Symptoms, causes and treatment of celiac disease in children. Celiac disease
Celiac enteropathy (gluten-sensitive celiac disease) is an immune-dependent disease with lesions and systemic autoimmune manifestations caused by intolerance to the cereal gluten protein - gluten.
This disease is also known as abdominal sprue, gluten-sensitive enteropathy and non-tropical sprue, celiac disease, and idiopathic steorrhea.
There are no exact data on the incidence of celiac disease. Researchers compare gluten intolerance to an iceberg and believe that the number of identified cases of the disease is like the tip of the iceberg and that true quantity There are much more people suffering from this disease.
Screening studies of blood donors have found that the prevalence of the disease reaches 1:256 in all European countries. Low-symptomatic (latent forms) in adults are 4-5 times more common than those with severe symptoms. Almost 80% of patients are women.
Studies have shown that among the closest relatives of patients, approximately 10% have latent celiac disease.
Why is gluten dangerous?
Gluten is the gluten protein found in grains.
Wheat flour contains from 7 to 15% protein, 90% of which is gluten.
Gluten consists of four components:
- albumen,
- globulin,
- prolamine,
- glutenin.
Only prolamine has a toxic property that causes celiac disease.
The amount of prolamine in different cereals varies.
- millet 55%,
- wheat 33-37%,
- rye 33-37%,
- barley< 10 %,
- oats< 10 %,
- corn 6%,
- buckwheat 1%.
Prolamin in wheat is called gliadin, in rye - secalin, in barley - hordein, in oats - avenin, in corn - zein.
Gluten (prolamine) in corn, buckwheat and rice does not cause celiac disease.
There is no clear data yet regarding oats. When conducting special studies of gluten-free diets with and without oats, we were convinced that a small amount of it can be included in such diets - no more than 70 grams per day.
Reasons for the development of the disease
Several mechanisms of gluten intolerance are currently being considered.
- Congenital absence or reduced production of enzymes that break down gluten in the small intestine is one of the causes of celiac disease. In approximately 0.03% of patients, the disease is inherited. Accumulation in the mucous membrane small intestine toxic products due to incomplete breakdown of gluten leads to metabolic disorders. Products of incomplete breakdown of gluten come into contact with the intestinal mucosa and damage it. This leads to the development of the disease.
- In addition to hereditary, there is a secondary, acquired gluten intolerance. Some researchers consider the cause of its development to be a consequence (probably adenoviral) or other diseases.
- A significant role in the development of the disease belongs to malfunctions of the immune mechanism. In this case the process is similar. In people with celiac disease, the mucous membrane responds to gluten jejunum produces more IgA and IgM antibodies, as well as T-lymphocytes.
- One of the reasons is the body’s inadequate toxic reaction to the absorption of incompletely broken down gluten products in the intestine. At the same time, lymphokines are produced, which contribute to damage to the mucous membrane of the small intestine.
The mechanism of the damaging effect of gluten (gliadin)
The effect of gliadin on the intestinal mucosa leads to partial or total villous atrophy. The epithelium of the mucous membrane of the small intestine is quickly renewed, in just 3-5 days.
Modern research has shown that in celiac disease there is an increased rate of cell rejection, which leads to increased speed formation of new tissue. But the accelerated new formation of cells leads to the fact that immature cells (enterocytes) appear on the surface of the villi, unable to perform their functions.
By following a strict gluten-free diet, the structure of the intestinal mucosa is gradually restored. If such a diet is not strictly followed, there is no positive dynamics of recovery.
What areas of the intestine are affected?
Most often, celiac disease affects the proximal (middle) part of the small intestine, with lesions decreasing towards the distal part (as it approaches the large intestine). The extent of intestinal damage depends on the severity of the disease.
The involvement of the proximal part can be moderate in asymptomatic cases of the disease with minor or even histologically undetectable changes in the mucosa.
In some cases, the mucous membrane of the stomach and rectum may be affected.
Damage to the duodenum and jejunum occasionally appears as plaques. In this case, it is necessary to urgently perform a biopsy to examine them.
Species
Most experts adhere to the following classification of the disease:
- classical is accompanied by symptoms characteristic of diseases of the gastrointestinal tract,
- atypical with one or more symptoms not characteristic of gastrointestinal diseases,
- asymptomatic with the absence of symptoms, despite the presence of characteristic intestinal lesions.
Symptoms
Gluten intolerance manifests itself in many ways various symptoms. The typical course of the disease is characterized by alternating constipation and diarrhea, periods of remission and exacerbations.
Since celiac disease is associated with metabolic disorders, one way or another it affects the functioning of all organs and systems of the body. Often patients come with complaints that at first glance are not related to the gastrointestinal tract. They are worried about high fatigue, weakness, shortness of breath, pain in the bones and spine.
Lack of vitamins B1, B2 and B3 due to disruption of the small intestine where they are produced causes neurological symptoms such as:
- muscle weakness,
- impaired coordination of movements,
- Sensitivity disturbance (tingling, numbness).
A lack of vitamin A causes impaired twilight vision and “night blindness.”
Celiac disease can be combined with such skin diseases, How
- dermatoses,
- hives,
- cutaneous vasculitis,
- psoriasis,
- vitiligo,
- focal alopecia.
Main symptoms of gluten intolerance
The main signs of the disease are:
- chronic diarrhea,
- weight loss,
- anemia,
- bloating,
- feeling of fullness,
- vague pain and discomfort in the abdomen,
- loss of appetite,
- fatigue and malaise,
- foul-smelling feces
In some cases, the disease is practically asymptomatic. It may be limited to vague abdominal pain, bloating, occasional diarrhea and increased fatigue. In this case, the diagnosis is made during examination associated with other diseases and is confirmed by the presence of changes in the mucous membrane of the small intestine.
