In 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: to stuff 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 begins to keep quiet, it means he has begun to gain peasant labor force. 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 even with honey: the snarling and roaring is even louder. He pacifies the crybaby mother with a song."

Quote 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, the compassionate mother, an incorruptible friend of her child, so that it does not cry and whine, hunting painfully and persistently asking for food, puts a small box somewhere in a secluded place. Come to him whenever you want, take as much as you want and eat. as many as will fit in the box... Koloboks are small round loaves of bread or thick flatbreads, they are usually baked from leftover flour from a pie or bread. Mother's tenderness adds butter to make it rich, brushes it with sour cream or stirs it in milk to make it sweeter. : the food is delicious and loved by the kids. fresh air, with constant running and movement, a peasant son grows up faster and more agile 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. The trouble from a large belly goes away over time, disappears with age, all that remains is the ability to eat a lot, since floury foods only nourish 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 affected 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”))) ;)

I forgot to write - shame on me - that the diagnosis of celiac disease is confirmed by a biopsy of the small intestine.

Quite a wide variety of 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! :)

Disability benefits for children 2019 are social benefits And additional types assistance provided to parents whose children have health problems and are assigned a certain disability group.

List of diseases for determining disability for children in 2019

According to the provisions of Article 1 of the Law “On social protection disabled people in the Russian Federation" No. 181-FZ on assigning disability to children in 2019, a disabled child is considered to be a child who has a health disorder associated with a disorder of body functions.

Regardless of what disease the child suffers from and at what stage the development of the pathology is, according to this law, in 2019 on the establishment of disability for children, he can receive this category at the age of 18 years if one of these points is fulfilled:

1. Persistent distress noted normal functioning body caused by injury, childbirth or illness.
2. There is no opportunity to live, move, talk, study, work and perform self-care activities independently.
3. There is a need for social protection from the state.

The category of disability is not assigned forever, but for a certain period. According to Federal Law, in Russia, disability can be assigned for 1 year, 2 years and 16 years. Then you will need to be examined again to confirm your disability. The period when a child belongs to this category of citizens, he has the right to receive a social pension, the amount of which is indexed every year.

• mental disorders;
• disruption sensory system body;
• external physical deformities;
• lack of normal functioning of language and speech;
• violation of body functions associated with the ability to move;
• impaired functioning of the digestive organs, heart, blood vessels, respiratory, endocrine, circulatory, and immune systems;
• diseases associated with urinary dysfunction;
• dysfunction of the skin and related diseases.

Groups for assigning disability to children according to the 2019 Federal Law.

Currently, according to the legislation of the Russian Federation, there are the following categories of disability:

• Group I;
• Group II;
• III group.

First group– one of the most difficult disability categories. Its assignment is carried out only when severe violation functioning human body. As a rule, disabled people of group I everyday life cannot do without the help of other people.

The first group is usually assigned for the following violations:

• complete or partial absence organs of vision;
• hereditary or congenital diseases that severely damage the functioning of the central nervous system;
• absence of lower limbs;
• hearing damage of 80% or more.

The first group is also assigned for other, equally serious diseases.

Disabled people of group II- these are children who can perform minimal self-care activities without the help of other people, possibly with the use of special equipment. The list of disorders for which this group can be assigned usually consists of diseases such as:

• cirrhosis;
• visual impairment;
• paraplegia;
• fistula;
• disarticulation of the thigh;
• presence in the body of one lung or pulmonary failure second degree.

Disability Group III often assigned to children who have disabilities due to previous past diseases and injuries received. In the future, persons belonging to this category of citizens of the Russian Federation will not have special restrictions in labor activity, and will receive a salary at the level of other employees, but they are entitled to state social assistance and material support. Group 3 disabilities are considered to be children who have the following health problems:

• speech disorders;
• minor mental disorders;
• pulmonary tuberculosis;
• sensory perception disorders;
• minor manifestations of physical deformity.

Assignment of disability in 2019 to children with diabetes and clubfoot

In case of disability, children with diabetes mellitus in 2019, the first or second group may be assigned depending on the severity of the disease. First of all, social assistance and benefits for diabetic children is aimed at providing this category of citizens with all the necessary medications.

Disability for clubfoot in children in 2019 is assigned to a child based on the presence of defects and deformities lower limb. To do this you need to go through medical examination and get an opinion from a surgeon and orthopedist. With clubfoot, a child may have disability group 2 or 3.

Types of social assistance for disabled children

Disabled children are a special category of children who need care not only from loved ones and society, but also from the state. In 2019, payments for disability to a child are made to about 550 thousand children who fall into this category of Russian citizens.

