2 Causes of the onset

Celiac disease can manifest soon after the introduction of gluten into the diet of a child and in adolescence - inperiods of increased stress, infection or surgery, that is, in fact, at any age.

With celiac disease, there is an increased sensitivity to gluten - a protein of wheat grain. Gliadin is considered by the body as an antigen. It creates immune complexes in the intestinal mucosa, and also enhances the aggregation of lymphocytes, which damage the mucosa. This leads to damage to the villi of the intestine and, as a result, to a decrease in its absorbent surface.

In addition, celiac disease is also affected by the genetic factor. The presence of several genes that contribute to the development of hypersensitivity to gluten in children has been discovered. With celiac disease, it is necessary to exclude cereals rich in gluten, that is, wheat, barley and rye. Until now, discussions continue on the need to exclude oats from the diet of people with celiac disease. It is believed that the proteins contained in oats do not contribute to the development of the immune response typical of celiac disease, to the extent that proteins of wheat, rye or barley.

3 Symptoms of the disease

The first symptoms of celiac disease in a child are usually noticeable in the second half of the first year of life. Appears frothy and fetid stool, which does not disappear after the treatment, typical for diarrhea. The belly of the baby becomes very large and inflated, an increase in its circumference occurs.

This is due to the weak development of the muscles of the anterior abdominal wall in the child and the accumulation of gases in the intestine. As a result of the development of celiac disease, children become sensitive and sentimental. Due to inadequate absorption, there is a slowdown in body weight gain and impaired growth. Malnutrition in the first 2 years of a child's life, when there is an intensive development of the nervous system, promotes sustainable mental retardation.

Celiac disease in children may occur with various symptoms. During celiac disease, there are periods of exacerbation, which is associated with infections, severe stress or surgical procedures.

Usually there are 3 types of celiac disease:

• full-scale;
• with mild symptoms;
• hidden form.

Celiac disease with well-defined symptoms( full-scale) is also called classical. Despite the relatively characteristic symptoms, it often remains unidentified, and the patient's complaints are mistaken for the symptoms of irritable bowel syndrome or food allergies. Its main symptoms are as follows:

• pain and bloating;
• diarrhea;
• weight loss;
• disrupt the growth and development of the child;
• character change;
• symptoms of malnutrition, including difficult to treat anemia, is the result of malabsorption syndrome.

Celiac disease with mild symptoms develops in the mucosa of the small intestine, it is mostly not accompanied by clinical manifestations, characteristic of the classical form. This form of the disease occurs most often, and its symptoms are as follows:

• ulcerative stomatitis( one of the most characteristic symptoms of this form of the disease);
• tooth enamel hypoplasia;
• ulcers in the mouth;
• persistent headaches;
• constant fatigue;
• early osteoporosis;
• pain in the bones and joints;
• growth disorders;
• concomitant autoimmune diseases;
• in laboratory studies unexplained iron deficiency anemia and elevated cholesterol.

Hidden celiac disease occurs when the presence of characteristic antibodies is detected in the child's blood. These children are observed the disappearance of villi and the full development of the disease in the future.

Celiac disease is associated with other diseases, for example, with Down syndrome, Williams syndrome, Shereshevsky-Turner syndrome, thyroid disorders, IgA deficiency immunoglobulin. If in a family among relatives of the first degree of kinship there are people with celiac disease, this increases the risk of this disease in the child.

4 Diagnostic methods

In case of suspicion of celiac disease, it is necessary to consult a doctor who should refer the child for further diagnosis to a pediatric gastroenterologist. Without consulting with a gastroenterologist and without his research, you can not use a gluten-free diet. It can erase the picture of the disease, make it impossible to establish a further correct diagnosis and harm the health of the child. In the diagnostic cycle, serological blood tests are performed to determine the antibodies:

• against tissue transglutaminase( tTG);
• against deamidated gliadin peptides;
• against smooth muscle endomy( EmA).

The above antibodies are specific for celiac disease. Their detection in the blood almost always confirms the diagnosis of the disease, and their absence does not exclude celiac disease. This can be observed in young children, whose body is not yet sufficiently advanced to produce these antibodies.

For the correct diagnosis of celiac disease, an intestinal biopsy is necessary. This procedure is performed using an endoscope, during which samples of tiny fragments of the duodenal mucosa are taken. In the samples taken, the doctor assesses the degree of atrophy of the villi. A very important criterion for diagnosis is also the improvement of the child's condition after compliance with a gluten-free diet.

5 Treatment measures

Proper treatment of celiac disease should not be underestimated, as non-compliance with the diet leads to poor health and poor development of the child. In addition, if you do not treat celiac disease, it promotes the progression of ulcerative colitis, which belongs to the group of nonspecific inflammations of the intestine. The list of guidelines for feeding a child with celiac disease is as follows:

• excludes foods derived from wheat, barley and rye;
• gluten-free diet for the rest of life;
• products with gluten additives should be replaced with gluten-free products made from rice, corn, buckwheat and millet;
• can use potato flour, soy;
• gluten-free diet should be rich in a full-fledged animal protein - eggs, meat, milk;
• it should not contain a lot of fat;The
• diet should include vitamins A, C, D, folic acid and minerals, mainly calcium and iron;
• a child can consume vegetables and potatoes in the form of salads( they are a source of B vitamins and minerals - iron, selenium, manganese and dietary fiber);
• dishes should be cooked in water, steamed, stewed without fat or baked in foil;
• children with celiac disease tend to have no appetite, so it is important to give their food an attraction;
• gluten-free products are marked with an international symbol representing a crossed ear, and contain not more than 1 mg of gluten per 100 g of product.

After the introduction of a gluten-free diet, clinical symptoms should retreat for several days. A complete recovery of intestinal villi, as a rule, takes from several weeks to several months and is individual. If, despite the observance of the above recommendations, the child has diarrhea, milk is excluded from the diet. Inflammatory bowels are destroyed to such an extent that they can not digest the lactose contained in milk. Deficiency of protein as a result of cancellation of milk is supplemented by the introduction into the diet of more poultry meat, beef, rabbit meat, fish.

Celiac disease is a disease that, in addition to disturbances in the functioning of the child's body due to the underlying disease, contributes to a change in his daily life.

A life-long gluten-free diet is associated with many victims in the diet, often children do not want to adhere to it. Nevertheless, it is necessary to monitor compliance with the gluten-free diet and develop a child's sense of proper nutrition.