Provoking factors for exacerbation of the disease and the manifestation of the first signs are most often pregnancy and childbirth, neuropsychic injuries, acute intestinal infections.
Frequent signs are bloating, increasing in the evening, lack of appetite, nausea, and vomiting.
Severe abdominal pain is not typical, but is more common dull pain in all parts of the abdomen. Sometimes there is soreness around the navel, rumbling and splashing throughout the colon.
In patients with limited intestinal damage, including only the duodenum and middle sections of the jejunum, there is often no intestinal symptoms. In this case, the disease manifests itself with such symptoms as
- anemia due to iron deficiency and/or folic acid, vitamin B12,
- demineralization of bones, manifested by fractures.
Signs of severe celiac disease
At severe course The following symptoms are added to the main symptoms of the disease:
- the stool has a foamy, semi-formed character,
- stool is light brown, greasy and foamy,
- stool has a rancid or foul odor
- in some patients, diarrhea alternates with constipation,
- pinpoint hemorrhages appear on the skin,
- bleeding (uterine, nasal, gastrointestinal),
- muscle cramps,
- in the corners of the mouth, less often behind the ears and at the wings of the nose, weeping cracks appear,
- nails are dull, cross-striated, flaking,
- thickening may occur distal phalanges fingers,
- the tongue becomes crimson-red, with atrophied, smoothed papillae.
In these cases, adrenal insufficiency often develops, which in addition to fatigue causes symptoms such as:
- dizziness,
- hyperpigmentation of the skin and mucous membranes.
For very severe celiac disease
- stool frequency reaches 10 times a day,
- dehydration occurs
- acidosis (displacement acid-base balance body in the direction of increasing acidity and decreasing pH),
- malabsorption syndrome develops,
- secondary damage to many organs and systems.
Celiac disease in children
The disease most often develops in children 4-6 months old. This is due to the introduction of complementary foods containing gluten. Symptoms of the disease may disappear as the child grows up, but then appear again at the age of 20-40 years.
Symptoms of gluten intolerance appear within a period of 2 to 4-8 weeks after the introduction of gluten products into the child’s diet.
The disease may manifest itself in the 2-3rd year of life in the case of a hereditary predisposition and under the influence of traumatic factors (when joining a children's group, stress, sudden changes in diet, etc.).
At early artificial feeding mixtures containing flour, the disease can develop as early as 2-3 months of life.
Symptoms of celiac disease in children
The disease begins to manifest itself gradually:
- lethargy appears,
- appetite decreases until it is lost,
- stool disorder occurs.
In most cases, celiac disease is characterized by diarrhea, sometimes polyfecal matter ( large number feces) without changing the consistency of the stool, constipation rarely develops.
With the further development of gluten intolerance, symptoms such as:
- malnutrition,
- anemia (lack of iron in the blood),
- pallor, dryness and pigmentation of the skin,
- dystrophic changes hair and nails,
- sometimes glossitis (the tongue becomes crimson in color),
- inflammation of the gums (gingivitis),
- growth retardation,
- muscle hypotonia,
- an enlarged abdomen, against the backdrop of thin arms and legs.
During the most acute development illness, the child has a painful appearance, stools up to 3-4 times a day. The stool is watery, foul-smelling, foamy due to fermentation of undigested carbohydrates, shiny with fatty inclusions (steatorrhea).
The child is emotionally unstable, irritable, capricious, indifferent to everything around him.
Diagnosis and treatment of a child are the same as for adults.
Complications of celiac enteropathy
Malignant tumors
In patients with celiac enteropathy, lymphoma and small intestinal cancer develop 83-250 times more often than in the general population. Cancers of the esophagus, stomach and rectum are also more common. Overall, malignant tumors are the cause of death in about half of people with celiac disease.
A timely diagnosis of malignant tumors is established only with the help of instrumental methods (endoscopy of the esophagus, stomach, small and large intestines, x-ray examination of the entire gastrointestinal tract).
Unreasonable deterioration in the condition of patients and some laboratory parameters with strict adherence to a gluten-free diet, this is the basis for the assumption that the disease is complicated by a malignant tumor.
Most significant symptoms in this case are:
- intestinal obstruction,
- increased ESR,
- positive reaction to occult blood in the stool,
- deterioration of tests.
Chronic nongranulomatous ulcerative jejunoileitis and enterocolitis
This complication is characterized by multiple chronic ulcers, which are found more often in the jejunum, less often in the ileum, and sometimes in the colon.
Ulcerative jejunoileitis often develops at 50-60 years of age and may be the first manifestation of the disease.
This disease is accompanied by such symptoms as:
- fever,
- general weakness,
- weight loss,
- abdominal pain,
- diarrhea, possibly with blood.
Neuropathy
Neuropathy occurs in 5-8% of patients with celiac disease. It develops mainly in men aged 30-70 years. This complication develops quickly and is manifested by the following symptoms:
- numbness,
- tingling pains,
- weakness of the legs,
- sometimes difficulty writing and dressing.
The cause of these complications has not been identified.
Diagnostics
The World Organization of Gastroenterologists has developed a practical guide that specifies a diagnostic algorithm.
- Autoantibodies and endoscopy with intestinal biopsy (“gold standard”).
- Antibodies.
- Diagnosis based on symptoms, improvement when switching to a gluten-free diet.
Endoscopy
Although endoscopy is a valuable testing method, it should not be considered the only diagnostic method. The markers of mucosal atrophy discovered by this method are also characteristic of other diseases, for example, tropical sprue, malnutrition, and others.
