{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T13:05:01Z","timestamp":1773061501116,"version":"3.50.1"},"reference-count":57,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,8,12]],"date-time":"2022-08-12T00:00:00Z","timestamp":1660262400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012632","name":"Nazarbayev University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100012632","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Celiac disease (CD) is a common genetically predisposed autoimmune condition affecting the gut and other organs. Disease awareness is one of the key components of early case identification. This study aimed to assess awareness about CD among primary care physicians, who are the front-liners in suspecting the diagnosis, and other medical specialists.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and findings<\/jats:title><jats:p>The questionnaire for this survey-based study was created based on the latest international guidelines on CD and included a consent form, 5 general questions (age, gender, etc.), and 10 specific questions concerning CD. Overall, 232 respondents from 13 country provinces (out of 14) and two republican cities were recruited for this study. Of them, 110 (47.4%) were primary care physicians and 122 (52.6%) other medical specialists, including 10 (4.3%) gastroenterologists. A scoring system was used to classify the level of awareness of participants into 3 categories, namely, poor, fair, and good. Analysis of responses revealed poor awareness in 59.4% of physicians, associated with work in republican\/province\/district\/rural\/village hospitals (<jats:italic>p<\/jats:italic> = 0.004), male gender (<jats:italic>p<\/jats:italic> = 0.006), and age of 40\u201350 years (<jats:italic>p<\/jats:italic> = 0.02). The most common \u201cmyths\u201d about CD were the following: \u201csymptoms are always obvious in children\u201d or \u201cin adults\u201d (92.5 or 88.4% of respondents, respectively); \u201cgenetic mutation <jats:italic>HLA DQ2\/DQ8<\/jats:italic> causes the development of CD in all carriers of the mutation\u201d (51.3%); \u201cCD is a disease of children only\u201d (12.5%); and \u201cis triggered by dairy products\u201d (8.6%). Genotyping of HLA DQ genes has been recommended in case of CD suspicion by every third respondent and was advocated as a \u201cgolden standard\u201d confirmatory test by every fifth respondent. A quarter of respondents revealed their incorrect treatment strategies: gluten-free diet for 1 month, dairy-free diet, <jats:italic>Helicobacter pylori<\/jats:italic> eradication therapy, or responded that did not know how to treat. Overall, 93.5% of respondents expressed intention to learn more about CD, while the rest 6.5% thought that they knew enough, although their knowledge was poor.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study revealed a poor level of awareness among physicians in Kazakhstan and identified common misconceptions about CD, which potentially could lead to incorrect application of diagnostic tests, delay in diagnosis, and inefficient treatment. Development and implementation of educational programs as well as promotion of self-learning would increase awareness and unravel misconceptions.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2022.956135","type":"journal-article","created":{"date-parts":[[2022,8,12]],"date-time":"2022-08-12T04:42:26Z","timestamp":1660279346000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":9,"title":["Current knowledge and \u201cmyths\u201d about celiac disease among physicians in the Republic of Kazakhstan: A countrywide cross-sectional study"],"prefix":"10.3389","volume":"10","author":[{"given":"Aizhan","family":"Kozhakhmetova","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Serzhan","family":"Aidossov","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aissulu","family":"Kapassova","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karlygash","family":"Borsoldayeva","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,8,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"823","DOI":"10.1016\/j.cgh.2017.06.037","article-title":"Global prevalence of celiac disease: systematic review and meta-analysis","volume":"16","author":"Singh","year":"2018","journal-title":"Clin Gastroenterol Hepatol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"g1561","DOI":"10.1136\/bmj.g1561","article-title":"Coeliac disease","volume":"348","author":"Mooney","year":"2014","journal-title":"BMJ."},{"key":"B3","first-page":"369","article-title":"Das Cham\u00e4leon unter den Nahrungsmittelintoleranzen [Celiac disease\u2013the chameleon among the food intolerances]","volume":"36","author":"Str\u00f6hle","year":"2013","journal-title":"Med Monatsschr Pharm"},{"key":"B4","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1172\/JCI30253","article-title":"Celiac disease: pathogenesis of a model immunogenetic disease","volume":"117","author":"Kagnoff","year":"2007","journal-title":"J Clin Invest."