Gluten-free diets are becoming more common and more readily implemented into everyday lifestyles, gaining in popularity recently. Until now, it has been seen as a necessity, often inconvenient and inconvenient in conditions such as coeliac disease or During's disease [6], but nowadays, especially in the United States, following the example of celebrities, a growing number of people are implementing gluten-free products into their menus without justifying it medically. Another reason for the greater interest in this type of diet is that diagnostic techniques for autoimmune diseases, of which celiac disease is one, are more available and more technologically advanced [1].

Visceral disease

Visceral disease, or coeliac disease, is a condition that has its origin in genetics - it is an autoimmune disorder and its main feature is intolerance to gluten, a protein present in cereals (wheat, rye and barley). The toxic effect of gluten here is the degradation of the intestinal villi, i.e. the protrusions in the intestinal mucosa, due to which the surface area of the intestine is significantly increased and, consequently, the surface area of absorption is also increased. As a result of the pathological effect of gluten, the intestinal villi disappear, which contributes to impaired absorption of nutrients, and this in turn leads to a wide variety of clinical symptoms. The only treatment and therapy for coeliac disease is the elimination of gluten-free products from the diet [2].

Until recently, coeliac disease was associated primarily with childhood and was thought to be an abnormality 'that one grows out of', however, as cases of non-adherence to this diet in later life have shown, these individuals develop other, sometimes much more severe conditions due to the toxic effects of gluten not eliminated from the diet [2].

Epidemiology

The estimated prevalence of celiac disease in the general population is around 1%, with an ever-increasing number of sufferers, prompting the conclusion that gluten consumption is increasingly at risk. This is related, on the one hand, to the increased consumption of gluten, as well as to the development of diagnostics and their wider availability.

There is no specific age at which the disease can appear, it has been observed to occur at almost every stage of human development, and even people in the 30-50 age range have been diagnosed. In terms of gender, it is noteworthy that coeliac disease is twice as likely to be diagnosed in women than in men, with an overall incidence rate of 1:100 [2].

Risks

Coeliac disease is the most common food intolerance that, if untreated, can become the cause of many serious health conditions and problems. The spectrum of complications can be very wide and affect many areas of the body's functioning, ranging from osteoporosis, fertility disorders, psychiatric disorders to cancer. Early diagnosis and implementation of an appropriate diet is extremely important [2].

Worrying symptoms

Relatively common symptoms, and at the same time those most associated with coeliac disease, are diarrhoea and weight loss. These are typical symptoms for overt coeliac disease, which occurs in only 10% of sufferers. As statistics and research indicate, in up to 90% of cases, visceral disease gives rise to a range of other symptoms, which are largely related to disturbances of nutrients in the body and concomitant autoimmune processes.

Abdominal pain, increased abdominal circumference, diarrhoea alternating with constipation, weight loss, developmental disorders in children, a change in disposition towards hyperactivity or apathy or fatigue, depressive states and deficiency symptoms caused by malabsorption syndrome are the main symptoms of full-blown coeliac disease. The occurrence of these symptoms gives a certain picture and assumptions, so diagnosis should not pose major problems. The situation is different in the context of sparse-symptomatic coeliac disease, where the manifestations may affect very many spheres of the body's functioning, giving rise to a range of non-specific symptoms that are apparently in no way related to coeliac disease [2].

Based on the degree of damage to the small intestine, the severity of symptoms and the course of the disease, three forms of coeliac disease have been distinguished - classic, silent and lethal [3].

photo: panthermedia

In infants, the symptoms that should worry parents are vomiting, diarrhoea, enlarged abdominal circumference, weight loss and general developmental delay associated with malabsorption. Children with coeliac disease are often affected by short stature, anaemia, steatohepatitis, delayed sexual maturation, abdominal pain, skin lesions, aphthous and mouth ulcers, which should prompt the doctor to perform tests and investigations for visceral disease. Adults may also present with the classic symptoms of abdominal pain, bloating, fatty stools or recurrent oral aphthae, but here extra-intestinal symptoms such as osteoporosis, epilepsy, infertility or premature menopause predominate [3].