Olivia Man, MPH1, Jim Amerian, MD2, Wendy Ho, MD3, Guy A. Weiss, MD4 1David Geffen School of Medicine, Los Angeles, CA; 2United Gastroenterologists, Los Angeles, CA; 3University of California, Los Angeles, Los Angeles, CA; 4University of California Los Angeles, Los Angeles, CA
Introduction: Collagenous inflammation of the gut traditionally affects the colon, as part of microscopic colitis, and rarely the small bowel, as collagenous sprue. Angiotensin II receptor blocker (ARB) use has been implicated in sprue-like enteropathy. We present a rare case of olmesertan-associated pan-collagenous gastroenterocolitis.
Case Description/Methods: A 73-year-old man, with a history of tribenzor use (olmesartan-amlodipine-hydrochlorothiazide, 40 mg once a day for 5-10 years) for complicated hypertension and gastroesophageal reflux disease, developed severe diarrhea and weight loss. His work up included normal stool testing for parasitic and bacterial pathogens, normal pancreatic elastase, normal thyroid function test, normal celiac serology (tissue transglutaminase IgA, deaminated gliadin peptide IgA and IgG, and total IgA), and absent celiac genes (HLA-DQ2 and/or DQ8). He underwent pan-endoscopic evaluation showing a nodular gastric antrum and edematous duodenum with fissures and loss of folds, along with patchy nodularities of the right colon on colonoscopy. Histologic findings were consistent with subepithelial collagen thickening of his gastric antrum, duodenum, ileum, and right colon. He was diagnosed with malabsorption due to olmesartan-associated collagenous gastrointestinal (GI) disorders (CGID), and his symptoms resolved entirely following olmesartan discontinuation.
Discussion: Our case highlights the effects of olmesartan on the entire GI tract and is the first time patchy collagenous pan-gastroenterocolitis, or CGID, as we prefer to term it, has been associated with ARB use. Healthcare providers should suspect this entity even in patients who have been using ARBs for years.
Figure: Figure 1: Endoscopic images of the edematous duodenum with scalloping and loss of folds (A) and corresponding histologic findings of subepithelial collagen and villous blunting of the epithelium on trichrome stain x 100 (B).
Disclosures:
Olivia Man indicated no relevant financial relationships.
Jim Amerian indicated no relevant financial relationships.
Wendy Ho indicated no relevant financial relationships.
Guy Weiss: EverlyHealth – Advisory Committee/Board Member.
Olivia Man, MPH1, Jim Amerian, MD2, Wendy Ho, MD3, Guy A. Weiss, MD4. A0661 - Olmesartan-associated Collagenous Gastrointestinal Disorders: Case Report and Review of the Literature, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.