In 2019, the Russian Federation provides for the following types of social assistance for disabled children who are citizens of the Russian Federation:

• monthly charges;
• benefits provided for by the Labor Code;
• benefits related to housing issues;
• transport benefits;
• benefits for ensuring the upbringing and further education of children;
• benefits for treatment, sanatorium holidays;
• tax benefits.

According to the disability law, children are entitled to a social state pension in 2019. The following sizes are available for this year: financial assistance parents or guardians of disabled children:

• disabled people from childhood, group 1 - 10,376 rubles per month;
• disabled people of group 2 since childhood, as well as citizens who received a disability of group 1 - 8,647 rubles per month;
• disabled people of group 2 – 4,323 rubles per month;
• disabled people of group 3 – 3,675 rubles per month.

In addition, parents or guardians of children who fall into this category of citizens of the Russian Federation with limited abilities Those who care for them receive financial compensation. The amount of such financial assistance is 60% of the official minimum wage.

In addition, persons who care for a child are entitled to the following monetary payments:

• 5,500 rubles – to a parent or guardian;
• 1,200 rubles – to other categories of persons who care for a child with disabilities.

Benefits for families with disabled children in 2019

Not only pensions in the form monthly payments entitled to citizens of the Russian Federation. Families of children with disabilities in 2019 can count on the following benefits:

• payment benefits utilities – 50%;
• Telephone discount – 50%;
• the mother of a disabled child who has not yet turned 16 years old has the right to part-time work or a week;
• the organization does not have the right to refuse employment to the mother of such children and lower wages;
• the organization on its own initiative does not have the right to fire the mother of a disabled child;
• one parent or guardian has the right to an additional 4 days off per month;
• free travel to public transport citywide or natural communication;
• a permanent discount of 50% on all types of transport, it is valid for the period from October 1 to May 15 of each year;
• priority right to enrollment kindergarten if possible, visit him for health reasons;
• exemption of parents from paying for kindergarten services;
• priority right to enroll in a university if the necessary quotas are provided and the entrance exams are successfully passed;
• free receipt of prescription drugs prescribed by your doctor;
• free receipt of prostheses and other orthopedic products;
• receiving sanatorium-resort voucher per child and one accompanying person.

Establishment and extension of disability for a child in 2019

The determination and extension of disability for a child in 2019 is carried out by a medical and social expert commission - MSEC. The procedure is carried out in one of the following ways:

1. After the diagnosis has been made and the course of treatment completed, the doctors themselves recommend that the patient’s parents receive a disability group and refer him to the MSEC.
2. The child's parents or guardians themselves declare to the attending physician their intention to obtain a disability group and ask for a referral to undergo the MSEC.

Sometimes parents of a sick child who want to receive a disability category have to make efforts to convince representatives of the medical commission about the existence of dysfunctions in the child’s body.

To pass the expert medical commission, you must prepare documents from this list:

• Referral by the attending physician to MSEC.
• Original and copy of birth certificate.
• Original and copy of the passport of one of the parents or guardian.
• Original and photocopy of passport (for persons over 14 years of age).
• Certified copy work book parents or guardians.
• Child's outpatient card.
• Extracts from all hospitals where the child was treated, as well as copies thereof.
• Application for examination.
• A document confirming the place of registration of the child.

Extension of disability for a child in 2019 takes place in exactly the same way. Parents are collecting everything again necessary documents and together with the child they undergo a medical and social expert commission.

Removal of disability from children in 2019 upon expiration

The removal of disability from children in 2019 takes place automatically after the expiration of the period for which this category was assigned. If parents or guardians of children who have been assigned disability status, for certain reasons, want to remove the child from the register earlier, a medical expert commission is required. During such a procedure, it is important to prove that the child does not have health problems or any restrictions in self-care.

Therefore, when thinking through the diet, caring parents make sure that the child receives all the necessary proteins, fats, carbohydrates, vitamins and minerals. However, few adults know that there is a whole category of products that can be harmful and even dangerous for some children. So, children with celiac disease should never eat food containing gluten. We talk about what celiac disease is and how to live with it with Sergei BELMER, professor of the Department of Childhood Diseases of the Russian State Medical University N2.

— Sergey Viktorovich, what is celiac disease and how often does it occur?

- If you give short definition, Celiac disease is an intolerance to the protein gluten. This protein is found in many cereals. The exceptions are rice, buckwheat and corn. In patients with celiac disease, gluten damages the mucous membrane small intestine, which causes it to atrophy. The consequences of this atrophy are impaired intestinal absorption. Moreover, the absorption of proteins, fats, carbohydrates, vitamins, and minerals is impaired. The child, naturally, suffers greatly: he loses weight no matter how much he eats, lags behind both physically and mental development, forgets even the skills that he has already acquired, grows and develops poorly, and the functioning of his internal organs is disrupted. If the process is not stopped, the outcome can be very sad.

