2019 Volume 61 Issue 8 Pages 1554-1560
A 64-year-old male was referred to our hospital with a weight loss of 23 kg over the previous nine months due to anorexia and diarrhea. The patient had been taking olmesartan for ten years for the treatment of hypertension. Esophagogastroduodenoscopy and colonoscopy did not reveal any abnormalities, but capsule endoscopy demonstrated villous atrophy in the duodenum and the small intestine. Duodenal biopsy showed no amyloid deposition nor atypical lymphocytes, and the patient tested negative for bacteria in stool culture and ova, suggesting celiac disease. Since the patient was on olmesartan, sprue-like enteropathy associated with olmesartan was suspected, the clinical presentation of which is similar to celiac disease. Olmesartan was discontinued, and his anorexia, diarrhea, and weight loss improved. Capsule endoscopy performed four months later demonstrated reduced villous atrophy in the duodenum and the small intestine. In patients receiving olmesartan therapy who develop chronic diarrhea, sprue-like enteropathy associated with olmesartan should be considered as a potential cause. Capsule endoscopy was effective in evaluating small intestinal villous atrophy.
