Issue 04

Clinical Question

Is elderly-onset (>60 years old) IBD different than younger-onset IBD?

Editor’s Bottom Line

Taken together, the natural history of elderly-onset Crohn’s disease (CD) and ulcerative colitis (UC) is less aggressive than in younger patients.

Reference

Charpentier C, Salleron J, Savoye G, et al. Natural history of elderly-onset inflammatory bowel disease: a population-based cohort study. Gut. 2014 Mar;63(3):423–32. https://www.ncbi.nlm.nih.gov/pubmed/23408350

Synopsis

The EPIMAD registry was searched to identify patients (>60 years of age) diagnosed with IBD from 1988 through to 2006 and had a follow-up of ≥2 years. Patients and their disease characteristics were recorded, including date of IBD diagnosis, medications, and surgeries. Within the catchment population of over 5 million, 11,724 patients were diagnosed with IBD of which 1,058 fit the study’s inclusion criteria (CD: 42%; UC: 53%; and indeterminate colitis: 5%). The median follow-up was 6 years.

Crohn’s disease:

Compared to younger patients, elderly-onset CD patients had:

•  More often a colonic disease location

•  A milder phenotype with less stricturing and penetrating disease and more inflammatory disease

•  Less behavior progression of disease

•  Less diarrhea, abdominal pain, extraintestinal manifestations, weight loss and fever

•  Less surgery

•  Less immunosuppressive and anti-TNF therapy

Ulcerative colitis:

Compared to younger patients, elderly-onset UC patients had:

•  Less proctitis and more left-sided colitis

•  Less progression of disease

•  Less rectal bleeding and abdominal pain

•  Similar rates of colectomy but much less IAA

•  Less immunosuppressive and anti-TNF therapy

Details

Study Design: Population-based cohort study
Funding: French Ministry of Health and the Astra-Zeneca Company
Allocation: n/a
Setting: Northern France
Level of Evidence: 2b (Oxford Levels of Evidence)

The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.