Within you, without you: Is gastroenterology ready to embrace the 'exposome'?

摘要

It was the twins who compelled me to consider the limitations of genetics. My 29-year-old patient had experienced 3 years of intermittent diarrhea that did not much trouble him, but the eventual onset of right lower quadrant abdominal pain and weight loss prompted an imaging study suggesting ileal Crohn's disease (CD), confirmed by colonoscopy and biopsy. The family history elicited no inflammatory bowel disease (IBD), but raised a single probing question from the patient: What was the likelihood that his twin brother, now residing 2500 miles away in Boise, Idaho, would also develop CD?