Introduction
The incidence of elderly-onset ulcerative colitis (EO-UC) and Crohn’s disease (EO-CD) is increasing globally. However, whether the initial disease presentation of EO-UC and EO-CD differs from that in adult-onset (AO) is currently poorly investigated.
Aims & Methods
The aims of this study were to explore the initial presentation, severity, and disease course of newly diagnosed EO-UC and EO-CD (age ≥60 years) in comparison to AO-UC and AO-CD (18–59 years). The study was conducted as an ongoing prospective population-based inception cohort, IBD Prognosis Study, with enrollment between May 2021 and April 15th, 2023, within a catchment population of 1.050.000 citizens (~20% of the Danish population). We defined severe disease course as requiring surgery or initiation of biological therapies within six months of diagnosis.
Results
The cohort comprised 501 patients, including 398 (79.4%) with AO disease (AO-UC: 223 (56.0%), AO-CD: 145 (36.4%), AO-IBDU: 30 (7.5%)), and 99 (19.8%) with EO disease (EO-UC: 64 (64.6%), EO-CD: 35 (35.4%), EO-IBDU: 5 (5.1%)). A comparison of the clinical presentation, severity, and initial disease course is presented in Table 1. As shown, EO-UC and EO-CD did not differ significantly from AO-UC and AO-CD in terms of demographic factors, disease phenotype, severity, and initial therapy. However, a significantly higher proportion of patients with EO-UC had left-sided UC, and tended to be treated less frequently with biological therapies and immunomodulators.
In a Cox multivariable regression model with Bonferroni correction adjusting for disease type and gender, patients with EO-UC (adjusted hazard ratio (aHR)=1.9 (95% confidence interval (CI) 0.5-7.3)) and EO-CD (aHR =4.1 (95% CI 0.3-12.3)) were not at different risk of requiring surgery or initiation of biological therapies within six months of diagnosis than patients with adult-onset IBD.
Table 1: Pairwise comparison of newly diagnosed elderly-onset and adult-onset inflammatory bowel diseases
| AO-UC
(n=223)
| EO-UC
(n=64)
| AO-CD
(n=145)
| EO-CD
(n=35)
| AO-IBDU
(n=30)
| EO-IBDU
(n=5)
| p-values
|
Patient characteristics
Age, median (IQR)
Female gender
Smoking (current or previous)
Body mass index >30
|
33 (26-48)
125 (56.1)
64 (28.7)
15 (6.7)
|
68 (63-76)
31 (48.4)
14 (21.9)
6 (9.4)
|
30 (22-40)
69 (47.6)
47 (32.4)
15 (10.3)
|
70 (65-72)
18 (51.4)
14 (40.0)
6 (17.1)
|
32 (25-47)
10 (33.3)
9 (30.0)
4 (13.3)
|
62 (62-62)
2 (40.0)
3 (60.0)
1 (20.0)
| NS
|
Disease characteristics
Diagnostic delay (>12 months)
Disease location
Disease behaviour
|
28 (12.6)
E1: 99 (44.4)
E2: 57 (25.6)
E3: 72 (32.3)
|
8 (12.5)
20 (31.3)
25 (39.1)
14 (21.9)
|
20 (13.8)
L1: 49 (33.8)
L2: 49 (33.8)
L3: 46 (31.7)
L4: 1 (0.7)
B1:122 (84.1)
B2: 15 (10.3)
B3: 8 (5.5)
Perianal: 17 (11.7)
|
0
10 (28.6)
15 (42.9)
9 (25.7)
1 (2.9)
28 (80.0)
6 (17.1)
1 (2.8)
2 (5.7)
|
4 (13.3)
E1: 2 (6.7)
E2: 5 (16.7)
E3: 22 (73.3)
|
1 (20.0)
0
2 (40.0)
3 (60.0
|
E2, p=0.04
|
Mayo Endoscopic Score=3 or SES-CD>16
C-reactive protein > 10 mg/L
Fecal calprotectin > 1800
| 28 (12.6)
42 (18.8)
51 (22.9)
| 8 (12.5)
17 (26.6)
10 (15.6)
| 10 (6.9)
71 (49.0)
34 (23.4)
| 2 (5.7)
13 (37.1)
4 (11.4)
| 5 (16.7)
7 (23.3)
11 (36.7)
| 1 (20.0)
0
1 (20.0)
| NS
|
Need for IBD-related hospitalization
| 41 (18.4)
| 11 (17.2)
| 39 (26.9)
| 10 (28.6)
| 9 (30.0)
| 0
| NS
|
Medical treatment
None
Topical 5-ASA
Oral 5-ASA
Topical steroids
Systemic steroids
Immunomodulators
Biologic therapies
|
8 (3.6)
144 (64.6)
117 (52.5)
4 (1.8)
61 (27.4)
1 (0.5)
10 (4.5)
|
0
24 (37.5)
28 (43.8)
0
15 (23.4)
0
1 (1.6)
|
30 (20.7)
2 (1.4)
7 (4.8)
30 (20.7)
70 (48.3)
8 (5.5)
13 (9.0)
|
12 (34.3)
0
0
6 (17.1)
19 (54.3)
0
1 (2.9)
|
6 (20.0)
9 (30.0)
12 (40.0)
1 (3.3)
9 (30.0)
0
2 (6.7)
|
0
2 (40.0)
0
2 (40.0)
0
0
0
| NS
|
Surgical treatment (<30 days)
Ileocecal resection
Colectomy
Hemicolectomy
Fistula excision
|
0
5 (2.2)
0
0
|
0
1 (1.6)
0
0
|
7 (4.8)
1 (0.7)
1 (0.7)
3 (2.1)
|
2 (5.7)
0
0
0
|
1 (3.3)
1 (3.3)
0
0
|
0
0
0
0
| NS
|
Conclusion
In this population-based study, we found no difference between EO-IBD and AO-IBD in terms of initial disease presentation, severity, and course. However, patients with EO-IBD tended to be treated with less biological therapies and immunomodulators.
Disclosure
Mohamed Attauabi: None
Gorm Roager Madsen: None
Flemming Bendtsen: Tillotts, Ferring
Klaus Theede: Ferring, Janssen, Takeda, Pfizer, and Tillotts
Jakob Benedict Seidelin: has received research grants from Takeda, Janssen and is national coordinator of studies from AbbVie, Arena Pharmaceuticals, Ely Lilly, and Boehringer Ingelheim. None of these pertain to the research submitted here.
Johan Burisch: reports grants and personal fees from AbbVie, grants and personal fees from Janssen-Cilag, personal fees from Celgene, grants and personal fees from MSD, personal fees from Pfizer, grants and personal fees from Takeda, grants and personal fees from Tillots Pharma, personal fees from Samsung Bioepis, grants and personal fees from Bristol Myers Squibb, grants from Novo Nordisk, personal fees from Pharmacosmos, personal fees from Ferring, personal fees from Galapagos, outside the submitted work.