{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T02:58:02Z","timestamp":1792205882931,"version":"4.4.0"},"reference-count":27,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,4,4]],"date-time":"2025-04-04T00:00:00Z","timestamp":1743724800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Danube Interreg program","award":["BG-RRP-2.004-0009-C02"],"award-info":[{"award-number":["BG-RRP-2.004-0009-C02"]}]},{"name":"European Union-NextGenerationEU, through the National Recovery and Resilience Plan of the Republic of Bulgaria","award":["BG-RRP-2.004-0009-C02"],"award-info":[{"award-number":["BG-RRP-2.004-0009-C02"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Celiac disease (CD) is a chronic immune-mediated systemic disorder induced by gluten in genetically predisposed individuals, requiring lifelong management through a strict gluten-free diet (GFD). Although its global prevalence is around 1%, awareness and diagnosis remain suboptimal, contributing to challenges in disease management. Objectives: To assess the awareness, knowledge, and experiences of Bulgarian CD patients and caregivers regarding CD, diagnosis, and dietary adherence. Methods: A structured survey was conducted to evaluate patient and caregiver knowledge, awareness, and experiences with CD, focusing on the diagnostic process and dietary practices. Data were collected from a sample of Bulgarian CD patients and their caregivers. Results: The majority of the 191 respondents (94%) recognized CD as a lifelong condition, but only 26.7% correctly identified its autoimmune, systemic nature. The average diagnostic delay was 8.1 months, with over 50% of patients relying on serological tests alone, consistent with recent non-biopsy guidelines. Dietary adherence was significantly hindered by misconceptions about gluten-containing grains and societal barriers. Notably, 83.6% of participants reported bringing their own food when eating outside. Conclusions: The findings underscore the need for targeted public health initiatives, enhanced healthcare provider training, and improved dietary education to address knowledge gaps, expedite diagnosis, and improve dietary adherence. Such interventions could help reduce the psychosocial burden of CD and enhance the quality of life for affected individuals.<\/jats:p>","DOI":"10.3390\/nu17071267","type":"journal-article","created":{"date-parts":[[2025,4,4]],"date-time":"2025-04-04T03:36:45Z","timestamp":1743737805000},"page":"1267","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Bridging the Gap: Awareness, Knowledge, and Challenges of Living with Celiac Disease in Bulgaria"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8286-3923","authenticated-orcid":false,"given":"Rouzha","family":"Pancheva","sequence":"first","affiliation":[{"name":"Department of Hygiene and Epidemiology, Faculty of Public Health, Prof. Paraskev Stoyanov Medical University, 9000 Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jernej","family":"Dolinsek","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University Medical Center Maribor, 2000 Maribor, Slovenia"},{"name":"Department of Pediatrics, Medical Faculty, University of Maribor, 2000 Maribor, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marlena","family":"Panayotova","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Faculty of Medicine, Trakia University, 6000 Stara Zagora, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivan","family":"Yankov","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denitza","family":"Kofinova","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, University Multiprofile Hospital for Active Treatment and Emergency Medicine \u201cN.I. Pirogov\u201d, 1000 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silviya","family":"Nikolova","sequence":"additional","affiliation":[{"name":"Department of Social Medicine and Healthcare Organization, Faculty of Public Health, Prof. Paraskev Stoyanov Medical University, 9000 Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mila","family":"Baycheva","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, University Children\u2019s Hospital, Medical Univerity of Sofia, 1000 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miglena","family":"Georgieva","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Faculty of Medicine, Prof. Paraskev Stoyanov Medical University, 9000 Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1097\/MPG.0000000000002497","article-title":"European Society for Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for Diagnosing Coeliac Disease 2020","volume":"70","author":"Husby","year":"2020","journal-title":"J. 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