By Jason Clevenger
Summary: A case report published by physicians in British Columbia describes identical twin sisters in their late twenties who each developed adult-onset celiac disease symptoms within 10 weeks of giving birth. The celiac disease diagnosis was confirmed in both sisters with elevated TTG levels and small bowel biopsy, and was successfully managed with adherence to the gluten-free diet. There was no familiar history of celiac disease in either parent of the sisters, but genetic typing analysis confirmed the presence of the HLA DQ2 gene. The pregnancies, spaced approximately one year apart, resulted in birth of healthy daughters.
Conclusion: Although this case report is limited to the two individuals involved, identical twin studies are generally considered important for understanding the relative importance of genetic and environmental factors in disease development. In this case, the time of onset in both twins shortly after giving birth suggests that pregnancy or the post-partum period may involve higher risk for the clinical appearance of celiac disease.
 “Postpartum onset of adult celiac disease in identical twin sisters”, Freeman H, Chung H, Nimmo N, Canadian Journal of Gastroenterology 2012 Sept;26(9):581-582.