Abstract：
Although enteropathy due to angiotensin II receptor blockers (ARBs) has been known for over 10 years, clinicians\' awareness of this condition is still low.
To systematically review the literature about clinical phenotypes, distribution of mucosal changes throughout the gastrointestinal tract and prognosis of enteropathy due to ARBs.
According to PRISMA guidelines, we searched PubMed and Embase for relevant articles up to November 6, 2023. We included full-text papers, letters, case reports and case series describing enteropathy due to ARBs. Patients were classified into subgroups based on endoscopic and histological findings of different regions of the gastrointestinal tract. The protocol was registered with Open Science Framework (https://doi.org/10.17605/OSF.IO/TK67C).
We included 94 articles reporting 183 cases (101 female, mean age at diagnosis 69 ± 10 years). The clinical picture at diagnosis was characterised by severe diarrhoea (97%) and weight loss (84%, median -13 kg), leading to hospital admission in 167 (95%) patients. Olmesartan (90%) was most frequently implicated. Villous atrophy (VA) was reported in 164/183 (89%) patients. One hundred and nine had only VA, 12 had pan-gastrointestinal involvement, 23 had VA and gastric involvement and 19 had VA and colon involvement (predominantly microscopic colitis). Outcomes were reported for 178/183 (97%) patients, who all recovered clinically on ARBs withdrawal. Histological recovery occurred in all 96 patients with VA at baseline who underwent follow-up duodenal biopsy.
Enteropathy due to ARBs is characterised by severe malabsorption often requiring hospital admission and can involve the entire gastrointestinal tract. Clinician awareness can lead to prompt diagnosis and excellent prognosis.
To systematically review the literature about clinical phenotypes, distribution of mucosal changes throughout the gastrointestinal tract and prognosis of enteropathy due to ARBs.
According to PRISMA guidelines, we searched PubMed and Embase for relevant articles up to November 6, 2023. We included full-text papers, letters, case reports and case series describing enteropathy due to ARBs. Patients were classified into subgroups based on endoscopic and histological findings of different regions of the gastrointestinal tract. The protocol was registered with Open Science Framework (https://doi.org/10.17605/OSF.IO/TK67C).
We included 94 articles reporting 183 cases (101 female, mean age at diagnosis 69 ± 10 years). The clinical picture at diagnosis was characterised by severe diarrhoea (97%) and weight loss (84%, median -13 kg), leading to hospital admission in 167 (95%) patients. Olmesartan (90%) was most frequently implicated. Villous atrophy (VA) was reported in 164/183 (89%) patients. One hundred and nine had only VA, 12 had pan-gastrointestinal involvement, 23 had VA and gastric involvement and 19 had VA and colon involvement (predominantly microscopic colitis). Outcomes were reported for 178/183 (97%) patients, who all recovered clinically on ARBs withdrawal. Histological recovery occurred in all 96 patients with VA at baseline who underwent follow-up duodenal biopsy.
Enteropathy due to ARBs is characterised by severe malabsorption often requiring hospital admission and can involve the entire gastrointestinal tract. Clinician awareness can lead to prompt diagnosis and excellent prognosis.
摘要：
背景：尽管由血管紧张素II受体阻滞剂（ARB）引起的肠病已有10多年的历史，临床医生对这种情况的认识仍然很低。
目的：系统回顾有关临床表型的文献，整个胃肠道粘膜变化的分布和ARB引起的肠病的预后。
方法：根据PRISMA指南，我们搜索了截至2023年11月6日的PubMed和Embase相关文章。我们包括全文论文，信件,描述ARB引起的肠病的病例报告和病例系列。根据胃肠道不同区域的内镜和组织学发现将患者分为亚组。该协议已在OpenScienceFramework（https://doi.org/10.17605/OSF）中注册。IO/TK67C）。
结果：我们纳入了94篇文章，报告183例（101名女性，诊断时的平均年龄69±10岁）。诊断时的临床表现以严重腹泻（97％）和体重减轻（84％，中位数-13公斤），导致167名(95%)患者入院。奥美沙坦（90％）是最常见的牵连。在164/183（89％）患者中报告了绒毛萎缩（VA）。一百一十九只有VA，12有泛胃肠道受累，23例患者有VA和胃受累，19例患者有VA和结肠受累（主要是显微镜下结肠炎）。结果报告了178/183（97％）患者，他们都在ARBs戒断后临床康复。在基线时接受十二指肠活检的所有96例VA患者均发生组织学恢复。
结论：ARB引起的肠病以严重的吸收不良为特征，通常需要住院治疗，并可累及整个胃肠道。临床医生的认识可以导致及时的诊断和良好的预后。
目的：系统回顾有关临床表型的文献，整个胃肠道粘膜变化的分布和ARB引起的肠病的预后。
方法：根据PRISMA指南，我们搜索了截至2023年11月6日的PubMed和Embase相关文章。我们包括全文论文，信件,描述ARB引起的肠病的病例报告和病例系列。根据胃肠道不同区域的内镜和组织学发现将患者分为亚组。该协议已在OpenScienceFramework（https://doi.org/10.17605/OSF）中注册。IO/TK67C）。
结果：我们纳入了94篇文章，报告183例（101名女性，诊断时的平均年龄69±10岁）。诊断时的临床表现以严重腹泻（97％）和体重减轻（84％，中位数-13公斤），导致167名(95%)患者入院。奥美沙坦（90％）是最常见的牵连。在164/183（89％）患者中报告了绒毛萎缩（VA）。一百一十九只有VA，12有泛胃肠道受累，23例患者有VA和胃受累，19例患者有VA和结肠受累（主要是显微镜下结肠炎）。结果报告了178/183（97％）患者，他们都在ARBs戒断后临床康复。在基线时接受十二指肠活检的所有96例VA患者均发生组织学恢复。
结论：ARB引起的肠病以严重的吸收不良为特征，通常需要住院治疗，并可累及整个胃肠道。临床医生的认识可以导致及时的诊断和良好的预后。
