Potential coeliac disease markers and autoimmunity in olmesartan induced enteropathy: A population-based study

作者：Esteve Maria^*; Temino Rocio; Carrasco Anna; Batista Lissette; Del Val Adolfo; Ble Michel; Santaolaria Santos; Molina Infante Javier; Soriano German; Agudo Sandra; Zabana Yamile; Andujar Xavier; Aceituno Montserrat; Ribes Josepa; Madridejos Rosa; Fernandez Banares Fernando

来源：Digestive and Liver Disease, 2016, 48(2): 154-161.

DOI：10.1016/j.dld.2015.09.014

• Anti-TG2 IgA deposits
• Lupus-like disease
• Lymphocyte subpopulations
• Sprue like

Aims: (1) Assess the population-based incidence of severe olmesartan-associated enteropathy. (2) To describe patients of the Spanish registry. (3) Evaluate markers of potential coeliac disease and associated autoimmunity.
Methods: Crude incidence rates in the area of Terrassa (Catalonia) were calculated. Clinical characteristics of patients in the Spanish registry were collected. Duodenal lymphocyte subpopulations and anti-TG2 IgA deposits were assessed in a subset of patients.
Results: Annual incidence rates (2011-2014) ranged from 0 to 22 cases per 104 treated patients. Twenty patients were included in the Spanish registry. Nineteen (95%) exhibited villous atrophy and 16 (80%) had severe enteropathy. Lupus-like disease occurred during olmesartan treatment in 3 patients. HLA-DQ2/DQ8 was positive in 64%. Markers of potential coeliac disease were present in 4 out of 8 patients (positive anti-TG2 deposits and/or increased CD3+ gammadelta+ intraepithelial lymphocytes and reduced CD3-). Histopathological changes and clinical manifestations including autoimmune disorders improved after olmesartan discontinuation but not after gluten-free diet, irrespective of the presence or absence of coeliac markers.
Conclusions: Incidence of severe olmesartan-associated enteropathy was low. Autoimmune phenomena were present in a subset of cases and reversed after olmesartan removal. A genetic coeliac disease background and the presence of potential coeliac markers might uncover predisposing factors.

• 出版日期2016-2