Journal Article

Elderly-onset vs adult-onset ulcerative colitis: a different natural history?

Lanzarotto, Francesco, Cannatelli, Rosanna, Zammarchi, Irene, Benini, Federica, Lanzini, Alberto, Munari, Francesca, Ricci, Chiara, Pozzi, Alessandro

2020

Overview

Background Incidence of ulcerative colitis (UC) in elderly population is increasing because of ageing and because of its minimal impact on life span. Data on natural history, outcomes and therapeutic strategies are limited. Our aim is to characterize UC in elderly-onset patients followed at our Inflammatory Bowel Disease outpatient clinic and compare with adult-onset UC. Methods From January 2000 to June 2019, 94 patients with UC diagnosed after the age of 65 years (elderly group, E-O) were identified and matched 1–1 according to gender and calendar year of diagnosis with patients diagnosed with UC at age between 40 and 64 years (adult age, A-O). Results Comorbidity Index (3.8 vs 1.6, p < 0.0005 ) was higher for elderly UC patients. Symptoms at presentation were similar between the two groups, although abdominal pain was more common in adults, and weight loss was more common in the elderly. At diagnosis, left colitis (61% vs 39%) and proctitis (14% vs 26%) ( p = 0.011 ) were more frequent in the elderly. Therapy and clinical behaviour were similar. Surgery was more frequently performed in the elderly (20% vs 9%, p  = 0.02), while biological therapy was less used (2.1% vs 22%, p < 0.0005 ). Complications were more frequent in the elderly. Extraintestinal manifestations were lower in elderly patients (9.6% vs 19.2%, p = 0.061 ). Time to first relapse was similar between the two groups . Mortality ( p < 0.0005 ) was higher in elderly patients. Conclusions Ulcerative Colitis has similar presentation and behaviour in elderly and adults patients. However, the elderly are more fragile because of comorbidities, increased risk of infections and disease-related complications.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adult / Adults / Age / Age of Onset / Aged / Aging / Anemia / Cardiovascular disease / Care and treatment / Chronic illnesses / Colitis, Ulcerative - pathology / Colitis, Ulcerative - therapy / Comorbidity / Comparative analysis / Development and progression / Diagnosis / Disease age factors / Disease Progression / Elderly / Elderly patients / Epidemiology of gastroenterological disorders / Family medical history / Female / Gastroenterology / Gender / Geriatrics / Hepatology / Humans / Infections / Inflammatory bowel disease / Inflammatory bowel diseases / Internal Medicine / Intestine / Life span / Male / Medicine / Medicine & Public Health / Middle Aged / Patients / Physiological aspects / Proctitis / Prospective Studies / Research Article / Risk Factors / Sepsis / Surgery / Therapeutic strategies / Ulcerative colitis