The main histological signs of gluten enteropathy are atrophy of the mucous membrane with a sharp shortening of the villi or even their complete atrophy and elongation of the crypts, increased content MEL.
Coprological examination and urine analysis
In severe cases of celiac disease, protein is detected in a urine test.
A scatological examination reveals polyfecality (a large amount of feces is excreted). The daily weight of feces can reach 1500-2500 grams. Feces have light color and a rancid smell. Microscopic examination shows steatorrhea (excessive fat production).
Blood test
At mild form disease, there may be no changes in the blood test.
In moderate and severe forms, there is a lack of iron, vitamin B12, increase in ESR, a decrease in the number of platelets and leukocytes is possible.
In some patients, anemia may be one of the first or even the only sign of the disease.
A biochemical blood test reveals deviations from the norm only in patients with severe forms of malabsorption and not in all cases.
Significant changes in blood tests are detected when the intestines are damaged and the process spreads to other organs.
Only a decrease in one or another substance in the blood (for example, potassium, sodium, calcium, magnesium, zinc) has diagnostic significance. Physiological blood constants can remain at normal levels for a long time.
Immunological diagnostic methods
In patients with untreated gluten enethropathy, the concentration of antibodies to the ɑ-fraction of gliadin in IgA and IgG is significantly increased. When following a gluten-free diet, their level decreases to normal, which indicates the importance of these indicators for the diagnosis of celiac disease.
Methods characterizing the absorption function of the small intestine
These methods allow one to judge absorption by the rate and amount of appearance in the blood, saliva, urine or feces. various substances, taken orally or introduced through a probe into the duodenum. These methods have diagnostic value only in patients with severe malabsorption (grades II and III).
X-ray examination
This type of examination is not basic, but for some types of gluten intolerance it can confirm the diagnosis. This is because most cases of celiac disease affect the upper small intestine and there are no changes in the ileum.
Nowadays, more and more often in the doctor’s office you can hear such a diagnosis as celiac disease. Parents are scared and worried, because this disease is unknown to few people. Celiac disease is a congenital or acquired intolerance to gluten. In this case, the disease is chronic.
Gluten is a plant protein found in grains such as wheat, rye, oats, and barley. In case of intolerance, it irritates the intestinal walls, which disrupts its function. However, other organs also suffer, so you need to recognize the symptoms of pathology in time and take the necessary measures.
Symptoms of the disease
The difficulty in diagnosis lies in this. That signs of pathology do not appear immediately, that is, it is almost impossible to detect the disease in an infant. Diagnosis is usually carried out at an older age.
The first symptoms appear in babies only when foods containing gluten enter their diet. This usually occurs at the age of 7-8 months, although sometimes it happens that the disease makes itself felt at 2-3 years.
You can recognize it by the following signs:
- Underweight;
- Slow growth;
- Psycho-emotional characteristics: hot temper, capriciousness, irritability, attacks of aggression, which can abruptly give way to lethargy and indifference;
- Stool disorders: stools have an unbearably unpleasant odor, their quantity gradually increases, the stool becomes foamy and mushy;
- Dull abdominal pain that occurs in attacks;
- Rickets. Pathology occurs due to a lack of calcium, because the intestines are not able to absorb it;
- Delayed eruption permanent teeth, existing caries;
- Edema;
- Cow's milk intolerance.
We have listed the classic symptoms of the disease, but it can behave completely unpredictably and manifest itself atypical signs. For example, stomatitis, anemia, arthritis, dermatitis, intense thirst, weakness, frequent urination, baldness and fatigue.
But the first manifestations are always observed after gluten enters the child’s diet. In this case, you need to see a doctor and undergo a full diagnosis, since timely prescribed treatment will avoid rather sad consequences.
Diagnosis of celiac disease in young children
The doctor prescribes tests and examinations, guided by symptoms and his own conclusions, since there is no clear algorithm for action in this case.
The diagnosis is made based on the following measures:
- blood test;
- clinical symptoms;
- coprograms (stool analysis);
- colonoscopy (examination of the intestines with a special device);
- biopsy of the intestinal mucosa;
- Ultrasound of the peritoneum;
- X-ray of the intestines.
The sooner a diagnosis is made, the sooner treatment can begin for the child. Correct and timely therapy will allow him to return to a full life.
Treatment of children with celiac disease: diet prescribed for celiac disease
In this case, a whole range of measures are taken. It is impossible to exclude any moments from it, since in this situation all activities are important and decisive. First of all, you need to change the baby's diet.
Diet correction is the basis of all therapy. You will have to adhere to it for life, so it is important to accustom your child to it as early as possible. By excluding gluten-containing foods from his menu, parents will relieve the baby of intestinal discomfort.
The following foods should be removed from your diet forever:
- All products made from oats, rye, wheat and barley;
- Pasta;
- Bread;
- Cookie;
- Pastries and cakes;
- Ice cream;
- Yoghurts;
- Semi-finished meat products;
- Sausages;
- Canned food;
- Sauces;
- Whole milk is highly undesirable.
The diet should include the following foods:
- potato;
- buckwheat;
- fish;
- corn;
- cottage cheese;
- vegetables/fruits;
- legumes;
- vegetable oil;
- lean meat.
Proper nutrition will help you get rid of unpleasant symptoms diseases.
During an exacerbation, the doctor may prescribe enzyme therapy. This will facilitate the function of the pancreas and liver. The gastroenterologist selects the medications, dose and duration of the course individually.
The most famous drugs in this group include Creon, Pancreatin, Mezim, Pancitrate.
