Blood Pressure Med Lisinopril Caused Rare Case of Small Bowel Angioedema, Report Shows

Blood Pressure Med Lisinopril Caused Rare Case of Small Bowel Angioedema, Report Shows

Lisinopril, a medication widely used to treat high blood pressure and other cardiovascular disorders,  sometimes may trigger small bowel angioedema, suggests a case report.

While rare, physicians should recognize angioedema as a possible side effect of lisinopril, and provide timely diagnosis and adequate treatment in the presence of acute abdominal pain.

The case report, “Angioedema of the small bowel caused by lisinopril,” was published in the journal BMJ Case Reports.

Lisinopril, an inhibitor of the angiotensin-converting enzyme (ACEi), often is used to treat hypertension and other cardiovascular diseases. These inhibitors are known to promote the accumulation of bradykinin, helping blood vessels relax and widen. But bradykinin also increases vessel permeability (allowing liquids and gasses to past through) the blood vessels, which contributes to angioedema.

ACEi-induced angioedema is a rare event that can affect any organ. Most often, the condition develops in the lips, tongue, face, and upper airway. But in rarer cases, it can affect other body tissues, such as the intestines.

Angioedema of the bowel, however, is difficult to diagnose, because it typically manifests with abdominal pain, nausea, vomiting, and diarrhea, which may mimic other diseases and lead to misdiagnosis.

A team led by Michigan State University researchers now presented the case of a 42-year-old man with small bowel angioedema. He had been referred to the hospital due to acute abdominal pain affecting mostly the left lower quadrant of the abdominal region.

He had a clinical history of hypertension and chronic kidney disease. He complained of severe abdominal pain that worsened whenever he ate or drank. These symptoms also were associated with nausea, vomiting, difficulty breathing, and dizziness.

An analysis of his blood showed high levels of white blood cells, suggesting inflammation. Then, a computed tomography (CT) scan from the abdominal region showed thick-walled small bowel loops, and evidence of mild free fluid in the abdominal and pelvic cavities.

Researchers suspected inflammatory bowel disease or colitis, and began treatment with the antibiotics ciprofloxacin and metronidazole. However, the patient showed no signs of improvement.

While an additional CT scan did not find any new clinical manifestation, a review of the patient’s clinical history revealed he had started lisinopril treatment about two weeks before experiencing symptoms.

Given the documented risk of bowel angioedema linked to ACEi use, treatment with lisinopril was immediately discontinued. Within 24 hours, the patient showed significant improvements, and he was subsequently discharged with no reports of recurrence.

“ACEi-induced angioedema of the small intestine is a rare adverse reaction; yet, it is important to recognize this side effect as the drug is one of the most commonly prescribed medications in the country,” the researchers concluded.

15 comments

  1. CHRISTIE PETERKIN says:

    I had this happen to me in 2010 just days after starting Lisinopril. I suffered for 2 1/2 months with 5 hospitalization, unnecessary gall bladder removal and unnecessary exploratory surgery. This was pure hell and I wouldn’t wish it on my worst enemy. No doctor had ever heard of this reaction because it’s so rare.

  2. Ruth Johnson says:

    This is happening to me right now! I’ve have been treated for ulcerative colitis since 2013 I was Told I had high pressure and put on LISINOPRIL 10mg July 2013 I was diagnosis With UC and given Asacol 800mg stomach pain started put on Prednisones for pain and told it was the UC in my upper stomach diagnosis with post nasel drip and stomach Hernia because of my coughing and throat irritation! But now after reading this I think i feel it’s the LISINOPRIL that has been causing my pain for so long! I went in the hospital for pain in February and came out with heart 2 stints I was told that’s what was causing my pain!!!! I’m so disappointed with the medicine and doctors, and hospitals!!!

    • Chris says:

      So did you not need the stents then? I’m scheduled for an angiogram on the 28th. Been having high blood pressure since emergency spinal fusion on September 25th.

  3. Rodney says:

    I have been suffering painful abdominal sensations on my left side.I know for sure now it’s the lisinopril.I added fiber,stool softener and stool softeners.Not to mention omeprazole antacids,all recommended.by my doctor.this started when I began taking lisinopril

  4. James From Bastrop says:

    I have been suffering for ten years. Sick for about 4-6 hours every night. Reviewing medical records indicate symptoms started a week after starting Lisinopril. When my next visit they told me that the abdominal pain was most likely colon cancer. They also treated me for a h Polaris infection. Last week I stopped my BP and have had no symptom.

