Inflammatory bowel disease in the elderly

Abstract

Inflammatory bowel disease (IBD) characteristically presents in early adulthood, but a second incidence peak is observed in the sixth to eighth decade of life. Ulcerative colitis (UC) presenting in older patients tends to show a predilection for distal involvement, with the initial attack often being more severe than in younger patients. The response to medical management, risk of extension and requirement for surgery, however, are similar to younger patients. The spectrum of medical management options is also similar, although the risk of complications related to prolonged steroid use, in particular hyperglycaemia, hypertension and osteoporosis, may be higher. The use of immunosuppressive agents may also be associated with a higher risk of infection. Although early studies suggested a higher complication rate and early mortality in elderly UC patients, more recent evaluations indicate the outcome is comparable to younger IBD patients. A small increase in mortality occurs postoperatively and seems more often related to co-morbid disease rather than to UC. The spectrum of clinical presentations for Crohn’s disease (CD), including extraintestinal manifestations and perianal disease, is no different from a younger population, with the exception of a higher incidence of Crohn’s colitis and a lower rate of surgery. However, in elderly Crohn’s colitis patients who require surgery either due to disease severity or complications, postoperative mortality and complication rates related to surgery may be higher. The overall mortality rate in elderly patients with CD is, however, not different from the general population. The risk of recurrence after resection seems to be less in older patients with CD. Important differential or coexistent diagnoses in the evaluation of elderly patients with possible IBD include ischaemic colitis, diverticulitis, neoplasms, infectious causes including Clostridium difficile and Escherichia coli 0157:H7, and NSAID-related fibrotic strictures. Thus, with certain exceptions, the presentation, clinical course and response to therapy for elderly patients presenting with IBD tend to be comparable to a younger population.