P3218 - Olmesartan's Hidden Side: Unveiling an Uncommon Cause of Chronic Diarrhea

Rebecca N. Dudley, BS¹, Olga Vitorsky, DO^2
1Edward Via College of Osteopathic medicine, Spartanburg, SC; ²VCOM and Gastroenterology Associates, Greenville, SC

Introduction: A common cause of chronic diarrhea is irritable bowel syndrome with diarrhea (IBS-D); however, other diagnoses, such as enteropathy, should be considered when the patient has additional concerning symptoms such as significant weight loss. One cause of enteropathy is drug-induced enteropathy, and olmesartan, an angiotensin receptor blocker (ARB), has been implicated in this condition. Olmesartan-induced enteropathy (OSE) was first discovered in 2012 and has since become categorized as an adverse effect of the medication.

Case Description/Methods: We report a case of OSE in an 85-year-old woman who had been on Olmesartan for several months. The patient had a recent history of a clostridioides difficile (C. diff) infection; however, despite antibiotic treatment, she continued to have intermittent diarrhea with associated abdominal discomfort and 30 lb weight loss. The onset of her weight loss predated the episode of C. diff by four months. The continued evaluation of the patient led to an esophagogastroduodenoscopy (EGD) with duodenal biopsy which revealed duodenal intraepithelial lymphocytosis concerning OSE. The patient was instructed to stop her olmesartan, which led to the resolution of her symptoms.

Discussion: OSE is a rare adverse effect seen in less than 0.05% of olmesartan users. The condition presents with symptoms of chronic diarrhea and weight loss, negative celiac serology studies, and resembles celiac sprue histologically. While the exact mechanism of the condition remains unknown, it has been postulated to be either a delayed type IV hypersensitivity reaction or a cell-mediated immune response related to TGF-beta. Recent studies have explored the possibility of a class effect due to reports of other ARBs causing a similar sprue-like enteropathy.


Disclosures:


Rebecca N. Dudley, BS¹, Olga Vitorsky, DO². P3218 - Olmesartan's Hidden Side: Unveiling an Uncommon Cause of Chronic Diarrhea, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.