近年来,新兴的证据揭示了肠病的非乳糜泻原因,为临床医生提出了诊断挑战。本研究讨论了与非乳糜泻相关的诊断挑战,特别关注奥美沙坦诱导的肠病(OIE)。一位73岁的女士出现在急诊科,有六个月的水样腹泻史,食物摄入和体重明显下降加剧了这种腹泻。入院时发现患者脱水,严重低钾血症和低钙血症。进行的广泛测试并不显著,包括腹腔疾病小组,肠面板,卵和寄生虫,艰难梭菌,粪便钙卫蛋白,腹部和骨盆的计算机断层扫描。入院时纠正了严重的电解质失衡,随后的十二指肠活检的上消化道内窥镜检查显示,中度至重度绒毛钝化,并伴有明显的CD3淋巴细胞上皮内浸润。同时进行的结肠镜检查并不明显,显微镜下结肠炎活检阴性。鉴于OIE的怀疑,奥美沙坦停用.一个月的随访显示吸收不良的解决,电解质正常化和十二指肠活检显示十二指肠炎改善。这项研究强调了考虑用药史和排除肠病其他潜在原因的重要性。奥美沙坦是一种血管紧张素II受体拮抗剂,通常用于高血压。然而,在极少数情况下,它可能会诱发肠病,这往往是诊断不足。这种罕见的副作用可能表现为慢性腹泻,减肥,和吸收不良的迹象。有趣的是,OIE表现为乳糜泻的临床和组织病理学特征重叠,因此,可能会误导医生进行广泛的诊断调查。应提高对诸如世界动物卫生组织等与药物有关的腹泻综合征的认识,鉴于简单的停药可以导致显著的临床改善。
Emerging evidence has shed light on non-celiac causes of enteropathy in recent years, presenting a diagnostic challenge for clinicians. This study discusses the diagnostic challenges related to non-celiac enteropathy, specifically focusing on olmesartan-induced enteropathy (OIE). A 73-year-old lady presented to the emergency department with a six-month history of watery diarrhea exacerbated by food intake and significant weight loss. The patient at admission was found to be dehydrated with severe hypokalemia and hypocalcemia. The extensive testing that was performed was unremarkable, including celiac disease panel, enteric panel, ova and parasites, Clostridium difficile, fecal calprotectin, and computed tomography of the abdomen and pelvis. A significant electrolyte imbalance was corrected at admission, and subsequent upper endoscopy investigation with duodenal biopsies revealed moderate to severe villi blunting with a significant intraepithelial infiltrate of CD3+ lymphocytes. A colonoscopy that was performed at the same time was unremarkable, with negative biopsies for microscopic colitis. Given the suspicion of OIE, olmesartan was discontinued. One-month follow-up revealed resolution of malabsorption, with electrolyte normalization and duodenal biopsies showing improved duodenitis. This study emphasizes the importance of considering medication history and ruling out other potential causes of enteropathy. Olmesartan is an angiotensin II receptor antagonist that is commonly prescribed for hypertension. However, in rare cases, it may induce enteropathy, which often remains underdiagnosed. This rare side effect may present as chronic diarrhea, weight loss, and signs of malabsorption. Interestingly, OIE presents with overlapping clinical and histopathological features to celiac disease and, therefore, may mislead physicians to an extensive diagnostic investigation. Greater awareness of medication-related diarrheal syndromes such as OIE should be promoted, given that simple discontinuation of the medication can lead to dramatic clinical improvement.