Clinical and gastro-duodenal histopathological features of enteropathy due to angiotensin II receptor blockers

Background: Clinical elements differentiating enteropathy due to angiotensin II-receptor-blockers (ARBs -E) from coeliac disease (CD) are poorly defined. The histopathological features on duodenal and gastric biopsies in these patients still need to be investigated. Aims: To describe the clinical phenotype of ARBs-E in comparison to CD, and the histological findings of gastric and duodenal biopsies in ARBs-E. Methods: Clinical data of patients with ARBs-E and CD diagnosed between 2013 and 2020 were retro-spectively reviewed. Baseline presenting symptoms and demographics were compared (Fisher's exact test and t-test). Gastric and duodenal histology in ARBs-E were revised by two independent pathologists. Results: 14 ARBs-E and 112 CD patients were enroled. Weight loss ( p < 0.01), acute onset of diarrhoea ( p < 0.01), hospitalization ( p < 0.01), and older age at diagnosis ( p < 0.01) were more common in ARBs-E. Duodenal histology in ARBs-E showed intraepithelial lymphocytosis in 71%, increased mucosal eosinophilic count in 57%, with preserved neuroendocrine, Paneth and goblet cells in all patients. Gastric histologic lesions at baseline, including lymphocytic gastritis, eosinophilic gastritis, chronic active gas-tritis, and metaplastic atrophic gastritis patterns were observed in 73% of patients, without Helicobacter pylori infection. Conclusions: ARBs-E showed a severe clinical phenotype, often requiring hospital admission. Gastric in-volvement at diagnosis is very common, and this could further support this diagnosis. (c) 2021 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.