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    Heart Failure, Cardiomyopathy and Celiac Disease By Laura Yick


    Scott Adams


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    Celiac.com 02/26/2003 - The subject of cardiology-related symptoms of celiac disease and celiac disease-associated cardiological disease has not been reviewed. So, here I attempt to summarize readings of research papers and abstracts of research papers dealing with the topic. My interest in cardiac related issues in association with celiac disease is related to a familial history of hypertrophic cardiomyopathy which like celiac disease can be missed and some times before a person is found to have it he/she may experience an episode of sudden cardiac arrest, or syncope (fainting). End stage hypertrophic cardiomyopathy can look like dilated cardiomyopathy. Dilated cardiomyopathy has been associated with celiac disease.

    Celiac disease and Cardiomyopathy and Heart Failure
    A study of 642 patients who were candidates for heart transplant in Italy found that 1.9% had anti-endomysial antibodies (AEA) (compared to 0.35% of 720 healthy controls) and that 2.2% of 275 patients with dilated cardiomyopathy were AEA-positive (compared to 1.6% in the remaining transplant candidates) (Prati D, et al, 2002, Am J Gastroenterol 97:218; Prati D, et al, 2002, Dig Liver Dis 34:39). Although an association was found, there was no way to assess cause and effect. The AEA-positive patients and AEA-negative patients presented with similar cardiologic criteria and had similar 2-year post-transplant survival. Similar, but more limited findings were described in preliminary data (Curione M, et al, 1997, Lancet 354: 222). The authors suggest a study of whether a gluten-free diet improves cardiac function in such patients. A study in Italy found that 5% of 60 elderly (over 65 years) celiac disease patients died during the study due to heart failure (Gasbarrini G, et al, 2001, Gerontology 47:306). The authors determined that this was significantly higher than the non-celiac disease population, but dont give a non-celiac disease rate. Furthermore, 0.4% of 226 non-elderly adult celiac disease patients died with heart failure as the cause and this rate was not significantly higher than the comparable non-celiac disease population. Other cardiological symptoms and disorders were not assessed.

    Common Causes?
    In a case study, similar cellular changes were found in both the intestinal microvilli and the heart muscle of a patient who had both idiopathic congestive cardiomyopathy and celiac disease (Chuaqui B, et al, 1986, Pathol Res Pract 181:604). While this was a limited study and the molecular causes of each were not evaluated, it is an intriguing find. In another case study, a celiac disease patient also had recurrent hemoptysis and developed heart block (Mah MW, et al, 1989, Can J Cardiol 5:191). The authors hypothesize that there is a common cause of the symptoms above. The cause is undefined by the authors. Similarly, a patient who had chronic anemia, cardiomyopathy, and heart block but did not have digestive symptoms was found to have anti-gliadin antibodies (AGA), AEA, and anti-reticulin antibodies (ARA) as well as the typical celiac biopsy (Rubio JLC, et al, 1998, Am J Gastroenterol 93:1391). The authors found that after 1 year of gluten-free diet, blood tests and biopsy were normal and confirm celiac disease as a diagnosis; but they do not mention whether or not the cardiomyopathy and heart block resolved.

    Celiac Disease and Autoimmune Myocarditis
    In an Italian study, 187 patients, including 110 with heart failure and 77 with arrhythmias, diagnosed with myocarditis were tested for celiac disease (Frustaci A, et al, 2002, Circulation 105:2611). Thirteen patients had IgA tissue transglutaminase antibodies (tTGA); all had anemia. Nine of the thirteen were AEA-positive; these patients also had abnormal biopsies. Thus, 4.4% of myocarditis patients had celiac disease (they compare this to 0.6% in the non-myocarditis population; this was statistically significant. Eight of the nine myocarditis patients with celiac disease had HLA DQ2-DR3, the other patient had DQ2-DR5/DR7. Five of the nine myocarditis patients with celiac disease had heart failure and were treated with immunosuppression and gluten-free diet. The other four myocarditis patients with celiac disease had heart arrhythmias and were treated with gluten-free diet. All nine patients markedly improved in cardiologic features and were tTG- and AEA-negative post-treatment (8-12 months) .