— How common is this disease?

— Ten years ago it was believed that 1 in 1000 children had celiac disease, and in some countries, for example, in Ireland, 1 in 300-500. Over the past 3-5 years, a lot of research has been carried out to identify hidden celiac disease and it turned out that the frequency of the disease is much higher. According to some data, there are 1 in 100 people with celiac disease. But even if you are skeptical about these figures, then, probably, there is certainly 1 in 500. This does not mean that diseases have become more frequent - no, diagnosis has simply become better.

— What causes gluten intolerance?

- It is believed that celiac disease - hereditary disease. However, the gene for celiac disease has not yet been identified. There are several putative genes, but the exact one has not yet been found. And yet, everything indicates that the disease is genetic. However, it is never possible to say for sure that parents with celiac disease will have an unhealthy child. Very often we see the opposite situation: people suffering from celiac disease have completely healthy children.

— How can you notice celiac disease, by what signs?

— Signs appear in a wide variety of variations. Therefore, typical, atypical and latent celiac disease are distinguished. It appears a month or two after introducing gluten-containing foods into the diet. If, for example, a child is given some kind of cereal containing gluten at the end of the first half of life, then already in the second half of the year, at 8-9 months, the baby’s first symptoms appear. Classic signs of celiac disease: weight loss accompanied by loose stools (large, fluffy stools) with a grayish tint and big belly. A patient with typical celiac disease is sometimes compared to a spider: huge belly and thin limbs. In the first stages of the disease, the child may be agitated, even aggressive. But subsequently, excitability gives way to apathy and loss of interest in others. Appetite worsens, the functioning of the whole body is disrupted. The patient develops pain in the joints, head, hair loss, caries, fainting, bleeding, etc. However, the disease can manifest itself somewhat later, in the second year of life. That is, the symptoms, of course, are there initially, but they are not so pronounced as to attract the attention of parents. But atypical celiac disease is much more insidious, since it usually manifests itself with only one symptom, for example, anemia. And the problem is that there are a lot of diseases that cause anemia in a person. Therefore, identifying celiac disease is not so easy. This is precisely its danger. In addition, there is hidden, latent celiac disease, which does not make itself felt. It can only be identified through special research. For the patient with latent celiac disease, the disease is not dangerous, but it can be inherited.

— What can a late diagnosis lead to?

- To very serious changes in the body. If a sick child is delayed in growth, but was diagnosed on time, at 1-2 years of age, he will catch up in height with his peers. With the right timely treatment children return to normal life, grow and develop like completely ordinary babies. They don't give in healthy children neither in physical, nor in mental, nor in sexual development. And in patients who are diagnosed late, at 8-9-10 years old, secondary changes occur, which are then difficult to correct, for example, changes in bone tissue.

— Can any intrauterine development disorders occur in children whose mother has celiac disease?

- No, there is no such relationship. We have patients who were diagnosed in a timely manner and received adequate therapy. They followed the diet extremely strictly, and they had children who did not suffer from this disease.

— What diagnostic methods exist?

— The diagnostic process is quite complicated, all over the world, not just here. The most in an accessible way Determination of celiac disease is the detection of antigliadin and antitransglutaminase antibodies in the blood. To do this, blood is taken from a vein and serological test. However, we do not always get 100% information after this examination, so we have to do a biopsy of the small intestinal mucosa. In the hands of an experienced specialist, this procedure is quick and painless. The diagnosis is made based on the totality of all data: clinical picture, biopsy data and serological examination. The problem sometimes arises if the patient has started following a gluten-free diet before a comprehensive examination. Then many changes quickly go away, the mucous membrane begins to recover and the level of antibodies in the blood decreases. In such situations, sometimes it is even necessary to conduct a provocative test, when gluten is introduced into the patient’s diet, and after some time a repeated examination is carried out.

— How is celiac disease treated?