For children with gluten intolerance, treatment with probiotics is necessary to restore the natural intestinal microflora.
These include Bifidumbacterin, Lactobacterin, Hilak, Hilak-forte, Lacidofil. They are prescribed either during an exacerbation period or in preventive courses. Vitamin therapy is mandatory.
Gluten intolerance leads to a deficiency of vitamins and microelements because their absorption through the intestinal walls is impaired. Vitamins must be supplied to the body both through food and through the intake of special complexes. These should also be selected by a specialist.
Disability: is it given for celiac disease in children?
Theoretically, parents have the right to register a disability, since in the official definition of the disease it is indicated as disabling. Previously, such a child was given disability for 5 years. However, now the criteria have changed: they are determined not by the disease, but by the limitation of his life activity.
At untimely treatment Ciliac disease can lead to other pathologies that will really affect the patient’s quality of life.
At long term A disease that is not accompanied by therapy may occur:
- diabetes mellitus;
- chronic inflammation of the liver;
- joint pathologies;
- mental retardation;
- thyroid pathology;
- stomatitis;
- intestinal ulcers;
- tumors of the mouth and gastrointestinal tract;
- infertility, gynecological ailments;
- epilepsy, schizophrenia, etc.
People with celiac disease may develop cancer pathologies, which are known to high degree lethality.
But following a diet allows you to avoid these severe consequences. Accordingly, the child’s life activity is not limited, he grows and develops together with his peers. This means he is not eligible for disability, even though he must adhere to an expensive gluten-free diet for life.
Sanatorium for a child diagnosed with celiac disease
You must first consult a doctor. The question of the need for sanatorium-resort treatment is decided only by that person, guided by certain indications. However, celiac disease is not included in the list of indications for such treatment, but the child may be sent to a sanatorium for children with food allergies.
Medical and social examination and disability in celiac diseaseCELIACIA (celiac disease, Huy-Herter-Heubner disease, non-tropical sprue) is a disease caused by intolerance to the proteins of certain cereals (density), toxic and then trophic damage to the mucous membrane of the small intestine, characterized by secondary deficiency conditions and the effectiveness of a gluten-free diet.
Epidemiology: the frequency in the population ranges from 1:300 to 1:3000; It is assumed that the actual incidence of celiac disease is higher than available data due to imperfect diagnostic methods.
Etiology and pathogenesis. It is assumed that the disease is hereditary: there are no specific enzymes - proteolytic enzymes and peptidases in the small intestine that break down the gluten of cereals (wheat, rye, oats); this leads to the accumulation of gluten and its metabolites in the intestine, has a toxic effect on the cells of the small intestine, resulting in changes antigenic structure epithelial cells, ATs are produced to altered antigens, and the autoimmune mechanism is triggered. The disease may also occur under the influence of adenovirus type 12, which is similar to one of the components of gluten - gliadin. The autoimmune nature of inflammation of the mucous membrane of the small intestine leads to atrophy, which, in turn, leads to a decrease in the absorption surface, a decrease in the production of enterohormones (secretin and cholecystokinin) and the proximal part of the small intestine; reduced stimulation of the gallbladder and pancreas leads to disruption of the cavity digestion of proteins and fats. Damage to the enterocytes is accompanied by a decrease in the hydrolysis of small peptides and disaccharides in the ciliated zone, the membrane transport of amino acids, soluble vitamins, monosaccharides, sodium, potassium is disrupted, and the absorption of water in the duodenum is disrupted, which leads to diarrhea and polydeficiency syndrome. Atrophy of the mucous membrane is morphologically manifested by a decrease in the thickness of the glycocalyx, flattening or disappearance of villi, enlargement and elongation of crypts; in the lamina propria, the number of cells—plasmocytes—producing immunoglobulins of all classes increases, and autoATs (IgA, IgG) to gliadin and endomysium are also detected.
Clinical picture. The disease can appear at any age: in adults, usually after 30 years, in children - after introducing gluten-containing foods into the diet, i.e., at 9-24 months of life. Clinical manifestations are polymorphic and are accompanied by the involvement of many organs and systems in the process. From the digestive tract, symptoms of malabsorption and maldigestion develop: nausea, vomiting, severe pain in the abdomen, alternating diarrhea and constipation, hepatomegaly. A characteristic change in stool is noted: it becomes frequent, foamy, profuse, with unpleasant smell, somewhat acholic, with a characteristic oily sheen (steatorrhea). The child loses his appetite, there is a gradual lag in physical, and then in psychomotor development. Pathological changes in the stomach and intestines lead to skin damage ( atopic dermatitis, dry skin, angular stomatitis, dystrophic changes in teeth, nails, hair), bones (severe pain in the bones, spine, spontaneous fractures, rachitic deformities of the limbs, growth retardation); development of IDA; changes in the nervous system (paresthesia with loss of sensitivity, ataxia, partial demyelination spinal cord, convulsions, tetany); dysfunction of the endocrine system - signs of insufficiency of the adrenal cortex (weakness, decreased blood pressure, skin hyperpigmentation); changes in the blood coagulation system (gastrointestinal, nasal, renal bleeding). Changes also psychological status child: children become irritable, gloomy, capricious, selfish (characteristic posture - the child sits motionless on the bed, cross-legged, and angrily watches those around him from under his brows). The course of the disease is undulating, progressive, and a secondary infection may occur, aggravating the child’s condition. There is a connection with others autoimmune diseases: diabetes mellitus type I, autoimmune thyroiditis, nonspecific ulcerative colitis, fibrosing alveolitis, etc.
Complications: secondary infection(most often meningococcal and pneumococcal), high risk development of tumors - lymphomas (9-19%).
