Issue 4/2025
Topalova-Dimitrova, А.
Clinic of Gastroenterology, University Hospital „St. Ivan Rilski“ – Sofia
Leaky gut syndrome has gained significant attention in recent years, though it is not officially recognized as a medical diagnosis. The concept is based on the hypothesis of abnormally increased intestinal permeability, allowing the translocation of antigens and bacteria to pass into the bloodstream and trigger inflammatory responses. It is suspected to play a role in the development of autoimmune and neurological diseases such as type 1 diabetes, multiple sclerosis, autism, and fibromyalgia, although scientific evidence is still lacking. Zonulin, a protein involved in regulating tight junctions between enterocytes, is the main marker used for presumed diagnosis. However, zonulin levels are influenced by genetic factors and do not always indicate pathology. Stress, gluten, alcohol, medications (NSAIDs, antibiotics, chemotherapy), vitamin D deficiency, dysbiosis, and SIBO are also factors affecting the gut barrier. Symptoms are non-specific, including bloating, abdominal pain, headaches, and fatigue, often meeting the criteria for irritable bowel syndrome (IBS). Zonulin tests are unreliable, raising doubts about their diagnostic value for leaky gut.
Address for correspondence:
Topalova-Dimitrova, А.
Clinic of Gastroenterology,
University Hospital „St. Ivan Rilski“ – Sofia
15, „Akad. Ivan Gesho“, Blvd.
1000, Sofia