The authors present current data on the etiology, pathogenesis, clinical manifestations of celiac disease in children of different ages, associated diseases, laboratory and instrumental diagnostics, diet therapy, additional treatment methods, vaccination, and follow-up of children with celiac disease based on the developed clinical guidelines “Celiac Disease. Children”.

Celiac disease significantly affects the quality of life of children and their family in the context of adherence to a gluten-free diet (GFD). Ensuring dietary compliance is currently recognized as one of the most difficult and pressing challenges in gastroenterology. Various types of institutional and social support, as well as certain “agreements” between parents and children, are seen as means of improving adherence. Objective. To study some psychological factors influencing the adherence to healthy eating habits in children and adolescents, including parental factors. Patients and methods. This study involved parents of children following GFD (41 respondents) who completed a comprehensive online questionnaire survey: questions about general information and the severity of problems in children following GFD, “Dietary compliance in celiac disease” self-assessment questionnaire, “Strengths and difficulties” questionnaire, “Family anxiety analysis” questionnaire, and “Teenagers about parents” methodology. Children of all respondents (n = 41, aged 11–17) completed the online questionnaire “Dietary compliance in celiac disease.” Results. Based on intergroup comparisons, female respondents were found to have more severe psychological problems than male respondents. The total score of psychological problems depending on adherence to GFD was directly related to numerous characteristics of behavioral issues, school and family adaptation, and inversely related to behavior aimed at positive communication with society. Higher scores of hyperactivity and peer relationship issues were found in adolescent girls, which significantly distinguishes patients with celiac disease from the general population. Conclusion. The results of this study expand the idea of the role of family in adolescents’ adherence to GFD. Thus, celiac disease can be viewed as a family problem that affects not only patients but also their parents. Key words: celiac disease, gluten-free diet, adherence, children, adolescents, psychological support

Introduction. The history of celiac disease research spans more than one millennium, but it is only in the middle of the 20th century that the causal role of gluten was proved. Moreover, the 75 years since then were marked by impressive achievements that enabled an understanding of the nuances of pathogenesis, the development of highly informative diagnostic methods, and the identification of trends in drug treatments for gluten-associated diseases. Given that gluten intolerance and the resulting group of pathological conditions are widespread in the human population as a whole, studies of the quality of life, socio-economic and psychological aspects of the patients’ lives and their immediate environment are of particular value. Purpose of the study. To examine whether children with celiac disease and their immediate environment are satisfied with the availability and quality of social support measures. Materials and methods. This study was based on the results of an online survey conducted among 179 respondents (children, parents and guardians) with an established diagnosis of celiac disease using an original questionnaire to study the satisfaction of celiac patients with the availability and quality of social support measures. Results and discussion. The results of the study suggest that celiac disease in children has a multidimensional impact on the family’s daily life, going beyond clinical issues and affecting a wide range of social, organizational and psychological aspects, representing not only a medical problem, but also a persistent source of social difficulties, which necessitates comprehensive interdisciplinary support. The identified difficulties in confirming the diagnosis and organizing medical support allow us to hypothesize about insufficient integration of patients with celiac disease into primary health care and the lack of medical awareness. That is, children with celiac disease and their families remain in conditions of latent social and medical instability, without receiving a full-fledged, multidisciplinary trajectory of support. At the same time, fragmentary knowledge about social support measures indicates a deficit of institutional information and opacity of mechanisms for inclusion in the care system. This allows us to conclude that celiac disease does not yet hold an important place in the social policy system and remains insufficiently taken into account when forming specialized support measures, and that there is no systemic approach to supporting this group. In addition, the survey results record a persistent impact of the disease on daily activity, including limited mobility, difficulties with organizing meals outside the home, and challenges in academic inclusion. At the same time, against the background of the relatively preserved interpersonal communications and the significant role of support from family members, we can assume the presence of compensatory mechanisms grounded in the resource potential of the immediate social environment. That is, the sustainability of families with a child suffering from celiac disease relies rather on informal resources and internal strategies than on systemic external support. Conclusion. Celiac disease in children is not only a medical problem, but also an indicator of institutional vulnerability, structural gaps in routing, support and information. Effective integration of families into the support system requires a comprehensive interdepartmental model, including: regulatory consolidation of support measures, regular updating and dissemination of information in an accessible form, expansion of gastroenterological services and development of infrastructure for a safe everyday life.

It has now been proven that to develop celiac disease, patients must not only have a genetic predisposition, but also be exposed to epigenetic factors, including infections, antibiotic use, feeding patterns during the first year of life, age of introduction of glutencontaining foods, vaccination, and many other factors that affect the state of the gut microbiome. This review discusses recent research on the connection between the state of the gut microbiota and the development of celiac disease, as well as the potential for correction to restore the qualitative and quantitative characteristics of the microbiota. Based on the analysis of recent studies, it can be concluded that changes in the microbiota in patients with celiac disease are not only a consequence of the disease itself, but rather a part of a complex association between many causal factors. Among them are dietary and psychological factors. The benefits of probiotics include restoring the gut microbiota's composition and modulating the immune response, which increases resistance to pathogenic microorganisms and may reduce the severity of several gastrointestinal symptoms in patients following a gluten-free diet. Key words: celiac disease, gluten-free diet, gut microbiota, probiotic therapy

Celiac disease has historically been associated by doctors with underweight due to malabsorption; in recent decades, the clinical picture of the disease has become more heterogeneous, including its atypical manifestations. The link between celiac disease and overweight and obesity is increasingly recognized. The article presents an analytical review of scientific research on celiac disease among pediatric patients. A number of studies in children with celiac disease show that overweight/obesity is not uncommon for celiac disease. In addition, there is a tendency to develop overweight/obesity in celiac disease patients who strictly adhere to a gluten-free diet. It has been shown that among obese children, the prevalence of celiac disease is comparable to the frequency in the general population. Timely diagnosis of celiac disease in overweight / obese patients allows earlier dietary intervention, which will lead to normalization of morphological changes in the mucous membrane of the small intestine and clinical manifestations of the disease.

Introduction . Celiac disease is a chronic autoimmune disease requiring a lifelong gluten-free diet. Despite the effectiveness of the diet in controlling symptoms, patients’ quality of life remains at risk due to limitations in social, emotional, and gastronomic spheres. Aim : to analyze current approaches to assessing the quality of life of patients with celiac disease in order to optimise strategies for providing care to this category of patients. Key points. Current research emphasizes the importance of not only clinical control, but also of psychosocial support for patients This review describes validated tools for assessing life quality in patients with celiac disease, highlighting the differential impact of the disease on children and adults, the specifics of adherence to and perceptions of a gluten-free diet, and regional and cultural differences in access to support and gluten-free products. An unfavorable psychological state can reduce adherence to a gluten-free diet, creating a vicious cycle. A comparison with other chronic diseases showed that with strict adherence to a gluten-free diet, celiac disease may have a lesser impact on quality of life. Conclusion . Optimizing quality of life requires a multidisciplinary approach — from cultural adaptation of life quality scales to psychological and social support for these patients and normalizing nutrition outside the home.