ALIMENTARY TRACT High frequency of anti-endomysial reactivity in candidates to heart transplant 0l6ESlllUEA DIS 2002;34:39-43 D. Pratil 2 M.T. Bardella M. Peracchi3 L. Porrettil M. Cardillol C. Pagliari3 C. Tarantino3 E. Della Torrel M. Scalamogna2 PA. Bianchi3 G. Sirchial D. Conte3 for the North Italy Trans- plant Programme Working Group [NITpI* Fmnl ’ Blood Transfusion and Transplant Immunology Gentre; 2 Organ Procurement and Tissue Bank; 3 Chair of Gestmenterology, University of Milan, Mileno, Italy. Aildram fiw Ew7dypMdbllc Dr. D. fiati, Centro Tresfusionele e di lmmuno~ogie dei Trepianti, via Francesco Sforze 35, 2D122 M&no, lee/y. Fax: +39-02-5458129. E-mail: dprnti@yahDo. corn * NlTp members co-operating in present study: A. Gembe IBergamol, E. Gronda IMi/enol, G. Faggien 0IeroneI. U. Livi IPedovel, C. Puricetli Kldinel, M. viganb (Pavial. Supported by Reseerch Grent 11998-991 from “CARiPLO Found&ion” end “Assaciaziune Amici delle Gestroentemlogia Greneili” [AAGGI Milano, kely. Submitted July 27, 2001. Accepted after revision S@&er 18,2W’. Background. A possible link between coeliac disease and dilated car- diomyopathy has recently been suggested. Aims. To assess the frequency of anti-endomysial antibodies, the mark- er for coeliac disease, in patients with different forms of heart failure, and to establish the clinical features of those endomysial antibody pos- itive Subjacts and Methods. A total of 642 consecutive patients entering the waiting list for heart transplantation from 1995 through 1997 were studied. The prevalence of endomysial IgA antibodies, determined by indirect immunofluorescence, was compared to that observed in three surveys conducted in the Italian general population. Results. Of the 642 patients, 12 [I. 9%; 95% confidence interval 0.97-3.2) resulted endomysial antibody positive, versus 34/9720 healthy controls (0.35%; 95% confidence interval, 0.23-0.47), ac- counting for a relative risk of 5.3 (95% confidence interval, 2.8-10.31. Anti-endomysial antibodies were found in 6/275 patients with dilated cardiomyopathy and 6/367 with other forms of heart failure 12.2% versus 1.6%; 95% confidence interval 0.8-4.7 and 0.6-3.51, with no statistical difference. The 12 endomysial antibody positive patients were leaner (body mass index, 22. Ok I. 9 vs 24.2&3. I, ~~0.05) than 36 seronegative patients matched for baseline demographics and ae- tiology of cardiomyopathy No differences were observed as regards clinical, biochemical and echocardiographic features, mortality in wait- ing list and 2-year post-transplant survival. Conclusions. Patients with end-stage heart failure are at increased risk for coeliac disease as compared to the general population. Digest Liver Ois 2002;34:39-43 Key words: anti-endomysial antibodies; coeliac disease; end-stage heart failure: heart transplant. Introduction Coeliac disease (CD), the inflammatory disease of the small intestine which results from gluten ingestion in genetically susceptible individuals, presents a wide spectrum of symptoms, including several extra-intestinal manifesta- tions ’ ‘. In addition, it seems that long-term untreated CD predisposes to other autoimmune disorders ’ 34. The IgA antiendomysial antibody (EmA) test allows large-scale screening for biopsy-proven CD with an almost 100% sensitivity and specificity 3. Us- ing this tool, the prevalence of CD in the general population of most West- ern countries, including Italy, was found to be between 1 in 200 and 1 in 300 1256 In a recent preliminary report ‘, CD was diagnosed in three out of 52 pa- tients on follow-up for idiopathic dilated cardiomyopathy, suggesting a pos- sible association between the two diseases. Considering that in many CD- associated conditions, a gluten-free diet successfully improves both the 39