{"id":29884,"date":"2012-06-22T10:13:00","date_gmt":"2012-06-22T14:13:00","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=news&p=29884"},"modified":"2012-06-22T10:40:36","modified_gmt":"2012-06-22T14:40:36","slug":"olmesartan-use-associated-with-gi-disorder-that-mimics-celiac-disease","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2012\/06\/22\/olmesartan-use-associated-with-gi-disorder-that-mimics-celiac-disease\/","title":{"rendered":"Olmesartan Use Associated With GI Disorder That Mimics Celiac Disease"},"content":{"rendered":"

A gastroenterologist at the Mayo Clinic has uncovered a rare but potentially serious association between the angiotensin II receptor antagonist (ARB) olmesartan and severe gastrointestinal problems that resemble Celiac disease.\u00a0The report has been published online in\u00a0Mayo Clinic Proceedings<\/em><\/a>. In the U.S., olmesartan is sold as Benicar and, in combination with other drugs, as Azor, Benicar HCT, and Tribenzor.<\/p>\n

Dr. Joseph Murray first suspected the connection when two patients with refractory Celiac disease experienced symptomatic improvement after discontinuing olmesartan treatment. He eventually identified a total of 22 people over 3 years with unexplained chronic diarrhea and enteropathy who were taking olmesartan. 14 patients had symptoms so severe that they were hospitalized. \u00a0All the patients were unresponsive to a gluten-free diet and did not have tissue transglutaminase antibodies in the blood, which are used to detect celiac disease. After discontinuing olmesartan all the patients gained weight and had an improvement in symptoms.<\/p>\n

\u201cWe thought these cases were celiac disease initially because their biopsies showed features very like celiac disease, such as inflammation,\u201d said Dr, Murray, in\u00a0a Mayo Clinic press release<\/a>. \u201cWhat made them different was they didn\u2019t have the antibodies in their blood that are typical for celiac disease.\u201d<\/p>\n

[youtube=http:\/\/www.youtube.com\/watch?v=KjIWzIUN-eA&w=600]
\nIn\u00a0a statement released on video<\/a>, Murray emphasized that \u201cthe great majority of patients on this medication (olmesartan) do not need to do anything.\u201d However, he recommended that patients taking olmesartan discuss this finding with their physician if they\u00a0\u201dare experiencing GI symptoms or unexplained weight loss\u201d or \u201cif a diagnosis of celiac disease has been made in the recent past.\u201d<\/p>\n

Murray acknowledges that there is currently no evidence demonstrating a cause-and-effect relationship. \u201cWe\u2019ve reported an association,\u201d he said. \u201cWhat needs to be known next is the science to understand why there is such an association.\u201d<\/p>\n

Hypertension expert Franz Messerli offered the following comment:<\/p>\n

The report from the Mayo Clinic suggesting that olmesartan is associated with severe gastrointestinal adverse effects is of concern. Olmesartan sales have exceeded 500 million a year in the US alone and the drug, as are all ARBs, is perceived as being unique because of its paucity of side effects. Several issues should be scrutinized\u00a0 in this context:<\/em><\/p>\n

1. Were any of the patients re-exposed to olmesartan and did the symptoms recur? Mere cessation of a drug and vanishing of a symptom\u00a0 is not an acceptable criterion for confirming a cause and effect relationship. Only systematic (and not anecdotal) re-exposure can confirm that the GI side effects were indeed due to olmesartan.<\/em><\/p>\n

2. Has there been any other ARB indicted for the same issue or are the findings unique to olmesartan. Is this a class effect or is it specific to olmesartan?<\/em><\/p>\n

3. Was this syndrome ever seen in the extensive data base with olmesartan or with any other ARB? There are numerous clinical trials with olmesartan and GI adverse effects are exceedingly uncommon.<\/em><\/p>\n

4. And most importantly, what is the putative pathophysiologic mechanism? In this context the possibility of intestinal angioedema comes to mind which has been observed occasionally with ACE inhibitors but to my knowledge not with ARBs. If it were olmesartans\u2019s inhibitory effects on transforming growth factor B action as the authors suggest, then this phenomenon should have been observed with other ARBs such as losartan and valsartan (which are more commonly prescribed than olmesartan) as well.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

A gastroenterologist at the Mayo Clinic has uncovered a rare but potentially serious association between the angiotensin II receptor antagonist (ARB) olmesartan and severe gastrointestinal problems that resemble Celiac disease.\u00a0The report has been published online in\u00a0Mayo Clinic Proceedings. In the U.S., olmesartan is sold as Benicar and, in combination with other drugs, as Azor, Benicar […]<\/p>\n","protected":false},"author":196,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[],"tags":[],"class_list":["post-29884","post","type-post","status-publish","format-standard","hentry"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/29884","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/196"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=29884"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/29884\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=29884"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=29884"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=29884"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}