Laboratory and instrumental methods, confirming the diagnosis:
1) stool examination - coprogram in dynamics (steatorrhea, increased excretion of fatty acids);
2) duodenojeunoscopy (detection of signs of mucosal atrophy);
3) biopsy of the mucous membrane of the small intestine (histological confirmation of atrophic changes);
4) determination of antigliadin AT and AT to endomysium;
5) determination of transpeptidase activity in the blood.
Treatment: therapeutic nutrition excluding gluten-containing products from the diet; symptomatic treatment - enzymes, vitamins, iron and other microelements.
Prognosis with early diagnosis and proper treatment favorable, patients are generally socially adapted.
Disability criteria: deep violations metabolic processes, a delay in physical and psychomotor development of more than 2 epicrisis periods that cannot be relieved within 6 months of treatment.
Rehabilitation: medical rehabilitation during periods of exacerbations, psychological, pedagogical and professional rehabilitation during remission of the disease; Exercise therapy, massage.
“It’s a new-fangled disease, there’s nothing terrible about it, we just made it up... Our ancestors lived, didn’t bother, and you all consider yourself sick!”
“Yes, we were given such a diagnosis, and nothing... no worse than others... now we have been cured, and we eat bread and sandwiches...”
How many times over the past two years have I heard such words about celiac disease! And how many times have I been amazed by the point of view - there are no microbes, “patamoo” I don’t see them!
I would like to say a few words to those home-grown healers who do not trust doctors because they like to find sores in healthy people. First of all, no one likes to be sick. That is why he does not like to admit that he is sick, that is, weak, incompetent, helpless. Secondly, after talking with the parents of sick and not so sick children, I stopped being surprised at anything at all.
Thirdly, celiac disease was not diagnosed in our ancestors, but back in the 19th century in England, a doctor (I don’t remember the name) described similar symptoms in his patients - exhaustion, bloated belly, foamy, copious stools, pain in the bones and abdomen. Many of his patients died; he tried various diets on the survivors - either he made up their diet only from oysters and mussels, or he excluded oats from it. During the Great Patriotic War cases were also described that in patients whose diet, due to hunger and food shortages, lacked bread, improved general condition and well-being.
So, celiac disease is a hereditary congenital lack of the enzyme that digests the protein gluten. Take diabetes for example - the absence or small amount of an enzyme that digests sugar. Lactose deficiency is the absence of an enzyme that breaks down milk sugar. Everyone has heard about these diseases, and there is no doubt about their existence.
Gluten deficiency affects the villi in people with gluten deficiency. small intestine, which is why digested food is not completely absorbed into the blood. Absorption of fats is particularly affected. Pieces of food and foam appear in the stool. Undigested gluten poisons the body, which manifests itself in different ways. But all patients have weakness, general intoxication, fatigue, circles under the eyes. What will happen if you don’t follow a diet - the child grows poorly, is thin, has a swollen belly, pain in the bones, hair may fall out, teeth deteriorate, he will lag behind his peers in physical and even mental development, does poorly at school, and is constantly sick. The strength and intensity of these manifestations depend on how strongly his body reacts to gluten. Some people will eat a cracker and nothing will happen, while others will be unsettled for a month.
Celiac disease is diagnosed by a blood test for agliatin antibodies.
My personal examples - my eldest son does not have a very strong reaction to gluten, that is, eating questionable corn flakes does not worsen his stool. However, my husband’s reaction to the slightest traces of gluten is always very violent, which is manifested by foamy stools, a general deterioration in health, drowsiness, weakness, lethargy, etc. My husband’s father did not believe in the existence of a new-fangled disease, refused to go to the doctor, and does not want to follow a diet. As a result, at more than 50 years old, he looks like a decrepit old man who cannot hold down a single job. All his life he worked in primitive jobs with long breaks to stay at home. Poor health and weakness did not allow him to live life to the fullest. However, implicitly understanding that he feeling unwell conditioned by his diet, in his youth he tried all the diets on himself, from raw food eating to separate meals.
Why do people live with celiac disease all their lives and not complain? Yes, because poor health has always been in their lives and is not something unusual. Because they never felt differently. Because they don't know how it could be different.
In addition to celiac disease itself, there is an allergy to gluten, which is called a gluten allergy. semolina porridge and white bread. This is really not celiac disease; it comes with age in children.
Your doctor will tell you what people with gluten intolerance can and cannot eat. But I can tell you how to distinguish a prohibited product from an allowed product in a supermarket.
First of all, carefully read the composition of the product. You should be wary of the words “thickener”, “stabilizer”, “polysaccharides”, “starch”, “malt extract”; behind all these words starch and its derivatives are hidden. We don’t know what kind of starch is in the product - corn, potato - allowed for celiac disease, or, most likely, wheat. Because many or almost all products prepared using imported technology contain thickeners and stabilizers. Most often these are dairy products, yoghurts, cheese curds, dairy desserts, corn flakes, and any mayonnaise. Even packaged dried fruits contain traces of starch as a preservative. Also, the minced meat in the package contains starch; cheap cereals can be contaminated with oat grains.
What you can eat - almost all dairy products and cereals made using old Soviet technology. Yes, those scary and nondescript bags that we ignore when choosing bright packaging. How simpler composition product, the fewer additives it contains, including the likelihood of eating gluten.
From chocolate we choose chocolate from the Krupskaya factory, not imported bars, ice cream from the First Cold Storage Plant, milk from the Piskarevsky plant, sausages and frankfurters only top quality, without the above additives. By the way, don’t scare the seller with a question about starch in sausage - most likely, they simply won’t understand you! :-)
Buckwheat, corn and rice breads from whole grain, canned fish, where the ingredients say “fish, salt, oil” and that’s it, canned peas, corn, beans, frozen vegetables.