    Other Cardiologic Diseases
    Celiac Disease and Ischemic heart disease: In a report made in 1976, celiac disease was associated with a decrease in ischemic heart disease in 77 members of the Coeliac Society of England and Wales (Whorwell PJ, et al, 1976, Lancet 2:113). In another study with 653 celiac disease patients, the authors found no decrease in ischemic heart disease or stroke for celiac disease patients (Logan RF, et al, 1989, Gastroenterology 97:265). A recent study examined the risk factors for ischemic heart disease in dermatitis Herpetaformis patients (Lear JT, et al, 1997, J Royal Soc Med 90:247). The authors found that, compared to the normal population, dermatitis Herpetaformis patients had lower cholesterol, lower triglycerides, lower apolipoprotein B, lower fibrinogen, higher HDL2, smoked less, and were generally of higher social class.

    Pericarditis
    Dermatitis herpetiformis has also been found to be associated with recurrent pericarditis (Afrasiabi R, et al, 1990, Chest 97:1006). The authors found IgG, IgA, and complement in the pericardium, thus demonstrating similarities with the skin deposition of IgA in dermatitis Herpetaformis lesions.

    Summary
    While there hasnt been a comprehensive review by a celiac disease researcher, the research papers summarized here point to a correlation of celiac disease with cardiomyopathy, heart arrhythmias, and heart failure. The authors of the articles summarized here often point to a probable association of autoimmune disease in both celiac disease and related heart diseases.

    Glossary of terms:

    • Cardiomyopathy: aberrant heart muscle structure.
    • Congenital: non-inherited, usually referring to what is considered a "birth defect."
    • Heart block: blockage of the conduction of the heart electrical signaling system which regulates the heart beat.
    • Hemoptysis: spitting blood, usually due to lesions to the respiratory tract or voice box.
    • Idiopathic: often used to describe something whose origin is unknown.
    • Ischemic heart disease: heart damage due to insufficient blood flow to the heart (i.e., via the coronary arteries).
    • Myocarditis: inflammation of the heart muscle.
    • Pericarditis: inflammation of the pericardium, a sac which encloses the heart.
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    Guest G. LaValle

    Posted

    I have celiac/dermatitis herpetaformis and presently referred to a cardiologist for possible pericarditis.

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    Guest Mary-Frances Reavey

    Posted

    First article I could find linking celiac with dilated cardiomyopathy. I have had heart problems for 10 years and was recently diagnosed with celiac disease and now all my 'heart numbers' are out of whack. My Cardiologist is on the ball and is doing further testing for cardiomyopathy as well as changing some of my meds . . he was also the doctor to first notice the anemia and started that ball rolling. . . hope to find more articles on this link.

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    Guest Peter Robinson

    Posted

    At 30 years old I self diagnosed celiac disease and went gluten free for about 10 years. At forty I resumed regular diet. I'm 57 and just had a heart attack (ischemic, right coronary artery. I had been on BP and chloresterol meds for 2 years, my total was 158 but HDL's only 26, to low. I suspect the same thing killed Dad.

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    Guest Brian L. E.

    Posted

    I am in the medical profession. I diagnosed myself with celiac disease after slowly eliminating parts of my diet. I am positive for allergy to gluten, including wheat, rye and oats. I developed heart block after a two mitral valve transplant. I had returned to school and decided to eat very excellent quality breads. Thereafter, I developed ischemia with heart block. I have a pacemaker now but was fine right after the mitral valve operation. My symptoms were near syncope just before bowel movement, relieved by bowel movement. I also developed swelling due to inflammation and also edema. I recently discovered the oat gluten residual affects, after I had eliminated all wheat gluten with great results. Now (in the last week, since eliminated the Quaker oats products), I do not have the near syncope symptoms. Thank you for a nice article, which I will give to my Doctor--I am a Veteran in the U.S., so I have great medical care.

