Severe cases of sprue-like enteropathy associated with angiotensin receptor blockers other than olmesartan

Abstract

Background: Sprue-like enteropathy (SLE) has been reported in patients with arterial hypertension who are treated with the angiotensin receptor blocker (ARB) olmesartan. It is currently controversial whether this is a class effect or specific to olmesartan. Methods: A systematic literature search was conducted in Medline/PubMed, Embase, Web of Science and Scopus without language, publication year or publication status restrictions up to October 2019 to retrieve publications on SLE related to all ARBs excluding olmesartan. Results: Overall, 17 reports including a total of 21 patients describing SLE cases were identified with the following ARBs: candesartan (n = 1), eprosartan (n = 1), irbesartan (n = 4), losartan (n = 7), telmisartan (n = 4) and valsartan (n = 4). The treatment duration among these ARB-treated patients varied from 2 months to up to 13 years, while the onset of enteropathy-related symptoms ranged from 2 months to 10 years from treatment initiation. The most frequently reported SLE symptoms were as follows: chronic diarrhoea, abdominal symptoms, loss of appetite and weight loss (3-27 kg). Symptomatic treatment with antibiotics, corticosteroids and dietary modifications did not significantly improve the SLE symptoms in patients while on treatment with ARBs. However, diarrhoea resolved in all 21 patients after the withdrawal of ARBs and other gastrointestinal symptoms had resolved on follow-up in all but two patients. Conclusions: SLE is observed in patients treated with ARBs other than olmesartan. This suggests a class effect in the rare event of patients treated with ARBs developing SLE.