I do not claim to be true in my words, but these products do not cause a reaction in my family. Whether you can use them can only be determined by trial and error.
Discussion
If your children or grandchildren had this disease, you wouldn’t say “no big deal.” And when a child suffers from this disease from birth and not a single doctor can say what’s wrong with the child and you don’t know what it is, believe me, seeing a child in intensive care, it’s scary and painful.
26.01.2019 18:26:47, Dekhtyareva SvetlanaIn the book by the same author - Maksimova S.V. “How to calm a child when he screams? Breastfeeding or pumping until he faints - there is no time. It was invented a long time ago, as the Russian world stands: stuffing chewing gum into the child’s mouth from rye bread or porridge, a refuge from all troubles - it will suck and become silent. If he keeps quiet, it means he has begun to recruit peasant labor. Chewing gum will cause acid to develop in the child’s stomach and pain will appear; from pain he will begin to roar throughout the hut. The mother will tell herself that someone looked at her son with a black eye and cast the evil eye - and will calm down until the child roars, as they say, to take the saints out of the hut. And then the father will try to help the trouble: he will bring gingerbread-gopher from a merchant from the market or fair, again flour, and with honey: the snarling and roaring is even louder. He pacifies the crybaby mother with a song."
10/27/2017 12:31:46, Mirano1981Quote from the book “A Kul of Bread and Its Adventures”, S. V. Maksimov, 1873:
“So much bread for holidays and on holidays for the growth and health of a Russian person, almost from the first year after his birth! And since the faster a child grows, the more he craves for food, then more rye bread falls to his share than, for example, , porridge. Moreover, a compassionate mother, an incorruptible friend of her child, so that it does not cry and whine, hunting painfully and constantly asking for food, places it somewhere in a secluded place. small box. Come to him whenever you want, take as much as you want and eat as much as you like. In the box are koloboks... Koloboks are small round loaves of bread or thick flatbreads, they are usually baked from leftover flour from a pie or bread. Motherly tenderness adds butter to make it rich, smears it with sour cream or stirs it in milk to make it sweeter: the food is delicious and the children love it. They play pranks, do something wrong, and the village children are punished by being denied a kolobok. On mother's buns and on the street, that is, with sufficient food and on fresh air, with constant running and movement, a peasant son grows up faster and faster than city children. One difference: the village children are not in vain because they eat so much bread and flour. They grow large bellies, which do not happen in children who eat broths, soups and meat foods in general. Trouble from big belly passes over time, disappears with age, only the ability to eat a lot remains, since floury food only nourishes when consumed in large quantities."
Olga, it’s as if I read my conclusions in your article. That's right, everything is the same)) It seems so ordinary, 1.5 years later. And, dear forum visitors, I wish you endurance and happiness! ... on a personal note... I went online to look up a recipe for a gluten-free cake, it’s my daughter’s birthday. I came across a selection of topics on this site... and accidentally burst into tears. 1.5 years have passed since my child started the diet. today those first uncontrollable crocodile tears showed me how much the baby's diet situation was affecting my psychological well-being. but no one will see this, they will only continue to give advice from personal experience, like “they knock out a wedge with a wedge”))) ;)
09.11.2005 08:34:15, Elena Batrakova-MallettI forgot to write - shame on me - that the diagnosis of celiac disease is confirmed by a biopsy of the small intestine.
07.11.2005 12:58:49, RyndinaEnough great variety products. It is quite possible to live like this. :)
My husband has diabetes, and my son does not have an enzyme that breaks down some amino acids. Therefore, one has a diet without carbohydrates, and the other - without protein (both plant and animal).
This is where you need to get rid of yourself. to feed my family and eat something myself. :)))
So if the whole family is on the same diet, that’s really nothing! :)
Unfortunately, not all diseases are diagnosed at the birth of a child and in the first months of his life. Sometimes parents are sure that they are raising a healthy baby - well, there are problems with stool, and they are not gaining weight well. But these are frequent companions of infancy! However, digestive problems can be caused by intolerance to gluten, a protein found in wheat, rye and barley. And then the aphorism in the title of the article is filled with a new, not at all metaphorical meaning...
Many children are gluten intolerant at the beginning of complementary feeding. Therefore, pediatricians recommend giving the baby the so-called up to one year old. Gluten-free cereals - rice, buckwheat, corn. As a rule, as the child grows up, his digestive and enzymatic systems mature, and the problem goes away on its own. However, in some children this intolerance becomes a disease. With celiac disease—that’s the name of this disease—there should be no wheat, rye, barley or products containing these grains on the table. But the most important thing is that a gluten-free diet is for life.
What is celiac disease?
Celiac disease also known as celiac sprue, non-tropical sprue, gluten sensitive enteropathy. Medical reference books define celiac disease as a chronic disabling disease characterized by damage to the mucous membrane of the small intestine gluten free*(or rather his integral part gliadin) - vegetable protein, gluten, which is found in the main types of cereals. Intolerance to this protein causes a chronic immune inflammatory reaction, leading to damage to the villi in the small intestine, resulting in the syndrome of impaired intestinal absorption(malabsorption).
If the disease is not diagnosed on time, with prolonged exposure to gluten on the immune system of a sensitive person, its disorders develop with damage to other organs - autoimmune and oncological diseases.
The most insidious feature of this incurable disease is that it can be detected at any age. Often, neither parents nor doctors realize that their child has celiac disease. Let's take a real case as an example.
