Celiac disease in monozygous twin boys. Asynchronous presentation.

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.