Celiac disease associated with autoimmune myocarditis.

Area of Science:

• Cardiology
• Gastroenterology
• Immunology

Background:

• Celiac disease (CD) and myocarditis are linked to systemic autoimmune disorders.
• The co-occurrence of CD and myocarditis has not been previously investigated.
• Investigating this link may have significant clinical implications.

Purpose of the Study:

• To investigate the coexistence of celiac disease (CD) and myocarditis.
• To determine the prevalence of CD markers in patients with myocarditis.
• To evaluate the impact of autoimmune processes on both the heart and small intestine.

Main Methods:

• Serum screening of 187 myocarditis patients for cardiac autoantibodies, anti-tissue transglutaminase (IgA-tTG), and anti-endomysial antibodies (AEAs).
• Duodenal endoscopy, biopsy, and HLA analysis for IgA-tTG and AEA-positive patients.
• Comparison with a control group of 306 normal individuals.

Main Results:

• 9 out of 187 (4.4%) myocarditis patients tested positive for AEA and showed evidence of CD.
• CD was significantly more prevalent in myocarditis patients than in controls (4.4% vs 0.3%, P<0.003).
• Myocarditis patients with CD experienced heart failure or ventricular arrhythmias; treatment with immunosuppression and/or a gluten-free diet led to recovery or improvement.

Conclusions:

• A shared autoimmune process affecting the myocardium and small bowel is present in over 4% of myocarditis patients.
• Immunosuppression and a gluten-free diet are effective therapeutic strategies for these patients.
• This study highlights a potential autoimmune link between CD and myocarditis.