},{"key":"B5","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1111\/apt.16337","article-title":"Systematic review and meta-analysis: the incidence and prevalence of paediatric coeliac disease across Europe","volume":"54","author":"Roberts","year":"2021","journal-title":"Aliment Pharmacol Ther."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1318","DOI":"10.1016\/j.amjmed.2017.05.027","article-title":"Delay in diagnosis of celiac disease in patients without gastrointestinal complaints","volume":"130","author":"Paez","year":"2017","journal-title":"Am J Med."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1011","DOI":"10.1007\/s00431-012-1714-8","article-title":"Clinical practice: coeliac disease","volume":"171","author":"Kneepkens","year":"2012","journal-title":"Eur J Pediatr."},{"key":"B8","doi-asserted-by":"publisher","first-page":"627","DOI":"10.1542\/peds.2014-3675","article-title":"Clinical features of celiac disease: a prospective birth cohort","volume":"135","author":"Agardh","year":"2015","journal-title":"Pediatrics."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1123","DOI":"10.1111\/apt.12973","article-title":"Systematic review with meta-analysis: associations between coeliac disease and type 1 diabetes","volume":"40","author":"Elfstr\u00f6m","year":"2014","journal-title":"Aliment Pharmacol Ther."},{"key":"B10","first-page":"144","article-title":"Maladie coeliaque: particularit\u00e9s africaines. A propos de 8 cas \u00e0 Djibouti [Celiac disease: special features in Africa. description of 8 cases in Djibouti (horn of Africa)]","volume":"68","author":"Coton","year":"2008","journal-title":"Med Trop (Mars)."},{"key":"B11","doi-asserted-by":"publisher","first-page":"226","DOI":"10.1111\/apt.12373","article-title":"Systematic review: worldwide variation in the frequency of coeliac disease and changes over time","volume":"38","author":"Kang","year":"2013","journal-title":"Aliment Pharmacol Ther."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1095","DOI":"10.1111\/jgh.13270","article-title":"Prevalence of celiac disease in Asia: a systematic review and meta-analysis","volume":"31","author":"Singh","year":"2016","journal-title":"J Gastroenterol Hepatol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1038\/ajg.2015.398","article-title":"Prevalence of adult celiac disease in india: regional variations and associations","volume":"111","author":"Ramakrishna","year":"2016","journal-title":"Am J Gastroenterol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1111\/1751-2980.12587","article-title":"Prevalence of celiac disease in adult Chinese patients with diarrhea-predominant irritable bowel syndrome: a prospective, controlled, cohort study","volume":"19","author":"Kou","year":"2018","journal-title":"J Dig Dis."},{"key":"B15","doi-asserted-by":"publisher","first-page":"1272","DOI":"10.3748\/wjg.v28.i12.1272","article-title":"Epidemiological, clinical, and histological presentation of celiac disease in Northwest China","volume":"28","author":"Wang","year":"2022","journal-title":"World J Gastroenterol."},{"key":"B16","doi-asserted-by":"publisher","first-page":"1518","DOI":"10.1038\/ajg.2011.188","article-title":"Editorial: celiac disease in Turkey: lessons from the fertile crescent","volume":"106","author":"Catassi","year":"2011","journal-title":"Am J Gastroenterol."},{"key":"B17","doi-asserted-by":"publisher","first-page":"282","DOI":"10.1007\/s12519-009-0053-y","article-title":"Celiac disease in 87 children with typical and atypical symptoms in Black Sea region of Turkey","volume":"5","author":"Dinler","year":"2009","journal-title":"World J Pediatr."},{"key":"B18","doi-asserted-by":"publisher","first-page":"595","DOI":"10.5152\/eurjrheum.2018.18020","article-title":"Prevalence of celiac disease among school-age children in \u00c7orum, Turkey","volume":"29","author":"Comba","year":"2018","journal-title":"Turk J Gastroenterol."},{"key":"B19","doi-asserted-by":"publisher","first-page":"666","DOI":"10.1111\/jgh.12514","article-title":"Issues associated with the emergence of coeliac disease in the Asia\u2013Pacific region: a working party report of the world gastroenterology organization and the Asian pacific association of gastroenterology","volume":"29","author":"Makharia","year":"2014","journal-title":"J Gastroenterol Hepatol."},{"key":"B20","doi-asserted-by":"publisher","first-page":"2153","DOI":"10.3748\/wjg.v13.i15.2153","article-title":"Celiac disease in the developing countries: a new and challenging public health problem","volume":"13","author":"Cataldo","year":"2007","journal-title":"World J Gastroenterol."},{"key":"B21","doi-asserted-by":"publisher","first-page":"1449","DOI":"10.3748\/wjg.v16.i12.1449","article-title":"Celiac disease in middle eastern and North African countries: a new burden?","volume":"16","author":"Barada","year":"2010","journal-title":"World J Gastroenterol."