— The main thing is a lifelong gluten-free diet. If it is not observed, patients with celiac disease are at risk of developing oncological diseases. The insidiousness of celiac disease lies in the fact that patients who follow a diet are restored in all respects, and at some point the illusion may arise that a complete and irrevocable recovery has occurred, and now they can consume any food. This is the deepest misconception! A patient with celiac disease is sentenced to diet for life. Although, of course, it is not so simple. Firstly, patients with celiac disease love bakery products. And, secondly, patients do not always know which products contain gluten and which do not. Unfortunately, not all our products are labeled for gluten content. IN Western countries It is already customary to write whether the composition contains gluten or not. After all, it is found in many products: rye, wheat, barley, oats, semolina, pearl barley, in canned food, sausages, ketchup, in soy sauce, in some seasonings and spices, in concentrated soups or bouillon cubes, in crab sticks, in oriental sweets, in chocolate candies with filling, in some food additives etc. Besides food products Gluten is sometimes found in some cosmetics or in envelope glue. Therefore, in the West they are very careful that all products are labeled. And on gluten-free products they always depict a crossed out ear, which indicates the absence of gluten. In addition to diet, patients sometimes have to be prescribed other therapy, depending on the changes that have occurred in their gastrointestinal tract and internal organs. They can receive drugs to correct intestinal microflora, pancreatic enzymes or some other drugs to restore the body: iron for anemia, calcium for bone damage.

— What can you advise parents of sick children? How to choose products?

— The child’s diet should not contain any cereals, except rice, buckwheat and corn. You can eat meat, fish, vegetables, fruits, eggs, dairy products, legumes, chocolate, marmalade, some candies, marshmallows, and some types of ice cream. If we talk about newborns, then almost all modern milk formulas for nutrition and all medicinal mixtures do not contain gluten. If they contain gluten-containing components, this is always indicated on the packaging. Of course, you need to pay attention to the labeling. Today, special gluten-free products have appeared on our market. They have wonderful taste qualities and are created specifically for patients with celiac disease.

— Are there any radical cures for celiac disease?

“Unfortunately, the subtle mechanisms of its development are still unknown. There are many hypotheses, but this does not yet allow us to approach the creation of drugs that could cure the patient forever. However, when timely diagnosis, if an accurate diagnosis is made and a diet is prescribed in combination with other drugs, celiac disease will not manifest itself in any way.

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:

1. Underweight;
2. Slow growth;
3. Psycho-emotional characteristics: hot temper, capriciousness, irritability, attacks of aggression, which can abruptly give way to lethargy and indifference;
4. Stool disorders: bowel movements are unbearable bad smell, their number gradually increases, the feces become foamy and mushy;
5. Dull abdominal pain that occurs in attacks;
6. Rickets. Pathology occurs due to a lack of calcium, because the intestines are not able to absorb it;
7. Delayed eruption permanent teeth, existing caries;
8. Edema;
9. Cow's milk intolerance.

We have listed the classic symptoms of the disease, but it can behave completely unpredictably and manifest itself with atypical symptoms. For example, stomatitis, anemia, arthritis, dermatitis, strong 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 they accept the whole complex measures 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:

1. All products made from oats, rye, wheat and barley;
2. Pasta;
3. Bread;
4. Cookie;
5. Pastries and cakes;
6. Ice cream;
7. Yoghurts;
8. Semi-finished meat products;
9. Sausages;
10. Canned food;
11. Sauces;
12. Whole milk is highly undesirable.

The diet should include the following foods:

1. potato;
2. buckwheat;
3. fish;
4. corn;
5. cottage cheese;
6. vegetables/fruits;
7. legumes;
8. vegetable oil;
9. 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. IN mandatory vitamin therapy is necessary.

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 by taking 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.

If not treated in a timely manner, ciliacia 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, which is known for its high mortality rate.

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.

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 the true number of people suffering from this disease is much higher.

Screening studies of blood donors have found that the prevalence of the disease reaches 1:256 in all European countries. Asymptomatic ( hidden forms) in adults occur 4-5 times more often than 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.

1. 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. The accumulation of toxic products in the mucous membrane of the small intestine 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.
2. 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.
3. Malfunctions play a significant role in the development of the disease. 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.
4. One of the reasons is the body’s inadequate toxic reaction to the absorption of incompletely broken down gluten products in the intestines. 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 not strict adherence There is no positive dynamics of recovery with such a diet.

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.

Damage to 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 no symptoms despite the presence characteristic lesion intestines.

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,
• Sensory disturbance (tingling, numbness).

Vitamin A deficiency causes problems twilight vision, “night blindness” appears.

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 trauma, and 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 duodenum and the middle sections of the jejunum often lack 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 with transverse striations, 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 (a large amount of 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 in 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 background 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.

Timely diagnosis malignant tumors installed only with instrumental methods(endoscopy of the esophagus, stomach, small and large intestines, X-ray examination 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 feces
• 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

Developed by the World Organization of Gastroenterologists practical guide, which specifies the 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 diagnostic tool, 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 (II and III degree severity).

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.