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drug induced enteropathy

Andromachi Makri, Matilda Florentin, Moses S Elisaf, George Liamis
OBJECTIVE: Olmesartan-induced enteropathy consists a syndrome that mimics celiac disease both clinically and histologically. Cases of this entity have sporadically been reported since 2012 and are usually characterized by severe diarrhea and malabsorption, followed by significant weight loss. CASE REPORT: Herein, we report an uncommon case of this syndrome, where weight loss preceded several months the onset of gastrointestinal symptoms. Physicians should be aware of unexplained weight loss in patients taking olmesartan, as prompt discontinuation of the drug may prevent the deleterious consequences of malabsorption...
March 7, 2019: Current Drug Safety
Paulina Henry, Hélène Dano, Hubert Piessevaux, Anne Jouret-Mourin
Olmesartan induced enteropathy was first described in 2012. It is a rare adverse effect of this antihypertensive drug. The clinical presentation commonly includes severe chronic diarrhea leading to weight loss and a variable degree of dehydration. Histological findings are most commonly observed in the duodenum and consist of partial or total villous atrophy, increased intraepithelial lymphocytes and inflammation in the lamina propria. Involvement of gastric and colic mucosa has also been described. We report on the case of a 63-year-old man, treated by olmesartan, who presented with severe chronic diarrhea...
January 31, 2019: Annales de Pathologie
Sripriya Gonakoti, Sanjiv Khullar, Aarthi Rajkumar
BACKGROUND Olmesartan, an angiotensin receptor blockade class of antihypertensive medication has recently been associated with a seronegative sprue like enteropathy. Patients typically present with diarrhea and weight loss often prompting exhaustive diagnostic workup. Discontinuation of the drug leads to dramatic recovery and hence, physicians need to be aware of olmesartan associated enteropathy (OAE) in order to avoid unnecessary testing. CASE REPORT A 59-year-old Caucasian male was admitted to the hospital with complaints of intractable diarrhea, vomiting and considerable weight loss...
January 26, 2019: American Journal of Case Reports
Rocchina Colucci, Carolina Pellegrini, Matteo Fornai, Erika Tirotta, Luca Antonioli, Cecilia Renzulli, Emilia Ghelardi, Elena Piccoli, Daniela Gentile, Laura Benvenuti, Gianfranco Natale, Federica Fulceri, Pablo Palazón-Riquelme, Gloria López-Castejón, Corrado Blandizzi, Carmelo Scarpignato
Non-steroidal anti-inflammatory drugs (NSAIDs) can damage the small intestine, mainly through an involvement of enteric bacteria. This study examined the pathophysiology of NSAID-associated intestinal lesions in a rat model of diclofenac-enteropathy and evaluated the effect of rifaximin on small bowel damage. Enteropathy was induced in 40-week old male rats by intragastric diclofenac (4 mg/kg BID, 14 days). Rifaximin (delayed release formulation) was administered (50 mg/kg BID) 1 h before the NSAID. At the end of treatments, parameters dealing with ileal damage, inflammation, barrier integrity, microbiota composition, and TLR-NF-κB-inflammasome pathway were evaluated...
2018: Frontiers in Pharmacology
Kelly Makielski, Jonah Cullen, Annette O'Connor, Albert E Jergens
BACKGROUND: The optimal medical treatment for chronic enteropathy (CE) in dogs and cats is controversial. Sequential treatment using diet, antimicrobials, and immunosuppressive drugs is the most common strategy used by clinicians. OBJECTIVES: To review the evidence for the effectiveness of dietary, drug, and alternative health interventions for inducing clinical remission in dogs and cats with CE. ANIMALS: Retrospective study of dogs and cats with a diagnosis of chronic enteropathy...
December 6, 2018: Journal of Veterinary Internal Medicine
Emanuela Ferretti, Eric Tremblay, Marie-Pierre Thibault, Sepideh Fallah, David Grynspan, Karolina M Burghardt, Marcos Bettolli, Corentin Babakissa, Emile Levy, Jean-François Beaulieu
BACKGROUND: The use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as indomethacin (INDO) and ibuprofen (IBU) has been shown to be an effective therapy for the closure of patent ductus arteriosus (PDA). However, this treatment has been associated with an increased risk of developing enteropathies in neonates. Whether the use of IBU is safer than INDO for the immature intestine remains to be elucidated. METHODS: The direct impact of IBU on the human immature intestinal transcriptome was investigated using serum-free organ culture...
October 16, 2018: Pediatric Research
Nirmal K Onteddu, Venkata Siva Krishna Kumar Pulivarthi, Mihira Ginnavaram, Ramalinga Kedika
Olmesartan-induced enteropathy (OIE) typically presents with a constellation of signs and symptoms including chronic diarrhoea, weight loss and villous atrophy on biopsy. We describe a 68-year-old Caucasian woman with a history of hypothyroidism and hypertension who presented to our hospital with recurrent episodes of acute intermittent diarrhoea, nausea, vomiting, renal failure and 15 lbs weight loss. After an extensive workup, she was diagnosed with possible OIE. Cessation of the offending drug resulted in improvement of clinical symptoms and also hospital admissions for severe diarrhoea reinforcing the diagnosis of OIE...
