title: Potential coeliac disease markers and autoimmunity in olmesartan induced enteropathy: A population-based study.
abstract: OBJECTIVE
  (1) Assess the population-based incidence of severe olmesartan-associated enteropathy. (2) To describe patients of the Spanish registry. (3) Evaluate markers of potential coeliac disease and associated autoimmunity.
  
  
  METHODS
  Crude incidence rates in the area of Terrassa (Catalonia) were calculated. Clinical characteristics of patients in the Spanish registry were collected. Duodenal lymphocyte subpopulations and anti-TG2 IgA deposits were assessed in a subset of patients.
  
  
  RESULTS
  Annual incidence rates (2011-2014) ranged from 0 to 22 cases per 10(4) treated patients. Twenty patients were included in the Spanish registry. Nineteen (95%) exhibited villous atrophy and 16 (80%) had severe enteropathy. Lupus-like disease occurred during olmesartan treatment in 3 patients. HLA-DQ2/DQ8 was positive in 64%. Markers of potential coeliac disease were present in 4 out of 8 patients (positive anti-TG2 deposits and/or increased CD3+gammadelta+ intraepithelial lymphocytes and reduced CD3-). Histopathological changes and clinical manifestations including autoimmune disorders improved after olmesartan discontinuation but not after gluten-free diet, irrespective of the presence or absence of coeliac markers.
  
  
  CONCLUSIONS
  Incidence of severe olmesartan-associated enteropathy was low. Autoimmune phenomena were present in a subset of cases and reversed after olmesartan removal. A genetic coeliac disease background and the presence of potential coeliac markers might uncover predisposing factors.
authors.affiliation: Department of Gastroenterology, Hospital Universitari Mutua Terrassa, Universitat de Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Catalonia, Spain. Electronic address: mestevecomas@telefonica.net.
authors.forename: Maria
authors.initials: M
authors.lastname: Esteve
authors.affiliation: Department of Gastroenterology, Hospital Universitari Mutua Terrassa, Universitat de Barcelona, Catalonia, Spain.
authors.forename: Rocío
authors.initials: R
authors.lastname: Temiño
authors.affiliation: Department of Gastroenterology, Hospital Universitari Mutua Terrassa, Universitat de Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Catalonia, Spain.
authors.forename: Anna
authors.initials: A
authors.lastname: Carrasco
authors.affiliation: Department of Gastroenterology, Hospital Universitari Mutua Terrassa, Universitat de Barcelona, Catalonia, Spain.
authors.forename: Lissette
authors.initials: L
authors.lastname: Batista
authors.affiliation: Department of Gastroenterology, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
authors.forename: Adolfo
authors.initials: A
authors.lastname: Del Val
authors.affiliation: Department of Gastroenterology, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
authors.forename: Michel
authors.initials: M
authors.lastname: Blé
authors.affiliation: Department of Gastroenterology, Hospital San Jorge, Huesca, Spain.
authors.forename: Santos
authors.initials: S
authors.lastname: Santaolaria
authors.affiliation: Department of Gastroenterology, Hospital San Pedro de Alcántara, Cáceres, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Molina-Infante
authors.affiliation: Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Catalonia, Spain.
authors.forename: Germán
authors.initials: G
authors.lastname: Soriano
authors.affiliation: Department of Gastroenterology, Fundación Hospital Alcorcón, Madrid, Spain.
authors.forename: Sandra
authors.initials: S
authors.lastname: Agudo
authors.affiliation: Department of Gastroenterology, Hospital Universitari Mutua Terrassa, Universitat de Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Catalonia, Spain.
authors.forename: Yamile
authors.initials: Y
authors.lastname: Zabana
authors.affiliation: Department of Gastroenterology, Hospital Universitari Mutua Terrassa, Universitat de Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Catalonia, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Andújar
authors.affiliation: Department of Gastroenterology, Hospital Universitari Mutua Terrassa, Universitat de Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Catalonia, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Aceituno
authors.affiliation: Cancer Plan of the Catalan Government, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Catalonia, Spain; Cancer Epidemiology, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain.
authors.forename: Josepa
authors.initials: J
authors.lastname: Ribes
authors.affiliation: Department of Pharmacy, Hospital Universitari Mutua Terrassa, Universitat de Barcelona, Barcelona, Catalonia, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Madridejos
authors.affiliation: Department of Gastroenterology, Hospital Universitari Mutua Terrassa, Universitat de Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Catalonia, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Fernández-Bañares
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000009:adverse effects*; D001323:Autoantibodies / Q000276:immunology*; D015415:Biomarkers; D002446:Celiac Disease / Q000235:genetics / Q000276:immunology; D004386:Duodenum / Q000276:immunology*; D004751:Enteritis / Q000139:chemically induced* / Q000235:genetics / Q000276:immunology; D005260:Female; D019204:GTP-Binding Proteins / Q000276:immunology*; D006683:HLA-DQ Antigens / Q000235:genetics; D006801:Humans; D007093:Imidazoles / Q000009:adverse effects*; D007070:Immunoglobulin A / Q000276:immunology*; D008214:Lymphocytes / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D013030:Spain; D013777:Tetrazoles / Q000009:adverse effects*; D011503:Transglutaminases / Q000276:immunology*
chemical_list: D000959:Antihypertensive Agents; D001323:Autoantibodies; D015415:Biomarkers; D006683:HLA-DQ Antigens; C053186:HLA-DQ2 antigen; C109756:HLA-DQ8 antigen; D007093:Imidazoles; D007070:Immunoglobulin A; D013777:Tetrazoles; C437965:olmesartan; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins
keywords: Anti-TG2 IgA deposits; Lupus-like disease; Lymphocyte subpopulations; Sprue-like