    Brian

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    Guest stacey

    Posted

    I recently self diagnosed myself with gluten intolerance or celiac. One of my symptoms has been heart palpitations and chest pain. I am an avid runner and have been my whole life, so the heart issues confused me. I had various other health issues that could not be diagnosed. One being severe muscle pains as well as the strange heart symptoms. I stopped eating gluten and this has all gone away. I've retested myself by reintroducing gluten. Muscle pain, palpations and heart pain come right back.

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    I am in the medical profession. I diagnosed myself with celiac disease after slowly eliminating parts of my diet. I am positive for allergy to gluten, including wheat, rye and oats. I developed heart block after a two mitral valve transplant. I had returned to school and decided to eat very excellent quality breads. Thereafter, I developed ischemia with heart block. I have a pacemaker now but was fine right after the mitral valve operation. My symptoms were near syncope just before bowel movement, relieved by bowel movement. I also developed swelling due to inflammation and also edema. I recently discovered the oat gluten residual affects, after I had eliminated all wheat gluten with great results. Now (in the last week, since eliminated the Quaker oats products), I do not have the near syncope symptoms. Thank you for a nice article, which I will give to my Doctor--I am a Veteran in the U.S., so I have great medical care.

    Brian

    This is the first time I have ever heard anyone mention syncope before bowel movements. Doctors think I'm crazy and have no idea what I'm talking about. I have had many episodes of dropping blood pressure and near fainting before extreme episodes of diarrhea. I have always thought that I don't tolerate wheat but when I had blood tests they were negative. What causes the fainting? I have never heard of anyone else having that symptom.

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    Guest Tawanna

    Posted

    My son and I are gluten-free, self-diagnosed Celiacs, though my blood tests do show a positive allergy to gluten. The results I've seen since we have been gluten-free are astounding.

     

    My father died at age 50. He had numerous heart attacks prior to his death. Looking back, I wish I knew then what I know now. I wish he could have tried the gluten-free diet before I lost him.

     

    I'm convinced the remaining of my family members are Celiac as well. I just wish I could convince them. My brother, at age 32, has already began following in my father's footsteps with heart attacks at an early age. He doesn't believe that he has any problem with gluten, but I honestly fear that I will lose him if I can't change his mind.

     

    Glad that there are articles like this that I can share with him to try to get him to reconsider his diet.

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    Guest Helen

    Posted

    Very interesting. As I find more and more information, I am convinced that my father had celiac disease. He had classic symptoms like wasted buttocks and pot belly and flat feet. He was never diagnosed. My father had his first heart attack at age 63 and a fatal one at age 68. My paternal grandfather died at age 50 from a massive heart attack. My parents always wrote my grandfather's death off to his life style - cigarettes, alcohol and rich foods. Now, I'm thinking these heart attacks have to do with celiac disease.

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    Guest Melissa

    Posted

    This is the first time I have ever heard anyone mention syncope before bowel movements. Doctors think I'm crazy and have no idea what I'm talking about. I have had many episodes of dropping blood pressure and near fainting before extreme episodes of diarrhea. I have always thought that I don't tolerate wheat but when I had blood tests they were negative. What causes the fainting? I have never heard of anyone else having that symptom.

    I have had the same thing for many years. I was diagnosed with IBS and told I would have to suffer. Fast forward about 10 years when my son was diagnosed with celiac disease. I decided to go gluten free to keep him safe in our home. All problems stopped! What I had experienced all those years was due to undiagnosed celiac disease.