October 2, 2018: BMJ Case Reports
Lei Feng, Yongliang Yang, Xiaokui Huo, Xiangge Tian, Yujie Feng, Hanwen Yuan, Lijian Zhao, Chao Wang, Peng Chu, Feida Long, Wei Wang, Xiaochi Ma
β-Glucuronidase (GLU) as a vital factor in enterohepatic circulation and drug-inducing enteropathy has been given more and more attention in recent years. In this study, an off-on near-infrared (NIR) fluorescent probe (DDAO-glu) for selectively and sensitively sensing GLU was developed on the basis of its substrate preference. DDAO-glu can rapidly and selectively respond to bacterial GLU under physiological conditions for detecting the real-time intestinal GLU bioactivity of complex biological systems such as human feces in clinic...
September 28, 2018: ACS Sensors
Junji Umeno, Takayuki Matsumoto, Atsushi Hirano, Yuta Fuyuno, Motohiro Esaki
The widespread use of capsule endoscopy and balloon-assisted endoscopy has provided easy access for detailed mucosal assessment of the small intestine. However, the diagnosis of rare small bowel diseases, such as cryptogenic multifocal ulcerous stenosing enteritis (CMUSE), remains difficult because clinical and morphological features of these diseases are obscure even for gastroenterologists. In an issue of this journal in 2017, Hwang et al reviewed and summarized clinical and radiographic features of 20 patients with an established diagnosis of CMUSE...
July 28, 2018: World Journal of Gastroenterology: WJG
J Bazelle, A Threlfall, N Whitley
Diverse drugs with presumed cytoprotective effect have been used therapeutically in small animal veterinary practice for various gastro-intestinal conditions such as oesophagitis, gastric ulceration, gastritis or chronic gastro-enteropathies. Their efficacy has been doubted in human medicine, raising similar questions in the veterinary field. The aim of this review was to assess the current evidence on the efficacy and safety of these drugs in dogs and cats. Through a systematic review of the literature, we identified 37 articles on the use of misoprostol, sucralfate and other gastroprotectants in dogs and cats...
July 4, 2018: Journal of Small Animal Practice
Weixun Zhou, Yan Huang, Jinping Lai, Jun Lu, Michael Feely, Xiuli Liu
An increasing number of drugs including monoclonal antibodies and small molecules, either anti-inflammatory or immunity-enhancing, have been developed to treat human diseases and the number of medications in these classes is likely to expand in the future. The two most commonly used categories of such therapies are the anti-inflammatory group (anti- tumor necrosis factor (TNF) α, anti-interleukins/interleukin receptors, and anti-integrin bodies) and the anti-tumoral agents (immune checkpoint inhibitors, anti-CD20, and anti-endothelial growth factor)...
June 2018: Gastroenterology Research
Junseok Park, Seong Ran Jeon, Jin-Oh Kim, Hyun Gun Kim, Tae Hee Lee, Jun-Hyung Cho, Bong Min Ko, Joon Seong Lee, Moon Sung Lee
OBJECTIVE: Limited evidence is available on rebleeding due to nonsteroidal anti-inflammatory drugs (NSAIDs)-induced enteropathy. Previous studies have primarily analyzed endoscopic findings. Therefore, there is a need to evaluate their clinical implications for patients. This study aimed to evaluate the rebleeding rate and its related risk factors in patients with NSAIDs-induced enteropathy. METHODS: Of 402 patients with obscure gastrointestinal bleeding who were evaluated with capsule endoscopy, 49 were diagnosed with NSAIDs-induced enteropathy...
May 2018: Journal of Digestive Diseases
Munetaka Iguchi, Kazuki Kakimoto, Takanori Kuramoto, Kei Nakazawa, Minori Kubota, Yuki Hirata, Kaori Fujiwara, Satoshi Harada, Taisuke Sakanaka, Kazuhiro Ota, Shoko Edogawa, Yuichi Kojima, Sadaharu Nouda, Toshihiko Okada, Ken Kawakami, Toshihisa Takeuchi, Takuya Inoue, Kazuhide Higuchi
Low-dose aspirin, which is widely used to reduce the risk of cardio- and cerebrovascular thrombosis, often induces gastroenteropathy by increasing the permeability of the mucosa. However, therapeutic strategies for patients with low-dose aspirin-induced small intestinal injury have not been determined. We evaluated the preventative effect of egualen sodium hydrate, a gastro-protective agent that suppresses indomethacin-induced small-intestinal damage in rats, against small-intestinal mucosal damage induced by low-dose aspirin in healthy adult male volunteers...
