Common hypertension medication may cause Celiac like symptoms

 

Dr. Joseph A. Murray, a Gastroenterologist and Professor of Medicine at Mayo Clinic in Rochester, MN, discusses his article appearing online first and in print in the August 2012 issue of Mayo Clinic Proceedings.

In the article Dr. Murray discloses an association between celiac disease-like symptoms and a common hypertension medication, Olmesartan.

Read the full article at: http://www.mayoclinicproceedings.org/article/S0025-6196(12)00558-7/fulltext

Advertisements

Most With Celiac Disease Unaware of it, Study Reveals

Mayo Clinic News Release

ROCHESTER, Minn. — Roughly 1.8 million Americans have celiac disease, but around 1.4 million of them are unaware that they have it, a Mayo Clinic-led analysis of the condition’s prevalence has found. Meanwhile, 1.6 million people in the United States are on agluten-free diet even though they haven’t been diagnosed with celiac disease, according to the study published Tuesday in the American Journal of Gastroenterology.

Researchers have estimated the rate of diagnosed and undiagnosed celiac disease at similar levels prior to this study, but this is the most definitive study on the issue. “This provides proof that this disease is common in the United States,” says co-authorJoseph Murray, M.D., a Mayo Clinic gastroenterologist. “If you detect one person for every five or six (who have it), we aren’t doing a very good job detecting celiac disease.”

Celiac disease is a digestive disorder brought on when genetically susceptible people eat wheat, rye and barley. A gluten-free diet, which excludes the protein gluten, is used to treat celiac disease. Roughly 80 percent of the people on a gluten-free diet do so without a diagnosis of celiac disease.

There are a lot of people on a gluten-free diet, and it’s not clear what the medical need for that is,” Dr. Murray says. “It is important if someone thinks they might have celiac disease that they be tested first before they go on the diet.

To determine its prevalence, researchers combined blood tests confirming celiac disease with interviews from a Centers for Disease Control and Prevention (CDC) nationwide population sample survey called National Health and Nutrition Examination Survey. The survey, designed to assess the health and nutrition of U.S. adults and children, is unique in that it combines interviews and physical examinations.

Researchers found that celiac disease is much more common in Caucasians.

“In fact, virtually all the individuals we found were non-Hispanic Caucasians,” says co-author Alberto Rubio-Tapia, M.D., a Mayo Clinic gastroenterologist. But previous research in Mexico has shown that celiac disease could be just as common as it is in the U.S.

“So that is something we don’t fully understand,” Dr. Rubio-Tapia says. The study found the rate of celiac disease in the U.S. is similar to that found in several European countries.

The research was funded in part by the National Institutes of Healthand the CDC. Study authors include James Everhart, M.D., from the National Institute of Diabetes and Digestive and Kidney Disease; Jonas Ludvigsson, M.D., Ph.D., from Orebro University Hospital and the Karolinska Institutet; and Tricia Brantner from Mayo Clinic.

Medical follow-up in celiac disease is less than optimal

Courtesy American Gastroenterological Association 

joseph murrayFollow-up exams for patients with celiac disease are often inadequate and highly variable, according to a new study in Clinical Gastroenterology and Hepatology, the official clinical practice journal of the American Gastroenterological Association (AGA).

“In the group of celiac disease patients that we observed, we found that very few of them had medical follow-up that would be in keeping with even the most lax interpretation of current guidelines,” said Joseph A. Murray, MD, AGAF, of Mayo Clinic and lead author of this study. “Doctors and patients need to be aware of the need for medical follow-up of celiac disease. This is a chronic disease with the possibility of long-term complications. If gastroenterologists are leading the way in the detection of celiac disease, we must improve our communication to patients to ensure that they get needed follow-up care in order to improve outcomes in celiac disease.”

In this study, researchers collected data on 122 patients diagnosed with celiac disease between 1996 and 2006 in Olmsted County, MN (70 percent women, median age of 42 years). They determined the frequency at which patients received follow-up exams from six months to five years after diagnosis. Among 113 patients who were followed for more than four years, only 35 percent received follow-up analyses that were consistent with AGA recommendations.

Celiac disease occurs in the digestive system when people cannot tolerate the protein gluten. Patients diagnosed with celiac disease only represent a minority since most cases remain undiagnosed. While these patients may have a moderately increased risk of death, this risk may be higher in those with poor adherence to a gluten-free diet.

Although the only proven treatment is strict adherence to a gluten-free diet, achieving true compliance is a considerable challenge. This underscores the importance of long-term follow-up to improve compliance. However, patients with celiac disease are not followed consistently.

“This study shows that despite widespread dissemination of recommendations, it is obvious that these are not being implemented in the community. We in gastroenterology with the expertise in celiac disease need to encourage active follow-up of these patients and improve the overall quality of medical care provided to patients with this chronic disease. It should not be different from other chronic conditions for which medical follow up is a given such as liver disease, inflammatory bowel disease or even gastroesophageal reflux disease. Anecdotally, patients with celiac disease often feel they are on their own in the management of celiac disease,” added Dr. Murray.

Blood Pressure Drug Linked to Severe GI Problems

Mayo Clinic Press Release

Mayo Clinic researchers have discovered an association between a commonly prescribed blood pressure drug, Olmesartan, and severe gastrointestinal issues such as nausea, vomiting, diarrhea, weight loss and electrolyte abnormalities — symptoms common among those who have celiac disease. The findings are published online today in the medical journal Mayo Clinic Proceedings.

From 2008-11, Mayo Clinic physicians treated 22 patients with symptoms similar to celiac disease, including intestinal inflammation and abnormalities. Patients came from 17 states, and some had been diagnosed with celiac disease. They had chronic diarrhea and weight loss; the median weight loss was 39 pounds, and one patient lost 125 pounds. Fourteen of the 22 were hospitalized because of the severity of their symptoms. When given a blood test, however, these patients didn’t come back with results typical of celiac disease. They also didn’t respond to treatments such as gluten-free diets.

After examining their medications, Mayo Clinic gastroenterologist Joseph Murray, M.D., pulled several of the patients off Olmesartan. Their symptoms dramatically improved. Eventually, all 22 were taken off the drug, and all showed improvement. Eighteen of the 22 patients had intestinal biopsies after stopping the medication and showed improvement.

“We thought these cases were celiac disease initially because their biopsies showed features very like celiac disease, such as inflammation,” says Dr. Murray, the lead author. “What made them different was they didn’t have the antibodies in their blood that are typical for celiac disease.”

Olmesartan — prescribed for the treatment of hypertension, or high blood pressure — works by blocking substances that tighten blood vessels, allowing blood to flow more smoothly and the heart to pump more efficiently, according to the U.S. National Library on Medicine.

“It’s really an awareness issue. We want doctors to be aware of this issue, so if they see a patient who is having this type of syndrome — they think about medications as a possible association,” Dr. Murray says. “We’ve reported an association. What needs to be known next is the science to understand why there is such an association.”

The investigators were supported in part by the National Institutes of Health, the American College of Gastroenterology Junior Faculty Development Award, the Swedish Society of Medicine, the Swedish Research Council and the Fulbright Commission.