107 Significant Variation in Care for Women of Reproductive Age With Ulcerative Colitis

Abstract

The prevalence of Crohn's disease (CD) is increasing in the elderly but no data on the natural history of the disease is available in large population-based cohorts in this particular population. Methods: In a geographically derived incidence cohort diagnosed from 1988 to 2006, all CD patients with an age > 60 years at diagnosis were identified. Cumulative probabilities of receiving medications and need for surgery were calculated using KaplanMeier survival estimates. Results: 447 patients were identified representing 6% of the whole CD cohort. Follow-up was available in 371 (230 females) with a median follow-up time of 6 years [IQR: 2-11]. The median age at diagnosis was 70 years [IQR: 65-76]. At diagnosis among patients having both colonic and small bowel exploration, the most frequent disease location was the colon: L1 (Montreal classification): 19%; L2: 34%; L3: 47%. Follow up was characterized by the absence of disease extension in 96% of patients. Complicated (B2/ B3) behavior was observed in 29% of patients at diagnosis and 32% at maximal follow-up. Perianal lesions were present in 8% of patients at diagnosis and 16% at last follow-up. Cumulative probabilities of receiving steroids were respectively 32%, 45% and 47% at 1, 5 and 10 years with a median duration of 5.5 months [IQR: 3-11]. At 1 year steroid dependance was observed in 9% and steroid resistance in 5% of patients. Cumulative probabilities of receiving immunosuppressors (azathioprine, 6MP and methotrexate) and anti-TNF therapy were respectively 10% and 3% at 1 year, 18% and 5% at 5 years and 27% and 9% at 10 years. Cumulative probabilities of first intestinal resection were 18%, 27% and 32% at 1, 5, and 10 years, respectively. Conclusions: In this large populationbased cohort, the natural history of CD in the elderly was characterized by a colonic involvement in more than 80% of patients at diagnosis and by a complicated behaviour in 29% with a stable phenotype during follow-up. Ten years after diagnosis almost half of this population was exposed to steroids while only 27% and 9% had received immunosuppressors or anti-TNF therapy, respectively. One third of patients required intestinal resection at 10 years.