Role of angiotensin-converting enzyme inhibitors in visceral angioedema

Abstract

A rare complication that occurs in patients taking ACE-inhibitors is visceral angioedema. It can affect about 1 in 2500 patients during the first week of exposure [ 1 Brown N.J. Snowden M. Griffin M.R. Recurrent angiotensin-converting enzyme inhibitor-associated angioedema. JAMA. Jul 16 1997; 278: 232-233 Crossref PubMed Google Scholar , 2 Israili Z.H. Hall W.D. Cough and angioneurotic edema associated with angiotensin-converting enzyme inhibitor therapy. A review of the literature and pathophysiology. Ann Intern Med. Aug 1 1992; 117: 234-242 Crossref PubMed Scopus (887) Google Scholar , 3 Messerli F.H. Nussberger J. Vasopeptidase inhibition and angio-oedema. Lancet. Aug 19 2000; 356: 608-609 Abstract Full Text Full Text PDF PubMed Scopus (206) Google Scholar ]. The prevalence of angioedema secondary to the use of ACE inhibitors varies anywhere from 0.1 to 0.7 % and usually manifests itself with the involvement of the face, tongue, lips and in rare cases the gastrointestinal wall. Middle aged female patients on an ACE inhibitor presenting with abdominal pain, vomiting, diarrhea, leukocytosis, ascites and small bowel wall thickening on the imaging studies should be examined closely [ 4 Weber M.A. Messerli F.H. Angiotensin-converting enzyme inhibitors and angioedema: estimating the risk. Hypertension. Jun 2008; 51: 1465-1467 Crossref PubMed Scopus (47) Google Scholar , 5 Oudit G. Girgrah N. Allard J. ACE inhibitor-induced angioedema of the intestine: case report, incidence, pathophysiology, diagnosis and management. Can J Gastroenterol. Dec 2001; 15: 827-832 Crossref PubMed Scopus (37) Google Scholar , 6 Gibbs C.R. Lip G.Y. Beevers D.G. Angioedema due to ACE inhibitors: increased risk in patients of African origin. Br J Clin Pharmacol. Dec 1999; 48: 861-865 Crossref PubMed Scopus (116) Google Scholar , 7 Johnsen S.P. Jacobsen J. Monster T.B. Friis S. McLaughlin J.K. Sorensen H.T. Risk of first-time hospitalization for angioedema among users of ACE inhibitors and angiotensin receptor antagonists. Am J Med. Dec 2005; 118: 1428-1429 Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar ]. Multiple invasive and unnecessary procedures can be avoided by raising awareness of this complication. Most of the patients diagnosed with angioedema required hospitalization due to the severity of symptoms and the exclusion of other possible diseases [ [7] Johnsen S.P. Jacobsen J. Monster T.B. Friis S. McLaughlin J.K. Sorensen H.T. Risk of first-time hospitalization for angioedema among users of ACE inhibitors and angiotensin receptor antagonists. Am J Med. Dec 2005; 118: 1428-1429 Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar ].