{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T06:54:24Z","timestamp":1775890464771,"version":"3.50.1"},"reference-count":42,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2024,11,18]],"date-time":"2024-11-18T00:00:00Z","timestamp":1731888000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Celiac disease (CD) is associated with an increased risk of cardiovascular (CV) events, especially inflammatory heart diseases. We aimed to gather evidence on the association between CD and inflammatory CV diseases, including pericarditis and myocarditis, and the underlying pathophysiological mechanisms. Methods: The PubMed, Scopus, and Google Scholar databases were searched for studies assessing the prevalence and the long-term outcomes of patients with CD and inflammatory CV diseases. Result: Ten studies (nine case series\/reports and one prospective observational study) covering a total of 22 patients, including 9 women (41%) and 13 men (59%), were evaluated. The median age was 23 (IQR, 12\u201341) years. A total of 6 patients had recurrent pericarditis, while 16 patients had celiac-related myocarditis (11 patients presented with heart failure and 5 with arrhythmia). A strict gluten-free diet (GFD) alone was effective in 87.5% of cases (4\/6 for pericarditis and 10\/16 for myocarditis). All patients with pericarditis achieved complete resolution of symptoms. Conversely, heart function was restored in 81% of patients with myocarditis. Only one patient died. Conclusions: Myocarditis and\/or pericarditis, especially if recurrent, may complicate CD in pediatric and adult subjects due to an autoimmune reaction involving the pericardium\/myocardium and the small intestine.<\/jats:p>","DOI":"10.3390\/jcm13226936","type":"journal-article","created":{"date-parts":[[2024,11,19]],"date-time":"2024-11-19T10:44:37Z","timestamp":1732013077000},"page":"6936","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Celiac Disease and Inflammatory Cardiomyopathies: Exploring the Heart-Gut Axis"],"prefix":"10.3390","volume":"13","author":[{"given":"Lucia Ilaria","family":"Birtolo","sequence":"first","affiliation":[{"name":"Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, \u201cPoliclinico Umberto I\u201d Hospital, Viale del Policlinico, 155, 00161 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gianluca","family":"Di Pietro","sequence":"additional","affiliation":[{"name":"Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, \u201cPoliclinico Umberto I\u201d Hospital, Viale del Policlinico, 155, 00161 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Riccardo","family":"Improta","sequence":"additional","affiliation":[{"name":"Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, \u201cPoliclinico Umberto I\u201d Hospital, Viale del Policlinico, 155, 00161 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6211-4482","authenticated-orcid":false,"given":"Paolo","family":"Severino","sequence":"additional","affiliation":[{"name":"Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, \u201cPoliclinico Umberto I\u201d Hospital, Viale del Policlinico, 155, 00161 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4909-0436","authenticated-orcid":false,"given":"Endrit","family":"Shahini","sequence":"additional","affiliation":[{"name":"Gastroenterology Unit, National Institute of Gastroenterology-IRCCS \u201cSaverio de Bellis\u201d, 70013 Castellana Grotte, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3540-4983","authenticated-orcid":false,"given":"Carmine Dario","family":"Vizza","sequence":"additional","affiliation":[{"name":"Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, \u201cPoliclinico Umberto I\u201d Hospital, Viale del Policlinico, 155, 00161 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1007\/BF01393769","article-title":"Adult celiac disease and recurrent pericarditis","volume":"27","author":"Faizallah","year":"1982","journal-title":"Dig. Dis. Sci."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2611","DOI":"10.1161\/01.CIR.0000017880.86166.87","article-title":"Celiac disease associated with autoimmune myocarditis","volume":"105","author":"Frustaci","year":"2002","journal-title":"Circulation"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"101999","DOI":"10.1016\/j.cpcardiol.2023.101999","article-title":"Accelerated Atherosclerosis and Management of Cardiovascular Risk in Autoimmune Rheumatic Diseases: An Updated Review","volume":"48","author":"Karakasis","year":"2023","journal-title":"Curr. Probl. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1111\/j.1365-2796.2007.01843.x","article-title":"Cardiomyopathy, pericarditis and myocarditis in a population-based cohort of inpatients with coeliac disease","volume":"262","author":"Hamsten","year":"2007","journal-title":"J. Intern. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1136\/bmjebm-2017-110853","article-title":"Methodological quality and synthesis of case series and case reports","volume":"23","author":"Murad","year":"2018","journal-title":"BMJ Evid. Based Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"i4919","DOI":"10.1136\/bmj.i4919","article-title":"ROBINS-I: A tool for assessing risk of bias in non-randomised studies of interventions","volume":"355","author":"Sterne","year":"2016","journal-title":"BMJ"},{"key":"ref_8","first-page":"5437","article-title":"Atherosclerosis and cardiovascular involvement in celiac disease: The role of autoimmunity and inflammation","volume":"21","author":"Santoro","year":"2017","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Mannarino, S., Santacesaria, S., Raso, I., Fini, G., Pozzi, E., Cocuccio, C., Calcaterra, V., and Zuccotti, G. (2022). Atrioventricular Block in Celiac Disease: An Unusual Clinical Presentation in a Child. A Case-Based Review. Children, 9.","DOI":"10.3390\/children9111627"},{"key":"ref_10","first-page":"11","article-title":"Indirect immunofluorescence for anti-jejunum antibody detection in celiac disease: Comparison among different antigenic substrates","volume":"45","author":"Grosso","year":"1999","journal-title":"Minerva Gastroenterol. Dietol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.ejim.2021.08.018","article-title":"Exploring the possible link between myocarditis and mRNA COVID-19 vaccines","volume":"92","author":"Sinagra","year":"2021","journal-title":"Eur. J. Intern. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1179\/2046905513Y.0000000078","article-title":"Severe heart failure, dilated cardiomyopathy and pulmonary haemosiderosis in coeliac disease: Report of two cases","volume":"34","author":"Poddar","year":"2014","journal-title":"Paediatr. Int. Child. Health"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1304","DOI":"10.1080\/00365520410003533","article-title":"Severe heart disease in coeliac sprue and inflammatory Bowel disease: A common pathogenesis?","volume":"39","author":"Bardella","year":"2004","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Wang, Y., Chen, B., Ciaccio, E.J., Jneid, H., Virani, S.S., Lavie, C.J., Lebovits, J., Green, P.H.R., and Krittanawong, C. (2023). Celiac Disease and the Risk of Cardiovascular Diseases. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms24129974"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1097\/MCG.0000000000001267","article-title":"Celiac Disease: Extraintestinal Manifestations and Associated Conditions","volume":"54","author":"Therrien","year":"2020","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1210","DOI":"10.1136\/gutjnl-2013-306578","article-title":"Diagnosis and management of adult coeliac disease: Guidelines from the British Society of Gastroenterology","volume":"63","author":"Ludvigsson","year":"2014","journal-title":"Gut"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1186\/s43044-024-00534-x","article-title":"The heart of celiac disease: Understanding dilated cardiomyopathy, pathophysiology, and care\u2014A systematic review","volume":"76","author":"Yadavalli","year":"2024","journal-title":"Egypt. Heart J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"177","DOI":"10.7861\/clinmedicine.18-2-177","article-title":"Dilated cardiomyopathy as the first presentation of coeliac disease: Association or causation?","volume":"18","author":"Patel","year":"2018","journal-title":"Clin. Med."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Pecora, F., Persico, F., Gismondi, P., Fornaroli, F., Iuliano, S., de\u2019Angelis, G.L., and Esposito, S. (2020). Gut Microbiota in Celiac Disease: Is There Any Role for Probiotics?. Front. Immunol., 11.","DOI":"10.3389\/fimmu.2020.00957"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Nesci, A., Carnuccio, C., Ruggieri, V., D\u2019Alessandro, A., Di Giorgio, A., Santoro, L., Gasbarrini, A., Santoliquido, A., and Ponziani, F.R. (2023). Gut Microbiota and Cardiovascular Disease: Evidence on the Metabolic and Inflammatory Background of a Complex Relationship. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms24109087"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1499","DOI":"10.1016\/j.vaccine.2021.11.074","article-title":"Myocarditis and pericarditis: Case definition and guidelines for data collection, analysis, and presentation of immunization safety data","volume":"40","author":"Munoz","year":"2022","journal-title":"Vaccine"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"3158","DOI":"10.1016\/j.jacc.2018.09.072","article-title":"Cardiovascular Magnetic Resonance in Nonischemic Myocardial Inflammation: Expert Recommendations","volume":"72","author":"Ferreira","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1475","DOI":"10.1016\/j.jacc.2009.02.007","article-title":"Cardiovascular magnetic resonance in myocarditis: A JACC White Paper","volume":"53","author":"Friedrich","year":"2009","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2636","DOI":"10.1093\/eurheartj\/eht210","article-title":"Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: A position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases","volume":"34","author":"Caforio","year":"2013","journal-title":"Eur. Heart