Olmesartan-associated enteropathy: results of a national survey.

BACKGROUND: Recently, a new enteropathy has been described: olmesartan-associated enteropathy. However, the association has been questioned: a phase 3 trial and a cohort study found no association between gastrointestinal events and olmesartan. AIM: To collect French cases of sartan-associated enteropathy to describe further this entity, confirm or refute causality, and determine if the association exists with other sartans. METHODS: French gastroenterologists were invited to report cases of sartan-associated enteropathy and collect clinical, biological and histological data. Patients with diarrhoea and histological duodenal abnormalities were included. RESULTS: Thirty-six patients with olmesartan-associated enteropathy were reported, including 32 with villous atrophy and four without. There was only one patient with irbesartan-associated enteropathy. None of the patients died. Patients with villous atrophy had diarrhoea, vomiting, renal failure, hypokalaemia, body weight loss and hypoalbuminaemia. Thirty-one patients were hospitalised; four required intensive care. Anti-transglutaminase and anti-enterocyte antibodies were negative; anti-nuclear antibodies were positive (9/11). Endoscopic duodenal biopsies showed villous atrophy (32/32) and polyclonal intra-epithelial CD3+CD8+ lymphocytosis (11/11). Exactly, 14/15 patients responded to steroids and/or immunosuppressants, prescribed because of suspected autoimmune enteropathy. Ten olmesartan interruptions were followed by reintroductions before steroids or immunosuppressants. Interruptions were followed by remissions (9/10), but reintroductions were followed by relapses (9/9). Twenty-nine patients were in remission since olmesartan interruption, including 26 without immunosuppressants. Patients with normal villi had similar clinical characteristics, but mild histological abnormalities (intra-epithelial lymphocytosis and lamina propria lymphocytic infiltration). CONCLUSIONS: Olmesartan causes a severe and immune-mediated enteropathy, with or without villous atrophy. Enteropathy associated with other sartans seems to be very rare.

[Epithelioid hemangioendothelioma of the liver and superior vena cava. Radiological results apropos of a case in an adult]. / Hémangioendothéliome épithélioïde du foie et de la veine cave supérieure. Résultats radiologiques à propos d'une observation chez l'adulte.

Epithelioid hemangioendothelioma is a rare, ubiquitous, vascular tumor, difficult to diagnosis but sometimes identified after detection of metastases, and with a prognosis intermediary between angioma and angiosarcoma. The tumors have been described as developing in the large venous trunks and recently lesions have been reported in liver. Little documented data exist with respect to radiologic appearances. A case is reported with a histologically confirmed hepatic localization in association with a lesion in superior vena cava.

Papaverine-induced chronic liver disease.

The case history of a women with jaundice and laboratory evidence of chronic active hepatitis and cirrhosis is reported. The patient had taken papaverine for 6 yr for cerebral arterial disease. Jaundice improved after the drug was discontinued but reappeared when papaverine therapy was reintroduced. Antinuclear antibody and smooth muscle antibody were present. Clinical manifestations disappeared and laboratory results again returned to normal upon withdrawal of papaverine. This case suggests that papaverine should be added to the list of drugs known to produce chronic active hepatitis and cirrhosis.

[Continuous ambulatory enteral feeding in hospitalized adults: prospective experience in 98 patients]. / Nutrition entérale continue ambulatoire à l'hôpital, chez l'adulte: expérience prospective chez 98 malades.

The goal of this study, which describes a personal technique of continuous enteral nutrition (CEN) in hospitalized adults on an ambulatory basis, was: to prospectively evaluate, over a 2-year period, its efficacy and tolerance in 98 patients requiring CEN for at least 15 days; to compare its efficacy and tolerance with those of conventional non-ambulatory CEN on a prospectively randomized basis in 16 patients. Ambulatory CEN was given at the rate of 35-45 kcal/kg/d (lipids: 35 p. 100; carbohydrates: 45 p. 100); during day-time, a portable system, including pump, tubes and low-viscosity nutrient solutions, allowed ambulation. Ninety-eight consecutive patients with a minimal level of physical autonomy were treated for intestinal (n = 47), pancreatic (n = 20), esophagogastric (n = 17) diseases, or for malnutrition of other causes for an average of 38 days (15 to 141). The average weight gain (m +/- SD) was 1.2 +/- 5.5 p. 100 of ideal body weight (IBW) and the average nitrogen gain was 0.7 +/- 3.8 g/24 h; weight gain proved significantly lower in patients with inflammatory bowel disease receiving steroids. The clinical tolerance proved excellent, except for 5 cases of transient diarrhea and 9 cases of reposition of the nasogastric tube. A decrease in cholesterolemia below 3.9 mmol/l was noted in 25 p. 100 of patients during CEN. No significant difference between ambulatory and non-ambulatory CEN was observed in terms of evolution of body weight and other anthropometric variables, nitrogen balance, albuminemia, and oxygen consumption; conversely, the CEN experience, evaluated by patients on analogical visual scales, was significantly better endured in the ambulatory group.(ABSTRACT TRUNCATED AT 250 WORDS)

[Plasmodium falciparum malaria acquired in Kenya with type II or type III resistance to amino-4-quinolines]. / Paludisme à Plasmodium falciparum contracté au Kénya, avec résistance de type secondaire ou tertiaire aux amino-4-quinoléines.

The authors report a case of Plasmodium falciparum malaria acquired in Kenya by a French tourist under correct chloroquine prophylaxis. She recovered under quinine and a sulfadoxine-pyrimethamine association. This is a new case of high level resistance (R II or R III) of Plasmodium falciparum to amino-4-quinolines recognized in East Africa. Malarial chemoprophylaxis recommended until now for this area may need to be reviewed.