained chronic diarrhea and weight loss, especially when celiac testing is negative. Early recognition and stopping olmesartan can prevent ongoing intestinal injury and avoid unnecessary diagnostic testing.

Asset Subtitle

Angela Xue

Meta Tag

Author List Angela Xue, Emily Sturkie, Evan Raff, Jan Silverman, Mark Fowler

Category Clinical Vignettes

Concept Olmesartan-Induced Enteropathy

Concept Chronic Diarrhea

Concept Sprue-like Enteropathy

Concept Villous Blunting

Concept Duodenal Biopsy

Distinguished Non-Finalist

Presenter Organization University of North Carolina School of Medicine, Chapel Hill

Presenting Author Angela Xue

Track Adult

Keywords

olmesartan-associated enteropathy

chronic diarrhea

weight loss

sprue-like enteropathy

villous atrophy

duodenal biopsy

intraepithelial lymphocytes

crypt abscesses

negative celiac serology

angioiotensin II receptor blocker

Olmesartan-Induced Enteropathy

Chronic Diarrhea

Sprue-like Enteropathy

Villous Blunting

Duodenal Biopsy