Cardiomyopathy Associated with Celiac Disease in Childhood

Abstract

Celiac disease is predominantly a disease of the small intestine characterized by chronic malabsorption in genetically susceptible individuals who ingest grains containing gluten, such as wheat, barley, and rye. Although previously believed to be uncommon, celiac disease may be present in up to 1% of the adult and children population. Celiac disease is associated frequently with iron-deficiency anemia, dermatitis herpetiformis, selective IgA deficiency, thyroid disorders, diabetes mellitus, and various connective tissue disorders but is rarely associated with cardiomyopathy.

Left ventricular mechanics are affected in children with celiac disease: A study based on two‐dimensional speckle tracking echocardiography

“…In a previous evaluation of 277 consecutive patients with myocarditis, the presence of CD was found to be 4.4%, and the prevalence was 14 times higher than that in normal control subjects . Myocardial damage secondary to immune‐mediated mechanisms may be caused by the increased systemic absorption of various luminal antigens and infectious agents in patients with CD . Emilsson et al .…”

“…Autoimmune myocarditis and idiopathic dilated cardiomyopathy have been reported in patients with CD, and an immunological association has been suggested. Several theories have been proposed to explain the development of cardiac dysfunction, including nutritional deficiency caused by intestinal malabsorption, increased intestinal absorption of antigens, and infectious agents which may activate immune mechanisms …”

“…1 Myocardial damage secondary to immune-mediated mechanisms may be caused by the increased systemic absorption of various luminal antigens and infectious agents in patients with CD. 12 Emilsson et al 13 showed that patients with cardiomyopathy associated with CD had lower serum total carnitine levels than patients with isolated cardiomyopathy. This study supported the chronic malabsorption which is a proposed mechanism underlying in patients with CD.…”

Cardiovascular involvement in celiac disease

“…All patients diagnosed with cardiomyopathy and CD should be offered an endomyocardial biopsy for better histological and diagnostic definition[ 128 ]. It is beneficial to assess CD in children with dilated cardiomyopathy in the absence of known etiologies[ 104 , 135 ].…”

Prevalence and management of coeliac disease in people with Down’s syndrome

“…Evidence of the increased risks in infancy warrants early screening as advocated for by Bulls committee (2011) who reviewed health supervision in children with Down's syndrome. The pertinence of monitoring coeliac disease in babies with Down's syndrome is due to the links with physical and psychomotor development as well as congenital anomalies (Boskovic et al, 2012;Noori et al, 2016). Further monitoring throughout adult life if symptoms present which indicate signs of even mild gastrointestinal disturbance is also needed.…”