title: Sprue-like histology in patients with abdominal pain taking olmesartan compared with other angiotensin receptor blockers.
abstract: OBJECTIVE
  A severe syndrome characterised by life-threatening diarrhoea and severe sprue-like histology has been described in patients taking the angiotensin receptor blocker (ARB) olmesartan. It is unknown whether there are any histopathological changes in patients without severe diarrhoea exposed to this medication. It is also unknown whether other ARBs cause sprue-like histology.
  
  
  METHODS
  Retrospective cohort study of patients with abdominal pain undergoing upper gastrointestinal endoscopy with duodenal biopsy who were taking ARBs. Patients taking olmesartan (n=20) and a non-olmesartan ARB (n=20) were compared with age and sex-matched controls. Histological features (classic sprue-like and other inflammatory changes) were analysed.
  
  
  RESULTS
  No single histopathological finding was significantly more common in olmesartan-using patients than controls. However, 10 of 20 olmesartan patients had one or more sprue-like histological features compared with 4 of 20 age-matched and sex-matched controls not taking ARBs (p=0.10). Patients taking ARBs other than olmesartan were not more likely than controls to have one or more of these sprue-like histological features (9/20 vs. 12/20, p=0.34).
  
  
  CONCLUSIONS
  There were no statistically significant differences between olmesartan users with abdominal pain and controls for any single histopathological abnormality. However, there were trends towards significance for individual abnormalities as well as for a composite outcome of sprue-like changes. This raises the possibility that there is a spectrum of histological changes associated with olmesartan use.
authors.affiliation: Department of Pathology and Cell Biology, Columbia University and New York Presbyterian Hospital, New York, New York, USA.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Lagana
authors.affiliation: Department of Medicine, Celiac Disease Center, Columbia University Medical Center, New York, New York, USA.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Braunstein
authors.affiliation: Department of Medicine, Celiac Disease Center, Columbia University Medical Center, New York, New York, USA.
authors.forename: Carolina
authors.initials: C
authors.lastname: Arguelles-Grande
authors.affiliation: Department of Pathology and Cell Biology, Columbia University and New York Presbyterian Hospital, New York, New York, USA.
authors.forename: Govind
authors.initials: G
authors.lastname: Bhagat
authors.affiliation: Department of Medicine, Celiac Disease Center, Columbia University Medical Center, New York, New York, USA.
authors.forename: Peter H R
authors.initials: PH
authors.lastname: Green
authors.affiliation: Department of Medicine, Celiac Disease Center, Columbia University Medical Center, New York, New York, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Lebwohl
mesh_terms: D015746:Abdominal Pain / Q000139:chemically induced* / Q000453:epidemiology; D000328:Adult; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects*; D002446:Celiac Disease / Q000139:chemically induced* / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007093:Imidazoles / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013777:Tetrazoles / Q000009:adverse effects*
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D007093:Imidazoles; D013777:Tetrazoles; C437965:olmesartan
keywords: GASTROINTESTINAL DISEASE; GUT PATHOLOGY; INFLAMMATION; SMALL INTESTINE