E0735 - Angiotensin Receptor Blockers-Associated Lymphocytic Gastritis: A Case Series and Review of the Literature

Tuesday, October 25, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

Shailavi Jain, MD

University of California, Los Angeles, CA

Award: Presidential Poster Award

Shailavi Jain, MD¹, Stanley Yuan, MD¹, Neil Marya, MD², Wendy Ho, MD¹, Guy A. Weiss, MD³
¹University of California, Los Angeles, Los Angeles, CA; ²University of Massachusetts Memorial Medical Center, Worcester, MA; ³University of California Los Angeles, Los Angeles, CA

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.

Figure: Figure 1. Determination of the patient cohort with lymphocytic gastritis (LG) in the setting of angiotensin receptor blocker (ARB) use, with no other risk factors for LG, n= 4

Patient	Age (Years)	Gender	Race	Presenting Symptoms	Gastric Histology	Small Intestine Histology
Case 1	85	Female	Asian	Post-prandial abdominal pain and nausea, weight loss	LG with mild inflammation and focal intestinal metaplasia in antrum; LG with moderate inflammation in angularis; LG with moderate inflammation and multifocal intestinal metaplasia in body	None
Case 2	70	Female	White	Chronic nausea, vomiting and diarrhea, early satiety, significant weight loss	LG in antrum	Severe active duodenitis with complete villous atrophy; mild active inflammation and significant crypt dropout in jejunum
Case 3	71	Female	Asian	Unknown	LG in body and fundus; chronic antral and oxyntic gastritis	Increased intraepithelial lymphocytosis in the duodenal bulb
Case 4	57	Male	Asian	Chronic post-prandial abdominal pain and bloating	LG of antrum	Unremarkable

Table: Table 1. Demographic, clinical, and histologic characteristics of the patients with lymphocytic gastritis (LG) in the setting of angiotensin receptor blocker (ARB) use and no other associated risk factors for LG, n= 4

Disclosures:

Shailavi Jain indicated no relevant financial relationships.

Stanley Yuan indicated no relevant financial relationships.

Neil Marya: Boston Scientific – Consultant.

Wendy Ho indicated no relevant financial relationships.

Guy Weiss: EverlyHealth – Advisory Committee/Board Member.

Shailavi Jain, MD¹, Stanley Yuan, MD¹, Neil Marya, MD², Wendy Ho, MD¹, Guy A. Weiss, MD³. E0735 - Angiotensin Receptor Blockers-Associated Lymphocytic Gastritis: A Case Series and Review of the Literature, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.