Introduction
Inflammatory Bowel Disease (IBD), consisting mainly of Ulcerative Colitis (UC) and Crohn’s Disease (CD), is an inflammatory gastrointestinal condition of variable symptomatology, age of onset and disease course. IBD typically presents between 15 and 40 years. Awareness on the onset of IBD at a more advanced age has been increasing over recent years. The current prevalence of elderly-onset IBD is 10-15% [1]. Furthermore, there is presently no consensus on the age cut-off for elderly-onset IBD.
In elderly-onset CD, colonic disease with the B1 subtype predominates, and extent rarely lengthens [2,3]. In the same manner, elderly-onset UC progresses less when compared to younger-onset IBD [4]. These differences have prompted discussion on whether a different management algorithm should be executed when caring for patients with IBD of elderly onset.
Aims & Methods
Our study compares a cohort of 240 paediatric/adult-onset IBD patients with a cohort of 240 elderly-onset IBD patients, with the aim of assessing for differences between malignancy rates, infection rates and surgical procedures. Both cohorts were matched for IBD diagnosis (Crohn’s disease / Ulcerative Colitis / Inflammatory Bowel Disease-Undifferentiated) (CD/UC/IBD-U), extent and medication classes to avoid population bias. Data was collected in a retrospective anonymised manner.
The Mann-Whitney test was used to assess statistical significance across individual continuous variables. Fischer’s exact test was used to assess statistical significance across individual non-continuous variables. Results were statistically significant if the p-value was less than 0.05.
Results
The population characteristics were as follows; 76.46% of the population was diagnosed with UC (367 patients), 22.71% with CD (109 patients), and 0.21% with IBD-U (4 patients). Within the elderly-onset IBD cohort, median age at diagnosis was 70 years (SD +/- 6.01) and average age was 70.6 years. Within the paediatric/adult-onset IBD cohort, median age at diagnosis was 37 years (SD +/- 12.16) whilst mean age at diagnosis was 37.5 years.
Comparison of malignancy post-IBD diagnosis in both groups was almost statistically significant (p=0.006), with the elderly-onset IBD group having a higher likelihood of malignancy. Median time from IBD diagnosis to malignancy diagnosis was of 65 months (SD +/- 35.5) in the elderly-onset IBD group and of 42 months (SD +/- 51.9) in the paediatric/adult-onset IBD group (p=0.001). The same applied to infection rates post-diagnosis, as the elderly-onset IBD cohort demonstrated significantly more infections than the paediatric/adult-onset cohort (p=0.06). No significant differences were identified in terms of absolute surgery rate (p=0.38). However, the elderly-onset IBD group underwent a significantly larger number of colonic surgeries than the paediatric/adult-onset IBD group (p=0.007), as well as surgeries related to cancer (p=0.06).
Conclusion
This study provides insight into the clinical complications of IBD in patients with older age of onset when compared to those with a younger age of onset. Our findings suggest that despite matching elderly-onset IBD patients to their younger counterparts in terms of IBD diagnosis, extent and treatment, they experienced higher rates of malignancy, infections and underwent more colonic surgeries.
These results emphasize the need for an age-conscious approach to IBD management, with careful consideration of cancer surveillance, infection prevention, and individualized treatment goals in the elderly.
References
Gisbert JP, Chaparro M. Systematic review with meta-analysis: inflammatory bowel disease in the elderly. Aliment Pharmacol Ther. 2014 Mar;39(5):459-77. doi: 10.1111/apt.12616. Epub 2014 Jan 9. PMID: 24405149.
2)
Vernier-Massouille G, Balde M, Salleron J, Turck D, Dupas JL, Mouterde O, et al. Natural history of pediatric Crohn’s disease: a population-based cohort study. Gastroenterology 2008;135: 1106–13.
3)
Charpentier C, Salleron J, Savoye G, Fumery M, Merle V, Laberenne JE, et al. Natural history of elderly-onset inflammatory bowel disease: a population-based cohort study. Gut 2014;63:423–32.
4)
Gower-Rousseau C, Vasseur F, Fumery M, Savoye G, Salleron J, Dauchet L, et al. Epidemiology of inflammatory bowel diseases: new insights from a French population-based registry (EPIMAD). Dig Liver Dis 2013;45:89–94.
Disclosure
Nil