title: Olmesartan, other antihypertensives, and chronic diarrhea among patients undergoing endoscopic procedures: a case-control study.
abstract: OBJECTIVE
  To investigate a recent association between the use of the angiotensin receptor-blocker (ARB) olmesartan and a severe enteropathy resembling celiac disease.
  
  
  METHODS
  We searched our endoscopy database for all outpatient esophagogastroduodenoscopy (EGD) or colonoscopy examinations in patients aged at least 50 years during the period January 1, 2007, to March 31, 2013. Cases were those whose examination indication was diarrhea, and controls were those whose examination indication was esophageal reflux (EGD) or colorectal cancer screening (colonoscopy). We compared cases with controls with regard to the proportion of those listing olmesartan among their medications. Secondary exposures were the proportion of those taking nonolmesartan ARBs or other antihypertensive medications. We also examined biopsy results to determine whether there were histologic changes associated with the use of olmesartan.
  
  
  RESULTS
  We identified 2088 patients undergoing EGD and 12,428 patients undergoing colonoscopy meeting inclusion criteria. On multivariate analysis, there was no statistically significant association between olmesartan and diarrhea among those undergoing EGD (odds ratio, 1.99; 95% CI, 0.79-5.00) or colonoscopy (odds ratio, 0.63; 95% CI, 0.23-1.74). Review of pathology reports of the EGD and colonoscopy groups showed no association between the use of olmesartan and the histologic diagnosis of celiac disease (P=.61) or microscopic colitis (P=1.0), respectively.
  
  
  CONCLUSIONS
  Our findings suggest that neither olmesartan nor other ARBs were associated with diarrhea among patients undergoing endoscopy. The spruelike enteropathy recently associated with olmesartan is likely a rare adverse effect and milder presentations are unlikely.
authors.affiliation: Department of Medicine, Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, NY.
authors.forename: Ruby
authors.initials: R
authors.lastname: Greywoode
authors.affiliation: Department of Medicine, Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, NY.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Braunstein
authors.affiliation: Department of Medicine, Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, NY.
authors.forename: Carolina
authors.initials: C
authors.lastname: Arguelles-Grande
authors.affiliation: Department of Medicine, Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, NY.
authors.forename: Peter H R
authors.initials: PH
authors.lastname: Green
authors.affiliation: Department of Medicine, Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Electronic address: BL114@columbia.edu.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Lebwohl
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects*; D000959:Antihypertensive Agents / Q000009:adverse effects*; D016022:Case-Control Studies; D003113:Colonoscopy / Q000706:statistics & numerical data; D003967:Diarrhea / Q000139:chemically induced* / Q000209:etiology; D016145:Endoscopy, Digestive System / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007093:Imidazoles / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D013777:Tetrazoles / Q000009:adverse effects*
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000959:Antihypertensive Agents; D007093:Imidazoles; D013777:Tetrazoles; C437965:olmesartan