title: Gastrointestinal Disorder Associated with Olmesartan Mimics Autoimmune Enteropathy.
abstract: OBJECTIVE
  Anti-hypertensive treatment with the angiotensin II receptor antagonist olmesartan is a rare cause of severe Sprue-like enteropathy. To substantiate the hypothesis that olmesartan interferes with gut immune homeostasis, clinical, histopathological and immune features were compared in olmesartan-induced-enteropathy (OIE) and in autoimmune enteropathy (AIE).
  
  
  METHODS
  Medical files of seven patients with OIE and 4 patients with AIE enrolled during the same period were retrospectively reviewed. Intestinal biopsies were collected for central histopathological review, T cell Receptor clonality and flow cytometric analysis of isolated intestinal lymphocytes.
  
  
  RESULTS
  Among seven olmesartan-treated patients who developed villous atrophy refractory to a gluten free diet, three had extra-intestinal autoimmune diseases, two had antibodies reacting with the 75 kilodalton antigen characteristic of AIE and one had serum anti-goblet cell antibodies. Small intestinal lesions and signs of intestinal lymphocyte activation were thus reminiscent of the four cases of AIE diagnosed during the same period. Before olmesartan discontinuation, remission was induced in all patients (7/7) by immunosuppressive drugs. After interruption of both olmesartan and immunosuppressive drugs in six patients, remission was maintained in 4 but anti-TNF-α therapy was needed in two.
  
  
  CONCLUSIONS
  This case-series shows that olmesartan can induce intestinal damage mimicking AIE. OIE usually resolved after olmesartan interruption but immunosuppressive drugs may be necessary to achieve remission. Our data sustain the hypothesis that olmesartan interferes with intestinal immuno regulation in predisposed individuals.
authors.affiliation: Université Paris Descartes-Sorbonne Paris Centre, Paris, France; Gastroenterology department, Hôpital Européen Georges Pompidou APHP, Paris, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Scialom
authors.affiliation: Université Paris Descartes-Sorbonne Paris Centre, Paris, France; Gastroenterology department, Hôpital Européen Georges Pompidou APHP, Paris, France; Laboratory of Intestinal Immunology, Inserm UMR 1163 and Institute Imagine, Paris, France.
authors.forename: Georgia
authors.initials: G
authors.lastname: Malamut
authors.affiliation: Université Paris Descartes-Sorbonne Paris Centre, Paris, France; Laboratory of Intestinal Immunology, Inserm UMR 1163 and Institute Imagine, Paris, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Meresse
authors.affiliation: Université Paris Descartes-Sorbonne Paris Centre, Paris, France; Laboratory of Intestinal Immunology, Inserm UMR 1163 and Institute Imagine, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Guegan
authors.affiliation: Université Paris Descartes-Sorbonne Paris Centre, Paris, France; Pathology department, Hôpital Necker Enfants Malades APHP, Paris, France.
authors.forename: Nicole
authors.initials: N
authors.lastname: Brousse
authors.affiliation: Université Paris Descartes-Sorbonne Paris Centre, Paris, France; Pathology department, Hôpital Necker Enfants Malades APHP, Paris, France.
authors.forename: Virginie
authors.initials: V
authors.lastname: Verkarre
authors.affiliation: Université Paris Descartes-Sorbonne Paris Centre, Paris, France; Biological Hematology, Hôpital Necker Enfants Malades APHP, Paris, France.
authors.forename: Coralie
authors.initials: C
authors.lastname: Derrieux
authors.affiliation: Université Paris Descartes-Sorbonne Paris Centre, Paris, France; Biological Hematology, Hôpital Necker Enfants Malades APHP, Paris, France.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Macintyre
authors.affiliation: Gastroenterology department, Hôpital Saint Antoine APHP, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Seksik
authors.affiliation: Gastroenterology, CHU Rouen, Rouen, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Savoye
authors.affiliation: Gastroenterology department, CHU Reims, Reims, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Cadiot
authors.affiliation: Gastroenterology department, CHRU Besançon, Besançon, France.
authors.forename: Lucine
authors.initials: L
authors.lastname: Vuitton
authors.affiliation: Gastroenterology department Hôpital Bicêtre APHP, Paris, France.
authors.forename: Lysiane
authors.initials: L
authors.lastname: Marthey
authors.affiliation: Gastroenterology department Hôpital Bicêtre APHP, Paris, France.
authors.forename: Franck
authors.initials: F
authors.lastname: Carbonnel
authors.affiliation: Université Paris Descartes-Sorbonne Paris Centre, Paris, France; Laboratory of Intestinal Immunology, Inserm UMR 1163 and Institute Imagine, Paris, France.
authors.forename: Nadine
authors.initials: N
authors.lastname: Cerf-Bensussan
authors.affiliation: Université Paris Descartes-Sorbonne Paris Centre, Paris, France; Gastroenterology department, Hôpital Européen Georges Pompidou APHP, Paris, France; Laboratory of Intestinal Immunology, Inserm UMR 1163 and Institute Imagine, Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Cellier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects*; D003937:Diagnosis, Differential; D005260:Female; D005767:Gastrointestinal Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D007093:Imidazoles / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016884:Polyendocrinopathies, Autoimmune / Q000175:diagnosis* / Q000473:pathology; D013777:Tetrazoles / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D007093:Imidazoles; D013777:Tetrazoles; C437965:olmesartan