J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2921","DOI":"10.1093\/eurheartj\/ehv318","article-title":"2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC)Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS)","volume":"36","author":"Adler","year":"2015","journal-title":"Eur. Heart J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1136\/hrt.22.5.651","article-title":"Acute non-specific pericardity","volume":"22","author":"Swan","year":"1960","journal-title":"Br. Heart J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1136\/bmj.1.6112.537","article-title":"Celiac disease and immunological disorders","volume":"1","author":"Cooper","year":"1978","journal-title":"Br. Meal J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1136\/bmj.2.5600.272","article-title":"Recurrent pericarditis","volume":"12","author":"Robinson","year":"1968","journal-title":"Br. Med. J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1111\/j.0954-6820.1954.tb01714.x","article-title":"Acute non-specific pericardity","volume":"148","author":"Krook","year":"1954","journal-title":"Acta Med. Scand."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1161\/01.CIR.3.3.321","article-title":"Acute non-specific pericarditis, clinical, laboratory, and follow-up considerations","volume":"3","author":"Carmichael","year":"1951","journal-title":"Circulation"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1016\/S0140-6736(81)92187-5","article-title":"Coeliac disease presenting as recurrent pericarditis","volume":"1","author":"Dawes","year":"1981","journal-title":"Lancet"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"3168","DOI":"10.1001\/jama.1984.03350220074036","article-title":"Recurrent pericarditis and celiac disease","volume":"252","author":"Laine","year":"1984","journal-title":"JAMA"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1016\/S0022-3476(73)80361-0","article-title":"Immunology of the gastrointestinal tract. II","volume":"83","author":"Walker","year":"1973","journal-title":"J. Pediatr."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"439","DOI":"10.2223\/JPED.2219","article-title":"Celiac disease prevalence in children and adolescents with myocarditis and dilated cardiomiopathy","volume":"88","author":"Menezes","year":"2012","journal-title":"J. Pediatr."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"782","DOI":"10.12669\/pjms.38.4.6129","article-title":"Clinical spectrum of Celiac disease from a cardiology perspective","volume":"38","author":"Myrmel","year":"2022","journal-title":"Pak. J. Med. Sci."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"641","DOI":"10.2298\/SARH1210641M","article-title":"Dilated cardiomyopathy associated with celiac disease: Case report and literature review","volume":"140","year":"2012","journal-title":"Srp. Arh. Celok. Lek."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"5689","DOI":"10.4103\/jfmpc.jfmpc_2499_21","article-title":"Recurrent heart failure in a child with underlying dilated cardiomyopathy associated with celiac disease: An unusual presentation","volume":"11","author":"Mehra","year":"2022","journal-title":"J. Fam. Med. Prim. Care"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1604","DOI":"10.1002\/ehf2.13163","article-title":"The multiple faces of autoimmune\/immune-mediated myocarditis in children: A biopsy-proven case series treated with immunosuppressive therapy","volume":"8","author":"Marcolongo","year":"2021","journal-title":"ESC Heart Fail."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1016\/S0140-6736(75)90365-7","article-title":"Celiac disease, a cause of various associated diseases?","volume":"2","author":"Scott","year":"1975","journal-title":"Lancet"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1007\/s10787-023-01227-8","article-title":"Empagliflozin attenuates intestinal inflammation through suppression of nitric oxide synthesis and myeloperoxidase activity in in vitro and in vivo models of colitis","volume":"32","author":"Makaro","year":"2024","journal-title":"Inflammopharmacology"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Scisciola, L., Cataldo, V., Taktaz, F., Fontanella, R.A., Pesapane, A., Ghosh, P., Franzese, M., Puocci, A., De Angelis, A., and Sportiello, L. (2022). Anti-inflammatory role of SGLT2 inhibitors as part of their anti-atherosclerotic activity: Data from basic science and clinical trials. Front. Cardiovasc. Med., 9.","DOI":"10.3389\/fcvm.2022.1008922"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/22\/6936\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:34:22Z","timestamp":1760114062000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/22\/6936"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,18]]},"references-count":42,"journal-issue":{"issue":"22","published-online":{"date-parts":[[2024,11]]}},"alternative-id":["jcm13226936"],"URL":"https:\/\/doi.org\/10.3390\/jcm13226936","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,18]]}}}