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    I am 29 years old and found out I am gluten intolerant 2 years ago through genetic testing from Enterolab.com. I had always had a bad stomach and odd ailments like heart palpitations, arthritis as a teenager, anxiety and panic attacks in my 20's I was diagnosed with "irritable bowel" over and over again and it wasn't until I went gluten free that all my ailments disappeared! No more 3X daily stomach aches, no passing out after eating a bowl of pasta and now my father keeps having heart episodes and Minor attacks! He has had 6 or 7 stents done in the past 3 years and the doctors are all baffled by it because his #'s are good! I'm trying to convince him to go gluten free, it's been a 2 year battle! He just had another stent today. I hope I can convince him before it's too late! I will be sending him this article!

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    Sources:
    1. Toft M, Dietrichs E. Aggravated stuttering following subthalamic deep brain stimulation in Parkinson’s disease--two cases. BMC Neurol. 2011 Apr 8;11:44.
    2. Tani T, Sakai Y. Stuttering after right cerebellar infarction: a case study. J Fluency Disord. 2010 Jun;35(2):141-5. Epub 2010 Mar 15.
    3. Lundgren K, Helm-Estabrooks N, Klein R. Stuttering Following Acquired Brain Damage: A Review of the Literature. J Neurolinguistics. 2010 Sep 1;23(5):447-454.
    4. Jäncke L, Hänggi J, Steinmetz H. Morphological brain differences between adult stutterers and non-stutterers. BMC Neurol. 2004 Dec 10;4(1):23.
    5. Kell CA, Neumann K, von Kriegstein K, Posenenske C, von Gudenberg AW, Euler H, Giraud AL. How the brain repairs stuttering. Brain. 2009 Oct;132(Pt 10):2747-60. Epub 2009 Aug 26.
    6. Galantucci S, Tartaglia MC, Wilson SM, Henry ML, Filippi M, Agosta F, Dronkers NF, Henry RG, Ogar JM, Miller BL, Gorno-Tempini ML. White matter damage in primary progressive aphasias: a diffusion tensor tractography study. Brain. 2011 Jun 11.
    7. Lundgren K, Helm-Estabrooks N, Klein R. Stuttering Following Acquired Brain Damage: A Review of the Literature. J Neurolinguistics. 2010 Sep 1;23(5):447-454.
    8. [No authors listed] Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 43-1988. A 52-year-old man with persistent watery diarrhea and aphasia. N Engl J Med. 1988 Oct 27;319(17):1139-48
    9. Molteni N, Bardella MT, Baldassarri AR, Bianchi PA. Celiac disease associated with epilepsy and intracranial calcifications: report of two patients. Am J Gastroenterol. 1988 Sep;83(9):992-4.
    10. http://ezinearticles.com/?Food-Allergy-and-Stuttering-Link&id=1235725 
    11. http://www.craig.copperleife.com/health/stuttering_allergies.htm 
    12. https://www.celiac.com/forums/topic/73362-any-help-is-appreciated/
    13. Ford RP. The gluten syndrome: a neurological disease. Med Hypotheses. 2009 Sep;73(3):438-40. Epub 2009 Apr 29.
    14. Hadjivassiliou M, Gibson A, Davies-Jones GA, Lobo AJ, Stephenson TJ, Milford-Ward A. Does cryptic gluten sensitivity play a part in neurological illness? Lancet. 1996 Feb 10;347(8998):369-71.

