Celiac sprue nontropical sprue endemic sprue gluten enteropathy. Fda drug safety communication.
Sprue like enteropathy involves unexpected weight loss and severe diarrhea that can result in chronic gastrointestinal gi tract conditions including villous atrophy that can restrict the absorption of nutrients from consumed food.
Sprue like enteropathy wiki. Specific types of enteropathy include. Olmesartan sprue like enteropathy is an adverse drug reaction that mimics the appearance of celiac disease and is related to the use of olmesartan. The condition is similar to other diseases including celiac disease where the body becomes highly sensitive to gluten.
An incompletely defined syndrome of. Although enteritis specifically refers to an inflammation of the intestine and is thus a more specific term than enteropathy the two phrases are sometimes used interchangeably. It differs significantly from coeliac sprueit appears to be a more severe form of environmental enteropathy.
We present the case of a 71 year old female with severe enteropathy attributed to celiac disease for 5 years that improved only after valsartan. Enteropathy refers to any pathology of the intestine. Fda approves label changes to include intestinal problems sprue like enteropathy linked to blood pressure medicine olmesartan medoxomil.
Biopsy of small bowel showing coeliac disease manifested by blunting of villi crypt hypertrophy. An ester prodrug it is completely and rapidly hydrolyzed to its active acid form. Some have proposed that enteropathy may be a class effect rather than olmesartan specific.
Tropical sprue is a malabsorption disease commonly found in tropical regions marked with abnormal flattening of the villi and inflammation of the lining of the small intestine. Recent studies suggested this form of sprue like enteropathy could be caused by the inhibition of tgf b a polypeptide cytokine that maintains intestinal homeostasis. Olmesartan an angiotensin ii receptor blocker arb is associated with gastrointestinal symptoms resembling sprue like enteropathy.
In patients with drug induced enteropathy an upper endoscopy with small bowel biopsy may reveal sprue like histological features ranging from a mild alteration characterized only by increased intraepithelial lymphocytes to a flat mucosa with total mucosal atrophy complete loss of villi enhanced epithelial apoptosis and crypt hyperplasia. We performed a systematic review to identify literature of sprue like enteropathy for all arbs. Other intestinal disorders may have biopsy that look like coeliac disease including lesions caused by candida.
Over the past 5 years several case reports and cohort studies have been published that describe a sprue like enteropathy sle with abdominal pain chronic diarrhea and weight loss after taking angiotensin type 1 receptor blockers arb. However it is still unclear why this action was never observed with other arbs.