“My son has had problems with bowel movements since he was six months old. poor appetite, constantly bloated stomach. I have always had difficulties gaining weight - at six years old I weigh only 14 kg. with a height of 110 cm. At the children's clinic we were diagnosed with rickets. And only six months ago, after going to a gastroenterologist and conducting tests, we were diagnosed with celiac disease.”
The first thoughts of all parents whose children have been diagnosed with this disease are usually the same: “What kind of disease is this? How to live with her? Can she be cured? Now this information is not difficult to find - it periodically appears in parenting magazines, as well as on the Internet. After all, this disease, unfortunately, is not so rare - the incidence of celiac disease in Europe is 1:200-1:300 people. This disease is more common than previously thought - according to recent data, up to 1% of the population suffers from some form of celiac disease. Experts say that for every identified case in Europe, there are from 7 to 10 undetected ones.
In Russia, celiac disease is still considered a rare disease. This point of view is explained by the difficulties of diagnosis. The use of appropriate research has recently made it possible to identify both the classical and latent (latent) forms of this disease in many patients.
How can you tell if your child has celiac disease? Symptoms and diagnosis
This disease was characterized back in 1888 - at that time Samuel Gee described in detail the clinical features of celiac disease. And in 1921, Howland first recommended excluding complex carbohydrates from the diet of children with celiac disease.
Various symptoms may indicate celiac disease. Typical ones include: abdominal pain, diarrhea or persistent constipation, loss of strength, bloating and (or) increase in abdominal circumference, change in appetite (from complete absence to sharp increase), nausea and vomiting, lag in weight and height (primarily in children), bone pain, spontaneous fractures, aggressive behavior, isolation, apathy, depressive states, itchy skin, allergic lesions of the skin and respiratory system, frequent viral diseases, lethargy, fatigue, anemia, osteoporosis, lack of vitamins and minerals, lactose intolerance, nosebleeds or other bleeding.
The disease affects both sexes and can begin at any age, from infancy (as soon as grains are introduced into the child’s diet) to old age (even among those who eat grain products constantly). To start celiac disease, three components are needed: eating gluten-containing grains, genetic predisposition and what is called the “trigger factor.” Anything can be a “trigger factor”—excessive consumption of wheat, serious emotional stress, physical or pathological effects (pregnancy, surgery, viral infection) etc. The role and nature of action of this mechanism have not yet been precisely established, just as the exact algorithm (pathogenesis) of the development of the disease is unknown.
Recognition of celiac disease is often difficult because some of its symptoms are similar to those of other diseases, including irritable bowel syndrome, ulcerative colitis, intestinal diverticulosis, intestinal infections, chronic fatigue, depression.
Special studies have found that people with celiac disease have levels of certain antibodies in their blood that exceed normal indicators. These antibodies are produced by the immune system against substances that the body perceives as threatening its condition. Thus, to diagnose celiac disease, you need to check the level of antibodies to gluten in the blood (these are antigliadin, antiendomysial and antireticulin antibodies).
If symptoms and laboratory findings make it likely that you have celiac disease, your doctor may remove a tiny piece of tissue from the small intestine to check whether the intestinal villi are damaged. This is done in a procedure called a biopsy: a long, thin tube (endoscope) is inserted through the mouth and stomach into the small intestine, and then the desired tissue sample is removed using an instrument passed through the endoscope. Small bowel biopsy is the most best way detection of celiac disease.
Disabled or healthy child?
Do the parents of a child suffering from celiac disease have the right to apply for disability? Theoretically, yes, because even the official definition of celiac disease calls it a “disabling disease.” Previously, a child diagnosed with celiac disease received disabled status for up to 5 years. And any parent understands that that level is important here social support, which the state provides to a child whose disease can only be treated in one way - an expensive gluten-free diet. However, the criteria for disability have now changed. They are determined not so much by the child’s illness as by the limitation of his life activity.
Indeed, if celiac disease is not detected in a timely manner, it can lead to the development of a whole “bouquet” of diseases, which will entail restriction of the child’s life activities. In foreign medical literature, celiac disease is called the “great mime”, since its manifestations and complications are varied and depend on the individual characteristics of the body.
Thus, with a long course of unrecognized celiac disease due to prolonged intoxication of the body with gluten, severe secondary immune disorders begin: diabetes mellitus, mental retardation, chronic inflammation of the liver, joint diseases, thyroid gland, stomatitis, intestinal ulcers, tumors of the oral cavity and gastrointestinal tract, chronic temperature conditions, infertility and gynecological diseases, epilepsy and schizophrenia. Celiac disease in many cases causes not only decreased ability to work and disability, but also oncological diseases with a high degree of lethality.
However, by following a strict diet, all these consequences can be avoided. Fortunately, there are no restrictions on life activity - the child grows and develops in the same way as his peers. This means that he is not entitled to disability, despite the need for a lifelong expensive diet.
Here's what the mother of a child with celiac disease says: “But they didn’t give us disability. They said it was a healthy child. Of course, we follow a diet, play sports, study at a specialized school, and even look cool. It doesn’t matter, apparently, that our lungs are working at 64% capacity, we have a history of asthma... And, you know, I decided that means we are healthy and will break through on our own!”
Another mother, raising a three-year-old daughter with celiac disease, says this: “It is important how you treat celiac disease. Disease? For us - no!!! Lifestyle, and a healthy one? For us - YES!!! My subjective opinion is that our children are not SICK! They are healthy! There are a lot serious illnesses, in which children cannot live a full life, run and play with peers, play sports, dance. And our children live like everyone else, they make us happy, all the doors in this world are open for them. And we should be happy."
How to treat?