},{"key":"B22","first-page":"5","article-title":"Epidemiology of celiac disease in iran: a review","volume":"3","author":"Rostami Nejad","year":"2011","journal-title":"Middle East J Dig Dis."},{"key":"B23","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1016\/j.vhri.2015.09.002","article-title":"Project baiterek: a patient access program to improve clinical outcomes and quality of life in children with type 1 diabetes in Kazakhstan","volume":"7","author":"Muratalina","year":"2015","journal-title":"Value Health Reg Issues."},{"key":"B24","article-title":"Autism and the knowledge and beliefs of specialists in Kazakhstan","volume-title":"J Autism Dev Disord.","author":"Somerton","year":"2021"},{"key":"B25","doi-asserted-by":"publisher","first-page":"1817","DOI":"10.1177\/1362361320923494","article-title":"\u201cChasing hope\u201d: Parents' perspectives on complementary and alternative interventions for children with autism in Kazakhstan","volume":"24","author":"An","year":"2020","journal-title":"Autism."},{"key":"B26","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1007\/s11657-020-0701-3","article-title":"Epidemiology of osteoporotic fracture in Kazakhstan and development of a country specific FRAX model","volume":"15","author":"Issayeva","year":"2020","journal-title":"Arch Osteoporos."},{"key":"B27","first-page":"35","volume":"79","author":"Salkhanova","year":"2010","journal-title":"Vopr Pitan."},{"key":"B28","doi-asserted-by":"publisher","first-page":"2314813","DOI":"10.1155\/2017\/2314813","article-title":"Overview of celiac disease in Russia: regional data and estimated prevalence","volume":"2017","author":"Savvateeva","year":"2017","journal-title":"J Immunol Res."},{"key":"B29","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1111\/j.1749-6632.2009.04037.x","article-title":"Tight junctions, intestinal permeability, and autoimmunity: celiac disease and type 1 diabetes paradigms","volume":"1165","author":"Visser","year":"2009","journal-title":"Ann N Y Acad Sci."},{"key":"B30","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1016\/j.smim.2009.04.001","article-title":"Genetics and pathogenesis of coeliac disease","volume":"21","author":"Heap","year":"2009","journal-title":"Semin Immunol."},{"key":"B31","doi-asserted-by":"publisher","first-page":"6900","DOI":"10.3390\/nu7085314","article-title":"Intestinal microbiota and celiac disease: cause, consequence or co-evolution?","volume":"7","author":"Cenit","year":"2015","journal-title":"Nutrients."},{"key":"B32","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1038\/s41572-018-0054-z","article-title":"Coeliac disease","volume":"5","author":"Lindfors","year":"2019","journal-title":"Nat Rev Dis Primers."},{"key":"B33","doi-asserted-by":"publisher","first-page":"1461","DOI":"10.1007\/s10620-015-4020-2","article-title":"Gut microbiota and celiac disease","volume":"61","author":"Marasco","year":"2016","journal-title":"Dig Dis Sci."},{"key":"B34","doi-asserted-by":"publisher","first-page":"446","DOI":"10.1111\/jgh.15183","article-title":"Gut microbiota signatures and clinical manifestations in celiac disease children at onset: a pilot study","volume":"36","author":"Di Biase","year":"2021","journal-title":"J Gastroenterol Hepatol."},{"key":"B35","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1038\/ismej.2010.92","article-title":"Toward defining the autoimmune microbiome for type 1 diabetes","volume":"5","author":"Giongo","year":"2011","journal-title":"ISME Journal."},{"key":"B36","doi-asserted-by":"publisher","first-page":"673708","DOI":"10.3389\/fimmu.2021.673708","article-title":"Partners in leaky gut syndrome: intestinal dysbiosis and autoimmunity","volume":"12","author":"Kinashi","year":"2021","journal-title":"Front Immunol."},{"key":"B37","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1111\/apt.14490","article-title":"Review article: coeliac disease in later life must not be missed","volume":"47","author":"Collin","year":"2018","journal-title":"Aliment Pharmacol Ther."},{"key":"B38","first-page":"203","article-title":"Lack of health care professional's awareness for management of celiac disease may contribute to the under diagnosis of celiac disease","volume":"12","author":"Barzegar","year":"2019","journal-title":"Gastroenterol Hepatol Bed Bench."},{"key":"B39","doi-asserted-by":"publisher","first-page":"644","DOI":"10.1007\/s11606-005-0111-7","article-title":"Physician awareness of celiac disease: a need for further education","volume":"20","author":"Zipser","year":"2005","journal-title":"J Gen Intern Med."},{"key":"B40","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1155\/2013\/741740","article-title":"Clinical features and symptom recovery on a gluten-free diet in Canadian adults with celiac disease","volume":"27","author":"Pulido","year":"2013","journal-title":"Can J Gastroenterol."