Age at IBD Diagnosis Does Not Impact Long-term Outcomes

Abstract

Purpose: Inflammatory bowel disease (IBD) comprises either ulcerative colitis (UC) or Crohn's disease (CD). It is thought that IBD has a bimodal peak of incidence, often occurring in the 2nd decade of life and again after the 5th decade of life. Although some data suggest that patients diagnosed with IBD at an older age have a more aggressive disease with high mortality rates, there are no studies that report long-term outcomes according to the age at which IBD was first diagnosed. The goal of this study was to assess the incidence of death and CRC, as well as long-term survival outcomes in patients with IBD diagnosed before and after age 50. Methods: We reviewed in detail the medical records of all patients at Hines VA who underwent a complete GI investigation between 1996 and 2011 and were 1.) diagnosed as having UC or CD based on both clinical and histological evidence. or 2.) confirmed to have IBD from an outside hospital before coming to our institution. Late-onset and early-onset was defined as IBD diagnosed after and before age 50, respectively. Kaplan Meier survival curves were used to assess survival outcomes among the two groups. Results: A total of 447 patients were identified as having IBD during the 15-year study period. Patients were diagnosed with IBD at ages ranging from 16 to 87 years. Our follow-up time ranged from 2 to 17 years with a mean follow-up time after initial or confirmative diagnosis of 5.2 years. Of the 447 pts, 49% were diagnosed with IBD prior to age 50, and 51% were diagnosed with IBD after age 50. Only 76 (17%) patients have died, and almost three-quarters of these deaths, as expected, were in the older age group. Of the 76 patients who died, 3.9% (three patients, two in the younger age group) had CRC, and only 1.3% (one patient in the younger age group) died from it. There was no difference in survival outcomes between the younger and older age groups (HR 0.8, 95% CI [0.5, 1.3], P = 0.3). Conclusion: The incidence of death from CRC in our population is exceedingly low, regardless of the age at which IBD was diagnosed. There is no difference in survival of IBD patients diagnosed before age 50 compared to an older age. This is the first study to show that the age at which IBD is diagnosed does not impact the long-term disease outcomes.Figure