{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T18:48:12Z","timestamp":1772045292695,"version":"3.50.1"},"reference-count":35,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2018,2,19]],"date-time":"2018-02-19T00:00:00Z","timestamp":1518998400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Menarini Industrie Farmaceutiche Riunite Srl"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmacoepidemiology and Drug"],"published-print":{"date-parts":[[2018,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>The angiotensin II receptor blocker (ARB) olmesartan has been recently associated with sprue\u2010like enteropathy (SLE), a gastrointestinal condition characterized by intestinal malabsorption (IM) and severe diarrhea. Whether the increased risk of SLE is substance\u2010specific or a class effect involving all ARBs is uncertain. The aim of this study is to assess the risk of enteropathy associated with ARBs and angiotensin converting enzyme inhibitors (ACE\u2010i) by using data from large administrative and claim databases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We obtained data from Italian local health\u2010care units and a large German claim database and included patients treated with olmesartan, other ARBs, and ACE\u2010i. In the absence of a specific diagnosis code for SLE, International Classification of Diseases codes for IM were used. Analysis implemented a Poisson regression with robust error variance procedure, which allowed accounting for different clusters (local health\u2010care units and countries) and correctly estimating the standard error for the relative risk of rare event occurrence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Patients were divided into 3 groups: olmesartan (25.591, 5.5%), other ARBs (104.901, 22.5%), and ACE\u2010i patients (334.951, 72.0%). Baseline characteristics were similar overall. The incidence of unspecified IM in ACE\u2010i patients was not different compared with that of olmesartan, whereas a higher rate ratio was observed when comparing ARB patients with the olmesartan group (RR: 2.50, 95% CI 1.21 to 5.19, <jats:italic>P<\/jats:italic> .01). When International Classification of Diseases codes for coeliac disease were included, no differences were observed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We could not confirm previous findings of a higher risk of malabsorption in olmesartan\u2010only patients, and drug\u2010induced enteropathy should be considered the result of exposure to the class of ARBs rather than a specific drug\u2010related effect.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pds.4402","type":"journal-article","created":{"date-parts":[[2018,2,23]],"date-time":"2018-02-23T19:09:18Z","timestamp":1519412958000},"page":"581-586","source":"Crossref","is-referenced-by-count":23,"title":["Severe intestinal malabsorption associated with ACE inhibitor or angiotensin receptor blocker treatment. An observational cohort study in Germany and Italy"],"prefix":"10.1002","volume":"27","author":[{"given":"Peter","family":"Malfertheiner","sequence":"first","affiliation":[{"name":"Klinik f\u00fcr Gastroenterologie, Hepatologie und Infektiologie Otto\u2010von\u2010Guericke Universit\u00e4t  Magdeburg Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudio","family":"Ripellino","sequence":"additional","affiliation":[{"name":"HEOR Consultant Freelance  Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9970-8268","authenticated-orcid":false,"given":"Nazarena","family":"Cataldo","sequence":"additional","affiliation":[{"name":"Quintiles IMS  Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,2,19]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.12691\/ijcd-2-1-3"},{"issue":"4","key":"e_1_2_9_3_1","doi-asserted-by":"crossref","first-page":"230","DOI":"10.14797\/mdcj-12-4-230","article-title":"Olmesartan\u2010induced enteropathy","volume":"12","author":"Adike A","year":"2016","journal-title":"Methodist DeBakey Cardiovascular Journal: December 2016"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0125024"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.12780"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.12691\/ijcd-2-2-5"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2012.06.003"},{"key":"e_1_2_9_8_1","doi-asserted-by":"crossref","unstructured":"FiorucciG PuxedduE ColellaR Paolo ReboldiG VillanacciV BassottiG. \"Severe spruelike enteropathy due to olmesartan \"2014.","DOI":"10.4321\/S1130-01082014000200011"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2013.45"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1155\/2013\/618071"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.12937"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2015-309690"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.14176"},{"key":"e_1_2_9_14_1","first-page":"62","article-title":"Angiotensin II receptor blockers\u2010induced enteropathy: not just olmesartan! 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