  5. Karen says:

    I just had a terrible bout with Lisinopril. I took it for 3 days, and each day the stomach pain got worse until the 3rd day was absolutely debilitating. It felt like my intestines were on fire and they were so swollen I thought they would burst. I refused to go to the emergency room because i knew from googling it that there was nothing they could do (except a lot of unnecessary tests or surgeries) so I just endured it writhing in pain for 36 hours until it finally started to subside. I reported it to my doctor so she could have a record and maybe warn patients, and she just said since I didn’t go to the emergency room and she hasn’t heard of this reaction that it must be something else. I don’t take any other medications at all. I wouldn’t wish this terrible ordeal on my worst enemy. but since doctors don’t want to hear about it, more unsuspecting people will suffer this too.

  6. I just had a terrible bout with Lisinopril. I took it for 3 days and each day the stomach pain got worse until ti was absolutely excruciating after the 3rd dose. My intestines felt like they were on fire and they were so swollen I thought they would burst. I refused to go to the emergency room because I googled it, and knew there was nothing they could do (except lots of unnecessary tests and possibly surgeries). So i just endured it writhing in pain until it finally subsided after 36 hours. I reported it to my doctor so she could have a record and hopefully warn other patients about it, but she said since I didn’t go to the emergency room and she has never heard of this reaction, that it must be something else. I don’t take any other medications. I wouldn’t wish that pain on my worst enemy, but since doctors don’t seem to want to hear about it, I’m afraid more unsuspecting people might have to go through this.

  7. Lisa says:

    Having what feels like pressure upper left side… with gas and bloating i look 7 mths pregnant… intestines are not Functioning normal been on this meds for like 5 years… could it cause this???

  8. The OVC says:

    SO glad to discover this article! I have been on lisinopril, for a few years, but hadn’t had any issues. I ran out of medication, about a year ago and just started taking it again, the second week in Nov. The week before T’giving Day, I noticed pain on the left side of my upper abdomen, with moved to the right side, by the following week. My wife & I thought it was “gas pains”, because a belch relieved it, a bit. A week before Christmas, I couldn’t laugh, sleep on my left side or even take a bowel movement because the pressure of bearing down, shot up into that area! One morning, my throat was especially dry & irritated & I thought I must have REALLY been snoring. A drink of water didn’t relieve and it felt as if my uvula was swollen, as well. I didn’t want to go to the ER, for them to no know what to do, and was ready to go to the doctor. BUT, I thought on what was so different from last month, to this month, and why the pain was increasing. -The difference was 20g of lisinopril, every day and I just STOPPED. The next night, I felt less pain and five days later, the pain is almost gone, unless I press on the area, “looking for the pain.” I started taken garlic pills for HBP, instead! (Sending this URL to my doctor that originally prescribed the pill!)

  9. Vickie says:

    My husband currently taking this medication. He haven’t had any problems with it so far, but I will be on the look out for these symptoms.

  10. James Waker says:

    I am James from Bastrop. I have been off my Linisopril for 60 days with no reoccurrence of of the angieodemea of my intestines. I have done some research and it turns out that linisopril causes H-pylori and the H-pylori becomes a carcinogen. So my question is do I have to worry about intestinal, lung, liver or kidney cancer? After 10 years of thinking I was dying every night, now I have to worry about cancer. I did deserve this. No one does.

  11. Kari Carden says:

    I began taking this medication 5 days ago. On the third day, I was having excruciating abdominal pain/cramping and vomiting to the point of almost passing out. Went to the ER. White blood count elevated, rapid pulse and significant bloating. I had the pharmaceutical print out of possible reactions with me. Showed the first two Drs. and they basically laughed me off. Ended up having a CT scan and when the results came back; sure enough the radiologist and third doctor diagnosed angioedema. I was hospitalized, put on major steroids and pain medicine. Spent 2 nights and came home today. Still feeling cramped and not well but a hundred times better! This reaction needs to be recognized more! By far worse pain I have ever experienced. Doctors need to understand this better if they are going to prescribe this medicine. I am thankful the one ER doctor and radiologist listened to me. Sorry for those of you that had to endure such unnecessary procedures. Keep advocating for this diagnosis!!

  12. ClaudiaW3 says:

    I started taking lisinopril 10 mg. Today I came home from work due to sharp abdominal pain and diarrhea. Contacted my doctor and told me to monitor my symptoms for 2 days and continue the lisinopril, she said if the symptoms don’t go away it’s probably the lisinopril and a rare reaction…must be angioedema, at least she’s aware and wont have to deal with looking like your nuts. Hoping she switches me to something different anyway. Best of luck to all of you dealing with this, and thanks to those who have shared their stories!

  13. jon doe says:

    Started lisinopril 10 mg Jan 29 2019 by the 3rd day i thought i was dying . Worst stomach pain or pain i have ever had in my life. Never had bought with blood pressure being high until CDC rules on pain medication came out. Now i have uncontrolled pain and high blood pressure with heart problems due to CDC effects on doctors rx.

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