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Celiac disease in monozygous twin boys. Asynchronous presentation
Digestive Diseases and Sciences
|December 1, 1982
Insights
A 13-year-old boy with poor weight gain was diagnosed with gluten-sensitive enteropathy. His asymptomatic twin also showed biopsy evidence, and both boys achieved similar weight on a gluten-free diet.
Area of Science:
- Pediatric Gastroenterology
- Genetics
- Nutrition
Background:
- Monozygous twins present a unique model for studying genetic and environmental influences on disease.
- Gluten-sensitive enteropathy (celiac disease) is an autoimmune disorder triggered by gluten ingestion.
- Growth faltering in children can indicate underlying gastrointestinal or metabolic conditions.
Purpose of the Study:
- To investigate the diagnosis and management of gluten-sensitive enteropathy in a pair of monozygous twins.
- To assess the clinical presentation and subclinical evidence of celiac disease in an affected twin and his asymptomatic sibling.
- To evaluate the efficacy of a gluten-free diet in normalizing growth parameters in affected twins.
Main Methods:
- Clinical presentation and anthropometric measurements of the twins.
- Jejunal biopsies for histological examination to diagnose gluten-sensitive enteropathy.
- Dietary intervention with a strict gluten-free diet.
- Monitoring of weight gain and growth parameters over 15 months.
Main Results:
- One twin presented with significant weight gain delay compared to his sibling.
- Jejunal biopsies confirmed gluten-sensitive enteropathy in the symptomatic twin.
- The asymptomatic twin also exhibited biopsy evidence of gluten-sensitive enteropathy.
- Both twins achieved comparable weight gain after 15 months on a gluten-free diet.
Conclusions:
- Gluten-sensitive enteropathy can present with varying clinical severity even in genetically identical twins.
- Subclinical gluten-sensitive enteropathy may be present in asymptomatic individuals.
- A gluten-free diet is an effective treatment for normalizing growth in children with gluten-sensitive enteropathy.
Abstract:
A 13-year-old boy presented when his weight gain fell behind that of his monozygous twin brother. Following investigation, he was found to have gluten-sensitive enteropathy on jejunal biopsy. Investigation of his symptom-free brother showed biopsy evidence of the condition with changes similar to those of the clinically affected boy. Following treatment with a gluten-free diet, the boys achieved a similar weight after 15 months.