[All-Russian Consensus on Diagnosis and Treatment of Celiac Disease in Children and Adults]. / Vserossiiskii konsensus po diagnostike i lecheniyu tseliakii u detei i vzroslykh.

The paper presents the All-Russian consensus on the diagnosis and treatment of celiac disease in children and adults, which has been elaborated by leading experts, such as gastroenterologists and pediatricians of Russia on the basis of the existing Russian and international guidelines. The consensus approved at the 42nd Annual Scientific Session of the Central Research Institute of Gastroenterology on Principles of Evidence-Based Medicine into Clinical Practice (March 2-3, 2016). The consensus is intended for practitioners engaged in the management and treatment of patients with celiac disease. Evidence for the main provisions of the consensus was sought in electronic databases. In making recommendations, the main source was the publications included in the Cochrane Library, EMBASE, MEDLINE, and PubMed. The search depth was 10 years. Recommendations in the preliminary version were reviewed by independent experts. Voting was done by the Delphic polling system.

[Iron deficiency anemia and anemia in chronic celiac disease in children].

UNLABELLED: Anemia in celiac disease (CD) may be associated with deficiency of iron, vitamins, macro- and micronutrients. It is also possible the development of chronic disease anemia (CDA), associated with activation of proinflammatory cytokines. The aim of this work is to optimize the diagnosis and treatment of celiac disease in children on the basis of study of iron metabolism disorders heterogeneity, including the role of CDA. PATIENTS AND METHODS: We observed 34 children with CD aged 1.5 to 17 years, 27 of them children were observed both in the active stage of the disease and in remission. The control group included 25 children aged 1.2 to 17 years who were previously excluded for any chronic (including autoimmune) disease: these children were observed with chronic functional gastrointestinal motility disorders. Special methods of examination were study of iron metabolism, including the determination of the serum hepcidin level, as well as the determination of the serum proinflammatory cytokines (tumor necrosis factor [TNF] -α, interleukin [IL] -2, IL-6, IL-10). RESULTS AND DISCUSSION: In active CD in 14.71% of children anemia of varying severity (mild or moderate) were diagnosed. Among these children we observed mild decrease of serum iron in the range 2.2-8.0 g/ml in 15 of 34 children (44%) and a marked reduction in serum ferritin level in 59% of children. In the active celiac disease in the majority of children there is a decrease in the serum hepcidin, but approximately in 20% of children serum hepcidin level was increased. This indicates the development of CDA in these children. During the active stage the average values of IL-2 was significantly increased (p < 0.05). Thus, the iron metabolism disorders in celiac disease is a result of immunopathological process which results in a reduction in iron absorption in the gut due to the intestinal mucosa villous atrophy and to improve the hepcidin production by liver cells and iron depot blocking with the CDA development in 20% of children.

[Functional digestive disorders in infants. Working protocol of diagnostic and treatment].

Functional digestive disorders in infants comprise a group of disorders characterized by several specific features. They are related to structural and physiological peculiarities of the gastrointestinal tract in children during lactotrophic period of nutrition, limited pharmacotherapeutic options and supremacy of dietary correction in this age group, and psychological discomfort that has a negative impact on the quality of life of the whole family. The working protocol "Functional gastrointestinal disorders in infants' was prepared by the Russian Society for Pediatric Gastroenterology, Hepatology, and Nutrition (RusPGHAN) based on the previously proposed European (ESPGHAN) and American (NASPGHAN) guidelines. The protocol includes detailed description of the current approaches to diagnosis and management of the functional digestive disorders in young children, as well as algorithm tables that can be used by pediatricians and familial physicians in routine clinical practice.

[Modern concepts pathogenesis of celiac disease].

The purpose of the review was to familiarize pediatricians with the modern concepts of the etiology and pathogenesis of celiac disease in children. Article executed on the extensive material. In easily accessible language. Based on thorough analysis of modern, mostly foreign, literature, highlights some of the presently known characteristics of the key pathological process in celiac disease. In this article quite clearly shown how to develop mucosal damage of the small intestine in this disease. It was shown that celiac disease in any case isn't atopic, which was involved in mast cells and fixed them on the antibody class E and / or G. Although what is set to atopic reaction to gliadin, the process involves a completely different epitopes of the molecule. These are the sequence of molecules alpha beta gamma- and omega 5-gliadin with a common motif QQX1PX2QQ, where X1 can be represented by L, F, S or I and X2--Q, E or G). And at the same time, as an autoimmune disease, accompanied by increased activity of cytotoxic cells, damaging enterocytes, the development of antibodies in celiac disease is a secondary character. In conclusion, stated that all three concepts of celiac disease now seem to be quite distinct, suggesting three options for development of the disease, which, of course, is not excluded, but a single concept, uniting all together, would be preferable. This is the subject of further research.

[Disorders of humoral regulation of the digestive organ functions in children with malabsorption syndromes]. / Narusheniia gumoral'noi reguliatsii funktsii organov pishche- vareniia pri sindrome mal'absorbtsii u detei.

The authors provide the data obtained during examination of 36 children with celiac disease and 18 children with lactase deficiency. The children's age ranged from 8 months to 15 years. All the children underwent spot biopsy of the gastric and duodenal mucosa followed by immunomorphological PAP-staining of the biopsy specimens and count of the number of gastrin- and somatostatin-producing cells. Gastrin in the blood serum was measured by radioimmunoassay. The children with celiac disease manifested an increase of the number of somatostatin-producing cells in the duodenum and decrease of their number in the pyloric part of the stomach, seen in the acute phase of the disease. The number of gastrin-producing cells remained unchanged. The level of gastrin declined in the acute phase and increased during a remission. The alterations described were found to be related to the atrophic processes in the small intestinal mucosa. In lactase deficiency, no significant alterations were established in the number of pyloric and duodenal endocrine cells or in blood gastrin level.