March 2018: Journal of Clinical Biochemistry and Nutrition
Peter Malfertheiner, Claudio Ripellino, Nazarena Cataldo
PURPOSE: The angiotensin II receptor blocker (ARB) olmesartan has been recently associated with sprue-like enteropathy (SLE), a gastrointestinal condition characterized by intestinal malabsorption (IM) and severe diarrhea. Whether the increased risk of SLE is substance-specific or a class effect involving all ARBs is uncertain. The aim of this study is to assess the risk of enteropathy associated with ARBs and angiotensin converting enzyme inhibitors (ACE-i) by using data from large administrative and claim databases...
June 2018: Pharmacoepidemiology and Drug Safety
Shiro Nakamura, Toshio Watanabe, Tetsuya Tanigawa, Sunao Shimada, Yuji Nadatani, Takako Miyazaki, Masaki Iimuro, Yasuhiro Fujiwara
Activation of the NOD-Like Receptor Family, Pyrin Domain-Containing 3 (NLRP3) inflammasome, which consists of NLRP3, apoptosis-associated speck-like protein containing a caspase recruitment domain (ASC), and pro-caspase-1, triggers pro-caspase-1 cleavage promoting the processing of pro-interleukin (IL)-1β into mature IL-1β, which is critical for the development of non-steroidal anti-inflammatory drug (NSAID)-induced enteropathy. We investigated the effects of isoliquiritigenin, a flavonoid derived from the roots of Glycyrrhiza species, on NSAID-induced small intestinal damage and the inflammasome activation...
2018: Pharmacology
Teera Kijmassuwan, Pornthep Tanpowpong, Sani Molagool, Suporn Treepongkaruna
Enteritis and small bowel ulcers can be caused by inflammatory bowel disease, drug-induced enteritis, cytomegalovirus, tuberculosis, or intestinal lymphoma. Cryptogenic multifocal ulcerous stenosing enteritis (CMUSE) is an uncommon idiopathic cause of ulceration and stricture of the small bowel. CMUSE can occur in adults, but only few pediatric cases have been reported. Inflammatory bowel disease and other causes should be carefully sought first before the diagnosis of CMUSE can be made. Previous reports demonstrated that surgical intervention may be necessary for both diagnostic and therapeutic purposes...
January 2018: Turkish Journal of Gastroenterology: the Official Journal of Turkish Society of Gastroenterology
Zhiqiang Lu, Yuanfu Lu, Xue Wang, Fangyu Wang, Youcai Zhang
Nonsteroidal anti-inflammatory drugs (NSAIDs)-induced small intestinal injury (enteropathy) occurs in about two-thirds of regular NSAID users. To date, there is no proven-effective treatment for NSAID enteropathy, and its underlying mechanism remains obscure. The present study showed that glucocorticoids are an important determinant of NSAID enteropathy. High dose dexamethasone (DEX, 75 mg/kg) markedly exacerbated the acute toxicity of ibuprofen (IBU, 200 mg/kg) in the small intestine of mice, which was not due to the pregnane-X-receptor pathway...
March 2018: Archives of Toxicology
Yonghyun Kim, Seong Ran Jeon, Sang Myung Choi, Hyun Gun Kim, Tae Hee Lee, Jun-Hyung Cho, Yunho Jung, Wan Jung Kim, Bong Min Ko, Jin-Oh Kim, Joon Sung Lee, Moon Sung Lee
Background/Aims: Although the role of capsule endoscopy (CE) in Crohn's disease (CD) has expanded, CE is not used routinely for diagnosing and evaluating CD in Korea. We aimed to investigate current patterns of practice and evaluate the clinical significance of the use of CE in CD in Korean patients. Methods: Among 651 CE procedures performed for various indications, we retrospectively analyzed the medical records of patients who underwent CE in 57 cases of suspected CD (sCD) and 14 cases of established CD (eCD)...
October 2017: Intestinal Research
Sung Jae Shin, Choong-Kyun Noh, Sun Gyo Lim, Kee Myung Lee, Kwang Jae Lee
Non-steroidal anti-inflammatory drugs (NSAIDs) are well known to be associated with serious upper gastrointestinal complications, such as peptic ulcer, bleeding, perforation, and obstruction. Recently, attention has been mainly focused on the small bowel injuries caused by NSAIDs, and new endoscopic techniques such as capsule endoscopy and double balloon endoscopy can help in detecting such injuries. This article reviewed the epidemiology, pathogenesis, clinical manifestations, diagnosis, and treatment of small bowel injuries caused by NSAIDs...
October 2017: Intestinal Research
Ning Xu, Zhenhai Yu, Xiaoling Cao, Zhihua Wang, Ming Yan
BACKGROUND The special features of nonsteroidal anti-inflammatory drugs (NSAIDs) enteropathy were partially clarified by single-balloon endoscopy(SBE). We aimed to investigate the characteristics of NSAIDs injuries that were differ from other ulcer diseases and efficacy of SBE compared with capsule endoscopy(CE). MATERIAL AND METHODS 1,644 symptomatic patients (221 patients taking NSAIDs) hospitalized between January 2006 and March 2016 were recruited and underwent SBE and/or CE. RESULTS NSAIDs damages were identified in 110 patients (49...
November 3, 2017: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
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