Drug-induced Collagenous Sprue: A Reversible Small Bowel Mucosal Disorder

Collagenous sprue is an unusual small intestinal mucosal disorder characterized by flattened small intestinal mucosa, unusual sub-epithelial collagen deposits, increased intra-epithelial lymphocytes, often denuded epithelial cells and resistance to therapy, including a gluten-free diet. The disorder is heterogeneous with several potential causes now identified. Similar to sprue-like intestinal disease, collagenous sprue may be caused or precipitated by different pharmaceutical agents. Olmesartan, an angiotensin II inhibitor, often employed in treatment of hypertension, may cause a drug-induced form of sprue-like small intestinal disease with the pathological features of untreated celiac disease refractory to gluten-free diet treatment. In addition, collagenous sprue may be precipitated by olmesartan. Recognition and cessation of the medication has led to resolution of the small intestinal mucosal disorder without steroids or other treatment.