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    However, researchers really don’t have much data regarding the frequency and significance of clonal T cell receptor (TCR) gene rearrangements (TCR-GRs) in small bowel (SB) biopsies of patients without RCDII. Such data could provide useful comparison information for patients with RCDII, among other things.
    To that end, a research team recently set out to try to get some information about the frequency and importance of clonal T cell receptor (TCR) gene rearrangements (TCR-GRs) in small bowel (SB) biopsies of patients without RCDII. The research team included Shafinaz Hussein, Tatyana Gindin, Stephen M Lagana, Carolina Arguelles-Grande, Suneeta Krishnareddy, Bachir Alobeid, Suzanne K Lewis, Mahesh M Mansukhani, Peter H R Green, and Govind Bhagat.
    They are variously affiliated with the Department of Pathology and Cell Biology, and the Department of Medicine at the Celiac Disease Center, New York Presbyterian Hospital/Columbia University Medical Center, New York, USA. Their team analyzed results of TCR-GR analyses performed on SB biopsies at our institution over a 3-year period, which were obtained from eight active celiac disease, 172 celiac disease on gluten-free diet, 33 RCDI, and three RCDII patients and 14 patients without celiac disease. 
    Clonal TCR-GRs are not infrequent in cases lacking features of RCDII, while PCPs are frequent in all disease phases. TCR-GR results should be assessed in conjunction with immunophenotypic, histological and clinical findings for appropriate diagnosis and classification of RCD.
    The team divided the TCR-GR patterns into clonal, polyclonal and prominent clonal peaks (PCPs), and correlated these patterns with clinical and pathological features. In all, they detected clonal TCR-GR products in biopsies from 67% of patients with RCDII, 17% of patients with RCDI and 6% of patients with gluten-free diet. They found PCPs in all disease phases, but saw no significant difference in the TCR-GR patterns between the non-RCDII disease categories (p=0.39). 
    They also noted a higher frequency of surface CD3(−) IELs in cases with clonal TCR-GR, but the PCP pattern showed no associations with any clinical or pathological feature. 
    Repeat biopsy showed that the clonal or PCP pattern persisted for up to 2 years with no evidence of RCDII. The study indicates that better understanding of clonal T cell receptor gene rearrangements may help researchers improve refractory celiac diagnosis. 
    Source:
    Journal of Clinical Pathologyhttp://dx.doi.org/10.1136/jclinpath-2018-205023

    Jefferson Adams
    Celiac.com 06/13/2018 - There have been numerous reports that olmesartan, aka Benicar, seems to trigger sprue‐like enteropathy in many patients, but so far, studies have produced mixed results, and there really hasn’t been a rigorous study of the issue. A team of researchers recently set out to assess whether olmesartan is associated with a higher rate of enteropathy compared with other angiotensin II receptor blockers (ARBs).
    The research team included Y.‐H. Dong; Y. Jin; TN Tsacogianis; M He; PH Hsieh; and JJ Gagne. They are variously affiliated with the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School in Boston, MA, USA; the Faculty of Pharmacy, School of Pharmaceutical Science at National Yang‐Ming University in Taipei, Taiwan; and the Department of Hepato‐Gastroenterology, Chi Mei Medical Center in Tainan, Taiwan.
    To get solid data on the issue, the team conducted a cohort study among ARB initiators in 5 US claims databases covering numerous health insurers. They used Cox regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for enteropathy‐related outcomes, including celiac disease, malabsorption, concomitant diagnoses of diarrhea and weight loss, and non‐infectious enteropathy. In all, they found nearly two million eligible patients. 
    They then assessed those patients and compared the results for olmesartan initiators to initiators of other ARBs after propensity score (PS) matching. They found unadjusted incidence rates of 0.82, 1.41, 1.66 and 29.20 per 1,000 person‐years for celiac disease, malabsorption, concomitant diagnoses of diarrhea and weight loss, and non‐infectious enteropathy respectively. 
    After PS matching comparing olmesartan to other ARBs, hazard ratios were 1.21 (95% CI, 1.05‐1.40), 1.00 (95% CI, 0.88‐1.13), 1.22 (95% CI, 1.10‐1.36) and 1.04 (95% CI, 1.01‐1.07) for each outcome. Patients aged 65 years and older showed greater hazard ratios for celiac disease, as did patients receiving treatment for more than 1 year, and patients receiving higher cumulative olmesartan doses.
    This is the first comprehensive multi‐database study to document a higher rate of enteropathy in olmesartan initiators as compared to initiators of other ARBs, though absolute rates were low for both groups.
    Source:
    Alimentary Pharmacology & Therapeutics