Overview
Sprue, particularly sprue-like enteropathy (SLE), refers to a condition characterized by villous atrophy and malabsorption, often associated with the use of angiotensin II receptor blockers (ARBs) like telmisartan 1. In nontropical sprue, there is a notable impairment in nutrient absorption, particularly in the proximal small intestine 2.Diagnosis
Clinical Presentation: Diarrhea, abdominal pain, and malabsorption symptoms 1.
Endoscopic Findings: Villous atrophy in the small intestine 1.
Histological Examination: Biopsy showing characteristic changes in duodenal mucosa 1.
Differential Diagnosis: Exclude celiac disease and other causes of malabsorption 1.
Specific Tests: Absorption studies (e.g., L-methionine absorption) may show proximal zone impairment in nontropical sprue 2.Management
Discontinuation of Suspect Medications: Withdrawal of telmisartan or other ARBs if suspected 1.
Nutritional Support: Dietary modifications and supplementation to address malabsorption 1.
Symptomatic Treatment: Manage symptoms like diarrhea with supportive care 1.Special Populations
Elderly: Increased vigilance in elderly patients due to higher reported cases with telmisartan 1.Key Recommendations
Withdraw suspected ARBs in patients presenting with SLE symptoms to assess clinical improvement (Evidence: Moderate 1).
Consider proximal small intestine absorption studies in diagnosing nontropical sprue to identify specific absorption defects (Evidence: Moderate 2).
Monitor elderly patients closely for SLE when prescribing ARBs, given higher susceptibility (Evidence: Expert opinion 1).References
1 Alzueta N, Echeverría A, Sanz L, Fontela C, Acín T, Montenegro L et al.. Telmisartan-induced sprue-like enteropathy: a case report. European journal of hospital pharmacy : science and practice 2020. link
2 Schedl HP, Pierce CE, Rider A, Clifton JA. Absorption of L-methionine from the human small intestine. The Journal of clinical investigation 1968. link