A243 AN UNCONVENTIONAL CASE OF OLMESARTAN ASSOCIATED ENTEROPATHY
Notice bibliographique
Résumé
While chronic diarrhea is costly, drug-induced enteropathy is a treatable etiology if identified. Olmesartan has been reported to cause chronic diarrhea since 2012. There are approximately 200 cases reports/series linking Olmesartan with observed villous atrophy on duodenal biopsies. It is essential to recognize that OAE is a differential diagnosis in cases of refectory celiac disease and it’s severity ranges through a spectrum of clinical and histolpatholigcal findings. In our report, we identify a case of OAE based on clinical symptom with preserved villous architecture on small bowel biopsy. - To report a clinical case of OAE with preserved villous architecture on duodenal biopsy and modestly elevated serologic markers of Celiac Sprue. - To increase awareness among clinician of OAE; a new missed differential of sprue-like enteropathy. We present a clinical case of chronic worsening severe diarrhea encountered in gastrointestinal outpatient clinic followed up from January 2017 to September 2017. A 62- years-old female patient known for hypertension and Irritable Bowel Syndrome-D for 8 years presented in late 2016 with worsening persistent diarrhea. Work up including colonoscopy with biopsies and MRI Enterography was negative. Serologically, carcinoid and infectious etiology were also negative. However, transglutaminase antibody (IgA TTG) levels were modestly elevated (45U/ml - April 2017 then 19 U/ml- May 2017, N < 9U/ml). An earlier IgA TTG was negative in 2010. On the contrary, small bowel biopsies exhibited preservation of villous architecture with increased CD3+ intraepithelial lymphocyte (MARSH 1A). Therapeutic trials including gluten free diet (GFD) for 3 weeks, antibiotics, and corticosteroids failed. Supportive medications loperamide had modest benefit. Finally, on review of medication, patient was noted to be on Olmitec R (Olmesartan), and soon upon the cessation of the medication, patient reported improved bowel habits. Drug-induced enteropathy is a frequently missed differential for chronic diarrhea. Almost all previously reported cases depicted histological evidence of villous atrophy along with mucosal inflammation with recovery upon cessation of Olmesartan or other offending ARBs. Our case report has identified OAE presenting as celiac mimicker but without clinical response to GFD. OAE can be a difficult entity to diagnose in the setting of equivocal histological findings. Olmesartan can inflict a spectrum of intestinal injury ranging from mild lymphocyte infiltration to severe villous atrophy. Clinical judgment and careful medication review should be applied to distinguish celiac from drug-associated enteropathy. None
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».