Sprue-Like Enteropathy Associated With Olmesartan: A New Kid on the Enteropathy Block

Sprue-like enteropathy associated with olmesartan, first identified by our group in 2012,1 is characterized by chronic diarrhea (often severe) and weight loss that is unresponsive to a gluten-free diet. Laboratory work-up commonly reveals non-specific anemia, hypoalbuminemia, electrolyte imbalance, and vitamin deficiencies, consistent with a severe malabsorption process. Histopathological findings include a combination of duodenal villous atrophy, increased intraepithelial lymphocytes, and a thickened subepithelial collagen layer (collagenous sprue). Histologic changes can be limited to the small bowel, or may include the entire gastrointestinal tract, with findings such as lymphocytic/collagenous gastritis and colitis. Individuals with sprue-like enteropathy associated with olmesartan have negative celiac serology. The majority may have either HLA-DQ2 or DQ8 haplotypes (61--81%).1 Diagnosis of olmesartan associated enteropathy should therefore be considered in cases of villous atrophy with negative celiac serology (so-called seronegative villous atrophy). Confirmation of diagnosis requires clinical resolution of symptoms after olmesartan withdrawal. Mucosal recovery is also expected within 3--6 months of olmesartan withdrawal and a follow-up duodenal biopsy is reasonable.