Introduction: Lymphocytic gastritis (LG) has traditionally been associated with celiac disease (CeD), H. pylori, varioliform gastritis, common variable immunodeficiency, Crohn's disease, and human immunodeficiency virus, and less frequently with gastric lymphoma, esophageal carcinoma, gluten ingestion, and inflammatory polyps. However, there has been evidence associating chronic angiotensin receptor blocker (ARB) use (including olmesartan and valsartan) with about ten cases of LG. Patients with ARB- associated LG presented with chronic epigastric pain, nausea, early satiety, and weight loss, with pathology showing gastric intraepithelial lymphocytosis (at times with associated duodenal lymphocytosis). Patients experienced resolution of symptoms and LG after cessation of the ARB. Our case series aimed to further expand upon what is known about the prevalence and presentation of ARB-associated LG.
Case Description/Methods: The case series was performed in a large academic health system where 149 adult patients were found to have LG on endoscopic pathology from 2007-2020. We performed a retrospective chart review on these patients and found that 6/149 (4.0%) patients had been on an ARB (valsartan, olmesartan, or losartan). Of those, 2/6 had seronegative CeD. The remaining 4 patients (2.7%) did not have any of the abovementioned LG-associated comorbidities. These four patients were diagnosed with ARB-associated LG (Figure 1). The mean age of these patients was 70.8 years, 75% were Asian, and 75% were female (Table 1). They presented with symptoms including post-prandial abdominal pain, bloating, nausea, vomiting, diarrhea, anorexia, and weight loss. Their gastroduodenal biopsies were negative for CeD, Crohn’s disease, inflammatory polyps, malignancy, and H. pylori. Interestingly, one patient had LG with associated duodenal lymphocytosis, while another had the more commonly described ARB-induced sprue-like enteropathy.
Discussion: Based on the findings of this literature review and case series, following exclusion of the common causes of LG, physicians should consider ARB-associated LG, especially in elderly females from Asian descent. Increased awareness of this rare disease process could significantly improve the health outcomes of affected individuals.
