Journal Article

Epidemiology and Long-term Outcome of Inflammatory Bowel Disease Diagnosed at Elderly Age—An Increasing Distinct Entity?

Masclee, Ad A. M., Jonkers, Daisy M. A. E., Romberg-Camps, Mariëlle J. L., Hameeteman, Wim H., Oostenbrug, Liekele E., Jeuring, Steven F. G., Zeegers, Maurice P., van den Heuvel, Tim R. A., Pierik, Marieke J.

2016

Overview

Elderly onset (EO) inflammatory bowel disease (IBD) may become a more common entity as a result of population aging and the rising IBD incidence. Its management is challenging, because of multimorbidity, polypharmacy, and frailty. Insight into the long-term outcome is essential for optimal patient counseling and treatment. We studied the incidence and disease outcome of elderly-onset IBD in direct comparison to adult-onset (AO) IBD.MethodsAll 2823 cases with IBD from the Dutch population-based IBD South Limburg cohort, diagnosed between 1991 and 2011, were included. Long-term outcome (hospitalization, surgery, and disease phenotype) was compared between AO (<60 years at diagnosis) and EO (≥60 years at diagnosis) disease, for Crohn's disease (CD) and ulcerative colitis (UC) separately.ResultsIn total, 1162 patients with CD (136 EO/1026 AO) and 1661 patients with UC (373 EO/1288 AO) were included. The EO IBD incidence increased from 11.71 per 100,000 persons in 1991 to 23.66 per 100,000 persons in 2010, P < 0.01. Immunomodulators were less often used in EO CD (61.8% versus 77.1%, P = 0.03) and EO UC (22.8% versus 35.4%, P < 0.01), even as biologicals (25.1% versus 55.1%, P = 0.03 and 7.8% versus 18.0%, P < 0.01, respectively). No differences were observed in surgery risk (CD: hazard ratio [HR] 1.19; 95% confidence interval [CI], 0.85–1.67 and UC: HR, 0.88; 95% CI, 0.53–1.46), or in CD phenotype progression (HR, 0.81; 95% CI, 0.52–1.25), but more patients with EO UC required hospitalization (HR, 1.29; 95% CI, 1.01–1.63).ConclusionsEO IBD is rising, warranting physicians' alertness for IBD in elderly patients. The long-term outcome was not different from AO disease, despite a less frequent use of immunomodulators and biologicals.

• Publisher: Oxford University Press
• Subject: Adult / Age Factors / Aged / Biological Factors - therapeutic use / Colitis, Ulcerative - drug therapy / Colitis, Ulcerative - epidemiology / Colitis, Ulcerative - surgery / Crohn Disease - drug therapy / Crohn Disease - epidemiology / Crohn Disease - surgery / Digestive System Surgical Procedures - statistics & numerical data / Disease Progression / Female / Follow-Up Studies / Hospitalization - statistics & numerical data / Humans / Immunologic Factors - therapeutic use / Immunomodulators / Incidence / Inflammatory bowel disease / Male / Middle Aged / Netherlands - epidemiology / Young Adult