title: Celiac disease prevalence in children and adolescents with myocarditis and dilated cardiomiopathy.
abstract: OBJECTIVE
  To determine the prevalence of celiac disease in patients with myocarditis and dilated cardiomyopathy.
  
  
  METHODS
  Fifty-six patients between 1 and 18 years old with dilated cardiomyopathy or myocarditis were evaluated and followed up at Instituto de Medicina Integral Professor Fernando Figueira. Patients with previous diagnosis of celiac disease were excluded. The functional classification was determined according to the American Heart Association criteria (classes I, II, III and IV). Diagnosis of myocarditis was reported in the patients' medical records. Dilated cardiomyopathy was diagnosed by echocardiogram with systolic dysfunction of one or both ventricles, ejection fraction lower than 55%, ventricular dilatation, and left ventricular diastolic diameter bigger than 112%. Patients answered a questionnaire about gastrointestinal and cardiac symptoms; next, anti-tissue transglutaminase (tTG) and anti-endomysial (EMA) antibodies were dosed. Those with positive antibody results were referred to intestinal biopsy and histological evaluation to detect celiac disease according to Marsh classification.
  
  
  RESULTS
  One of the 56 children (1.8%) had positive tTG antibody level, but negative EMA. Intestinal histological evaluation showed total villous atrophy. Approximately, 30% of patients had heart failure. Gastrointestinal symptoms and signs were frequent, especially abdominal pain (70%, 39/56).
  
  
  CONCLUSIONS
  Celiac disease prevalence in pediatric patients with dilated cardiomyopathy or myocarditis was 1.8%. It is important to investigate celiac disease in patients with these conditions to avoid the progression of such diseases and patients' clinical deterioration.
authors.affiliation: Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil. thaysamgal@gmail.com
authors.forename: Thaysa Maria Gama Albuquerque Leão de
authors.initials: TM
authors.lastname: Menezes
authors.forename: Maria Eugênia Farias Almeida
authors.initials: ME
authors.lastname: Motta
mesh_terms: D000293:Adolescent; D001323:Autoantibodies / Q000097:blood; D001938:Brazil / Q000453:epidemiology; D002311:Cardiomyopathy, Dilated / Q000175:diagnosis / Q000453:epidemiology*; D002446:Celiac Disease / Q000453:epidemiology* / Q000276:immunology / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007070:Immunoglobulin A / Q000276:immunology; D007223:Infant; D008297:Male; D009205:Myocarditis / Q000175:diagnosis / Q000453:epidemiology*; D015995:Prevalence; D011446:Prospective Studies; D011503:Transglutaminases / Q000276:immunology
chemical_list: D001323:Autoantibodies; D007070:Immunoglobulin A; D011503:Transglutaminases