The only method of treating celiac disease is the complete and lifelong exclusion of gluten from entering the patient’s body, including with medications.
Throughout his life - if a person is interested in its long and prosperous course - he will have to follow a gluten-free diet. If there is no improvement, doctors prescribe drug treatment depending on the severity of the condition (including anabolic hormones, enzyme preparations, glucocorticoid therapy).
Perhaps the main problem for parents is explaining to a child with celiac disease the need to follow a diet and instilling in him a conscious attitude towards this situation. The only true way to this is to talk “like an adult” (regardless of the child’s age). Practice has shown that children perceive lisping and persuasion as a game. Imagine, for example, this situation - a mother says to her baby: “You can’t eat this. You have special, magical food.” And when a child is treated to something tasty in the absence of his parents, he may ask: “Is this magic candy?” And here it is, a trap! Of course, an adult who wants to pamper and please a child will answer “yes.” Therefore, the main task of parents is to try to prevent such situations.
There is only one way out: to convince the child that dieting is not a game, but a vital necessity. Understanding the need for a diet - as a way to live and not experience pain - children remember “allowed” and “forbidden” foods and, as a rule, are not mistaken.
Personal experience of parents raising children with celiac disease shows that children, as a rule, have a reasonable and responsible attitude towards diet therapy, perceiving it as the norm and a way of life. Oddly enough, children with celiac disease have much more difficulty explaining to other people - adults and peers - why they have to give up certain foods. Often, others consider the need to follow a diet to be just a whim. And often this becomes a problem that gives rise to a negative attitude towards such patients.
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DIET FOR CHILDREN WITH CELIAC DISEASE Gluten-containing products made from wheat, rye, barley and oats are excluded from the diet of people with celiac disease. Cereal products allowed are corn, rice, and buckwheat. Products containing “obvious” gluten: Products that may contain “hidden” gluten: Gluten also contains: |
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Gluten-free recipes for every day and for holidays Pie “CHARLOTTE” Compound. 3-4 eggs, 1 glass of sugar, 1 glass of rice flour, 3 apples. Lazy dumplings Compound. 100 g of cottage cheese, 3 potatoes, 1 egg, 2-3 tablespoons of corn flour (starch). Express khachapuri Compound. Dough. 1 cup gluten-free flour, 200 g cottage cheese, 125 g margarine, 1/2 tsp. slaked soda, 1 egg. Yanka Cake Compound. 1 can of condensed milk, 1 cup of gluten-free starch, 1/2 tsp. soda, a pinch of salt. |
Social disease
Unfortunately, children with celiac disease often face social problems. The requirement to adhere to a daily diet entails many organizational difficulties, restrictions, and lifestyle changes.
Problems often arise in the family: some parents experience constant fear for the child, which leads to excessive guardianship over him. It happens that instead of joy and pride in a son or daughter, an atmosphere of anxiety and tension dominates in the house, and conflicts between parents are increasingly occurring. Sometimes parents (more often this happens with fathers) emotionally reject a sick child. They demonstrate a feeling of disappointment because the baby did not live up to their expectations. Mothers, on the contrary, suppress this feeling and become overly caring.
There is no doubt that a child with celiac disease must be careful when eating. However, the diet should not affect other areas of his life! He needs to be able to go somewhere, participate in group activities and sports games. It is worth teaching him to act in such a way that he is almost no different from other, healthy children.
But this, unfortunately, is not an easy task for parents of a child with celiac disease. Kindergarten, summer holiday, school canteen, trips to cafes and restaurants... It is very difficult for children who require strict adherence to a diet to live, develop, study and relax with their peers - after all, most child care institutions cannot provide them with appropriate nutrition. That is why in some Russian cities, parents of children with celiac disease unite - to solve common problems.
For example, in Cherepovets there is experience working with families with children with celiac disease within the framework of the Vologda regional public organization “Celiac Disease Support Center”. The work of the center is aimed at improving the quality of life of children with this disease, as well as their relatives and friends. At the time of the organization's creation, the city community, including the medical community, had a limited understanding of celiac disease. Cherepovsk residents are proud that during their work they managed to change the situation and achieve a lot.
Another similar organization exists in St. Petersburg - this is the Emilia society created in 1998. They publish a newspaper and magazine called “Life without Gluten”, as well as a children’s newspaper “Glyuf”. In 2001, the first Russian-language website on celiac disease issues was created. The opening of the first gluten-free food store in Russia and the creation of gluten-free food groups in kindergartens were also initiated here. In a specially created center, patients are also provided with psychological support.
Dale Carnegie said, “If you get a lemon, make a lemonade out of it.” It’s quite difficult to find positives in illness. But on the website of the Emilia Society (www.celiac.spb.ru) you can read very important thing: “Now, living “around” celiac disease, we are constantly in creative search.” Parents of children with celiac disease are trying to realize themselves professionally in order to earn more money for expensive gluten-free products. They are constantly looking new information about illness. They read psychological literature and undergo training to help their children find a place in society and not lose themselves. The main thing is not to give up, and then the diagnosis of celiac disease will not be able to poison the lives of you and your beloved child.
Diana Loginova| mother of a child with celiac disease, founder and director of the Vologda regional public organization “Celiac Disease Support Center”
Ulyana Alfeeva| journalist, mother of two sons
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Informing society about people with celiac disease, as well as improving their quality of life, are the main tasks that all parents whose children have been diagnosed with this would like to solve. The Vologda regional public organization“Celiac Disease Support Center.” The result of persistent, systematic work was: -the opening of a specialized sanatorium kindergarten with a separate catering unit for children suffering from celiac disease (the only kindergarten similar profile in Russia); |
