Background:Olmesartan,an angiotensin Ⅱ receptor blocker(ARB),is associated with gastrointestinal symptoms resembling sprue-like enteropathy.Some have proposed that enteropathy may be a class effect rather than olmesa...Background:Olmesartan,an angiotensin Ⅱ receptor blocker(ARB),is associated with gastrointestinal symptoms resembling sprue-like enteropathy.Some have proposed that enteropathy may be a class effect rather than olmesartan-specific.We performed a systematic review to identify literature of sprue-like enteropathy for all ARBs.Methods:Case reports,case series and comparative studies of ARBs were searched on PubMed and Embase databases through 21 November 2018 and then assessed.Results:A total of 82 case reports and case series as well as 5 comparative studies,including 248 cases,were selected and analysed.The ARBs listed in the case reports were olmesartan(233 users;94.0%),telmisartan(5 users;2.0%),irbesartan(4 users;1.6%),valsartan(3 users;1.2%),losartan(2 users;0.8%)and eprosartan(1 user;0.4%).The periods between ARB initiation and onset of symptoms ranged from 2 weeks to 13 years.Histologic results were reported in 218 cases,in which 201 cases(92.2%)were villous atrophy and 131 cases(60.1%)were intraepithelial lymphocytosis.Human leucocyte antigen(HLA)testing was performed in 147 patients,among whom 105(71.4%)had HLA-DQ2 or HLA-DQ8 haplotypes.Celiacassociated antibodies were tested in 169 patients,among whom 167(98.8%)showed negative results.Gluten exclusion from the diet failed to relieve symptoms of enteropathy in 127(97.7%)of 130 patients with information.Complete remission of symptoms after discontinuation of ARB was reported in 233(97.4%)of the 239 patients with information.Seven cases(2.8%)reported recurrence of symptoms after restarting olmesartan;rechallenge was not reported for the non-olmesartan ARBs.The retrospective studies conducted worldwide had inconsistent study designs(e.g.differences in periods of study and case definition)and findings.Conclusions:Although enteropathy is rare,clinicians should remain vigilant of this potential adverse event even years after medication initiation.展开更多
文摘Background:Olmesartan,an angiotensin Ⅱ receptor blocker(ARB),is associated with gastrointestinal symptoms resembling sprue-like enteropathy.Some have proposed that enteropathy may be a class effect rather than olmesartan-specific.We performed a systematic review to identify literature of sprue-like enteropathy for all ARBs.Methods:Case reports,case series and comparative studies of ARBs were searched on PubMed and Embase databases through 21 November 2018 and then assessed.Results:A total of 82 case reports and case series as well as 5 comparative studies,including 248 cases,were selected and analysed.The ARBs listed in the case reports were olmesartan(233 users;94.0%),telmisartan(5 users;2.0%),irbesartan(4 users;1.6%),valsartan(3 users;1.2%),losartan(2 users;0.8%)and eprosartan(1 user;0.4%).The periods between ARB initiation and onset of symptoms ranged from 2 weeks to 13 years.Histologic results were reported in 218 cases,in which 201 cases(92.2%)were villous atrophy and 131 cases(60.1%)were intraepithelial lymphocytosis.Human leucocyte antigen(HLA)testing was performed in 147 patients,among whom 105(71.4%)had HLA-DQ2 or HLA-DQ8 haplotypes.Celiacassociated antibodies were tested in 169 patients,among whom 167(98.8%)showed negative results.Gluten exclusion from the diet failed to relieve symptoms of enteropathy in 127(97.7%)of 130 patients with information.Complete remission of symptoms after discontinuation of ARB was reported in 233(97.4%)of the 239 patients with information.Seven cases(2.8%)reported recurrence of symptoms after restarting olmesartan;rechallenge was not reported for the non-olmesartan ARBs.The retrospective studies conducted worldwide had inconsistent study designs(e.g.differences in periods of study and case definition)and findings.Conclusions:Although enteropathy is rare,clinicians should remain vigilant of this potential adverse event even years after medication initiation.
