Sprue-Like Enteropathy Associated with Olmesartan: An Unrecognized Emerging Drug-Induced Enteropathy?

Dear Editors,

We read with great interest the case reports by da Silva et al., Carneiro et al. and Eusébio et al. published in the late issue of GE Portuguese Journal of Gastroenterology.

We would like to emphasize the clinical relevance of this topic regarding its, until recently, unrecognized features and share our small case-series experience (Table 1).

Table 1

Clinical features of two cases of sprue-like enteropathy associated with olmesartan. F, Female; hypoK, hipokalemia; hypoAlb, hypoalbuminemia; hypoMg, hypomagnesemia.

Sex	Age	Time of diagnosis	Clinical presentation	Duration of symptoms	Laboratorial findings	Response to eviction of olmesartan	Time of follow-up endoscopy/histology	Resolution of histological changes
F	72	2014	Chronic diarrhea; abdominal discomfort	6 months	Normocytic anemia; hypoK; hypoAlb	Clinical remission	3 months	Yes
F	52	2015	Chronic diarrhea	4 months	Electrolyte abnormalities (severe hypoK and hypoMg)	Clinical remission	6 months	Yes

Curiously, in both cases symptoms developed long (fourteen and ten months, respectively) after starting therapy. This has rarely been addressed and may difficult the diagnosis.

The primary care physicians were informed and advised to switch class of medication in these cases. There were no recurrences of symptoms during follow-up.