Maria Esteve1, Rocío Temiño2, Anna Carrasco3, Lissette Batista2, Adolfo Del Val4, Michel Blé4, Santos Santaolaria5, Javier Molina-Infante6, Germán Soriano7, Sandra Agudo8, Yamile Zabana3, Xavier Andújar3, Montserrat Aceituno3, Josepa Ribes9, Rosa Madridejos10, Fernando Fernández-Bañares3. 1. Department of Gastroenterology, Hospital Universitari Mutua Terrassa, Universitat de Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Catalonia, Spain. Electronic address: mestevecomas@telefonica.net. 2. Department of Gastroenterology, Hospital Universitari Mutua Terrassa, Universitat de Barcelona, Catalonia, Spain. 3. Department of Gastroenterology, Hospital Universitari Mutua Terrassa, Universitat de Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Catalonia, Spain. 4. Department of Gastroenterology, Hospital Universitari i Politècnic La Fe, Valencia, Spain. 5. Department of Gastroenterology, Hospital San Jorge, Huesca, Spain. 6. Department of Gastroenterology, Hospital San Pedro de Alcántara, Cáceres, Spain. 7. Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Catalonia, Spain. 8. Department of Gastroenterology, Fundación Hospital Alcorcón, Madrid, Spain. 9. Cancer Plan of the Catalan Government, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Catalonia, Spain; Cancer Epidemiology, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain. 10. Department of Pharmacy, Hospital Universitari Mutua Terrassa, Universitat de Barcelona, Barcelona, Catalonia, Spain.
Abstract
AIMS: (1) Assess the population-based incidence of severe olmesartan-associated enteropathy. (2) To describe patients of the Spanish registry. (3) Evaluate markers of potential coeliac disease and associated autoimmunity. METHODS: Crude incidence rates in the area of Terrassa (Catalonia) were calculated. Clinical characteristics of patients in the Spanish registry were collected. Duodenal lymphocyte subpopulations and anti-TG2 IgA deposits were assessed in a subset of patients. RESULTS: Annual incidence rates (2011-2014) ranged from 0 to 22 cases per 10(4) treated patients. Twenty patients were included in the Spanish registry. Nineteen (95%) exhibited villous atrophy and 16 (80%) had severe enteropathy. Lupus-like disease occurred during olmesartan treatment in 3 patients. HLA-DQ2/DQ8 was positive in 64%. Markers of potential coeliac disease were present in 4 out of 8 patients (positive anti-TG2 deposits and/or increased CD3+gammadelta+ intraepithelial lymphocytes and reduced CD3-). Histopathological changes and clinical manifestations including autoimmune disorders improved after olmesartan discontinuation but not after gluten-free diet, irrespective of the presence or absence of coeliac markers. CONCLUSIONS: Incidence of severe olmesartan-associated enteropathy was low. Autoimmune phenomena were present in a subset of cases and reversed after olmesartan removal. A genetic coeliac disease background and the presence of potential coeliac markers might uncover predisposing factors.
AIMS: (1) Assess the population-based incidence of severe olmesartan-associated enteropathy. (2) To describe patients of the Spanish registry. (3) Evaluate markers of potential coeliac disease and associated autoimmunity. METHODS: Crude incidence rates in the area of Terrassa (Catalonia) were calculated. Clinical characteristics of patients in the Spanish registry were collected. Duodenal lymphocyte subpopulations and anti-TG2 IgA deposits were assessed in a subset of patients. RESULTS: Annual incidence rates (2011-2014) ranged from 0 to 22 cases per 10(4) treated patients. Twenty patients were included in the Spanish registry. Nineteen (95%) exhibited villous atrophy and 16 (80%) had severe enteropathy. Lupus-like disease occurred during olmesartan treatment in 3 patients. HLA-DQ2/DQ8 was positive in 64%. Markers of potential coeliac disease were present in 4 out of 8 patients (positive anti-TG2 deposits and/or increased CD3+gammadelta+ intraepithelial lymphocytes and reduced CD3-). Histopathological changes and clinical manifestations including autoimmune disorders improved after olmesartan discontinuation but not after gluten-free diet, irrespective of the presence or absence of coeliac markers. CONCLUSIONS: Incidence of severe olmesartan-associated enteropathy was low. Autoimmune phenomena were present in a subset of cases and reversed after olmesartan removal. A genetic coeliac disease background and the presence of potential coeliac markers might uncover predisposing factors.
Authors: María Curieses Luengo; Eva Barreiro Alonso; Marta Izquierdo Romero; Francisco Javier Román Llorente Journal: Aten Primaria Date: 2017-01-21 Impact factor: 1.137
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