Olmesartan induced gastritis and enteropathy

Excerpt

A 62-year-old lady complained of recurrent vomiting, bloating and watery diarrhea for one month. It was accompanied with about 9 kg (> 10%) of weight loss and mild iron deficiency anemia. There was no blood or mucous in the stools. Therefore, evaluation was done for small bowel diarrhea. Stool routine examination was normal and opportunistic organisms were not detected. Human immunodeficiency virus assay was negative. For the past three years, she was being treated with Olmesartan and Cilnidipine for hypertension. Tissue transglutaminase antibody and immunoglobulin A (IgA) were within normal limits. An upper gastrointestinal endoscopy showed hyperemia in the stomach and scalloping of duodenal folds (Fig. 1). Gastric biopsy showed inflammation and corkscrew glands suggestive of chemical injury (Fig. 2a). Duodenal biopsy showed marked villous atrophy with increased intraepithelial lymphocytes (IEL) (Fig. 2b). Olmesartan was stopped and her symptoms improved over the next few days. A diagnosis of Olmesartan induced gastritis and enteropathy was therefore made. On follow-up, her weight and anemia improved. She continues to do well on follow-up of more than a year from the diagnosis.

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