16 May marks International Celiac Day. In Slovakia, there are more than 33 thousand people registered with this diagnosis, but according to the Slovak Gastroenterological Society, there are actually many more. It is estimated that up to 9 out of 10 celiacs are undiagnosed.

Coeliac disease is typically an autoimmune disorder in which the immune system attacks the body’s own cells after consuming gluten, damaging the lining of the small intestine. Gluten is a protein found in commonly used cereals – wheat, barley, rye and oats, for example, contain it. “When gluten appears in the body of a celiac, their immune system evaluates it as dangerous and triggers a defensive inflammatory process against it. This inflammation damages the lining of the small intestine, which is then unable to receive and absorb nutrients. In a healthy person, the mucosa of the small intestine is very structured, made up of so-called villi, through which all nutrients are absorbed. In coeliacs, repeated inflammation caused by the consumption of gluten flattens or smooths out the villi, causing damage to them. As a result, the nutrients in the food are very difficult to absorb and, as a consequence, the organs and tissues of the whole body are damaged. explained MUDr. Soňa Lobotková, doctor of the internal department of the AGEL Bánovce Hospital. The incidence of celiac disease is increasing worldwide every year. There are more than 33 thousand celiacs registered in Slovakia, but this is only the tip of the iceberg.

“The figure is actually much higher. Statistics and experts say that 9 out of 10 coeliacs are undiagnosed, up to 80% of patients are unaware of their diagnosis. It is estimated that there are up to 45 thousand undiagnosed celiacs in our country. These are alarming figures, because neglected and late diagnosis leads to serious health complications. If celiac disease is undiagnosed, even though the patient may not be in great difficulty, the disease processes on the organs continue, sometimes with very serious consequences. Untreated celiacs have a higher risk of developing other autoimmune and malignant diseases, such as lymphoma, thyroid disease, type 1 diabetes. The earlier the diagnosis of celiac disease is made, the greater the chance of a complete correction of the health condition. A celiac who is diagnosed early and follows a gluten-free diet is essentially a healthy person,” explained MUDr. Lobotková. Although the exact cause of the development of celiac disease is unknown, according to experts, it is a combination of internal and external factors – genetic parameters that predispose to the development of celiac disease, and the influence of the environment, lifestyle and gluten consumption.

“There must be a trigger for all this, often it is psychological or physical stress, childbirth, injury, surgery, a viral disease, which weakens the body and leads to the outbreak of celiac disease. Celiac disease is not just a disease of childhood, as many people think, it can occur at any age. In our internal medicine department, it is not infrequently that we diagnose celiac disease in older patients. Diagnosis begins with the examination of specific antibodies to celiac disease from the blood, which, if elevated, we send the patient for a gastrofibroscopic examination with sampling of the lining of the small intestine – biopsy, followed by histological examination of the samples, which confirms the diagnosis. The only effective treatment for celiac disease is a lifelong gluten-free diet. When a strict gluten-free diet is followed, the prognosis is excellent,” noted the experienced doctor. Celiac disease is often called the chameleon among diseases. In fact, it has very diverse symptoms, which can even vary depending on whether the patient is a child or an adult.

“Interestingly, only about 50% of patients with celiac disease have classic intestinal symptoms such as diarrhoea, weight loss and abdominal pain. These symptoms tend to be more common and more pronounced in children. In adult patients, who are also seen in the internal medicine department, the manifestations of celiac disease are varied. Intestinal symptoms are not as frequent and may even be completely absent, or diarrhoea may be mild and intermittent, with non-specific digestive discomfort such as a feeling of fullness, flatulence or lack of appetite being more common. Patients usually present with extra-intestinal manifestations such as fatigue, iron and folic acid deficiency anaemia (anaemia), premature osteoporosis, migraines, skin manifestations, liver disorders, depression or psychiatric disorders, gynaecological disorders, spontaneous abortions and even infertility. Inadequate absorption of nutrients from the celiac-damaged small intestine affects all systems in the body. Therefore, if a patient is suffering from any of these problems, it is certainly advisable to look for their possible cause in the intestines as well,” concluded the internist MUDr. Soňa Lobotková.