},{"key":"B41","doi-asserted-by":"publisher","first-page":"552","DOI":"10.1097\/MPG.0000000000003019","article-title":"The knowledge about celiac disease among healthcare professionals and patients in central Europe","volume":"72","author":"Riznik","year":"2021","journal-title":"J Pediatr Gastroenterol Nutr."},{"key":"B42","article-title":"LD, A. MJ. Celiac Disease Online Course: Impact and Barriers to Diagnosis. In: 15thInternational Celiac Disease Symposium","author":"Voorhees Kristen","year":"2013"},{"key":"B43","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1097\/MPG.0000000000002497","article-title":"European society paediatric gastroenterology, hepatology and nutrition guidelines for diagnosing coeliac Disease 2020","volume":"70","author":"Husby","year":"2020","journal-title":"J Pediatr Gastroenterol Nutr."},{"key":"B44","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1177\/2050640619844125","article-title":"European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders","volume":"7","author":"Al-Toma","year":"2019","journal-title":"United European Gastroenterol J."},{"key":"B45","doi-asserted-by":"publisher","first-page":"751","DOI":"10.15537\/smj.2015.6.11519","article-title":"Assessment of knowledge of celiac disease among health care professionals","volume":"36","author":"Assiri","year":"2015","journal-title":"Saudi Med J."},{"key":"B46","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1186\/s12916-019-1380-z","article-title":"Celiac disease: a comprehensive current review","volume":"17","author":"Caio","year":"2019","journal-title":"BMC Med."},{"key":"B47","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1007\/s12664-019-00958-3","article-title":"Celiac disease: What the Indian pediatricians know about the disease","volume":"38","author":"Malik","year":"2019","journal-title":"Indian J Gastroenterol."},{"key":"B48","doi-asserted-by":"publisher","first-page":"797","DOI":"10.1038\/nm0797-797","article-title":"Identification of tissue transglutaminase as the autoantigen of celiac disease","volume":"3","author":"Dieterich","year":"1997","journal-title":"Nat Med."},{"key":"B49","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1136\/gut.2008.155879","article-title":"Recent advances in coeliac disease genetics","volume":"58","author":"Hunt","year":"2009","journal-title":"Gut."},{"key":"B50","doi-asserted-by":"publisher","first-page":"632","DOI":"10.1016\/j.jpeds.2004.01.035","article-title":"Tissue transglutaminase autoantibody detection in human saliva: a powerful method for celiac disease screening","volume":"144","author":"Bonamico","year":"2004","journal-title":"J Pediatr."},{"key":"B51","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1111\/cei.13115","article-title":"A quarter of patients with type 1 diabetes have co-existing non-islet autoimmunity: the findings of a UK population-based family study","volume":"192","author":"Kozhakhmetova","year":"2018","journal-title":"Clin Exp Immunol."},{"key":"B52","first-page":"1","volume-title":"Type 1 Diabetes: Current Perspectives","author":"Kozhakhmetova","year":""},{"key":"B53","doi-asserted-by":"publisher","first-page":"1454","DOI":"10.1111\/j.1572-0241.2007.01173.x","article-title":"Detection of Celiac disease in primary care: a multicenter case-finding study in North America","volume":"102","author":"Catassi","year":"2007","journal-title":"Am J Gastroenterol."},{"key":"B54","doi-asserted-by":"publisher","first-page":"419","DOI":"10.5152\/tjg.2018.17236","article-title":"Physicians' attitude and perception regarding celiac disease: a questionnaire-based study","volume":"29","author":"Jinga","year":"2018","journal-title":"Turk J Gastroenterol."},{"key":"B55","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1136\/jech-2015-206251","article-title":"Health challenges in Kazakhstan and Central Asia","volume":"70","author":"Adambekov","year":"2016","journal-title":"J Epidemiol Community Health."},{"key":"B56","doi-asserted-by":"publisher","first-page":"575","DOI":"10.1177\/0253717620957496","article-title":"The limitations of online surveys","volume":"42","author":"Andrade","year":"2020","journal-title":"Indian J Psychol Med."},{"key":"B57","doi-asserted-by":"publisher","first-page":"12235","DOI":"10.3390\/ijerph182212235","article-title":"Population health status of the republic of kazakhstan: trends and implications for public health policy","volume":"18","author":"Gulis","year":"2021","journal-title":"Int J Environ Res Public Health."}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2022.956135\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,8,12]],"date-time":"2022-08-12T04:42:37Z","timestamp":1660279357000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2022.956135\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,12]]},"references-count":57,"alternative-id":["10.3389\/fpubh.2022.956135"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2022.956135","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,12]]},"article-number":"956135"}}