Is IBD in the Elderly a Manifestation of Ischemia Precipitated by Underlying Cardiac Arrhythmias?

Abstract

Purpose: Inflammatory bowel disease (IBD) is a chronic inflammatory disease of the bowel, comprising ulcerative colitis (UC) and 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; interestingly, over 15% of atrial arrhythmias are also estimated as being diagnosed over age 65. While both UC and CD have distinct characteristics, their pathogenesis remains poorly understood. We questioned whether late-onset IBD was actually a marker of vascular ischemic disease rather than a primary disease of the intestine, and whether the focus of attention should be on underlying cardiovascular co-morbidities that predispose these patients to ischemic events. The goal of this study was 1.) to determine the prevalence of atrial arrhythmias in patients diagnosed with IBD, 2.) to compare the rates in CD and UC, 3.) to compare the rates in late-onset IBD to those with early-onset IBD, and 4.) to determine whether the presence of atrial arrhythmias in IBD influences long-term survival. 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 diagnosed with UC or CD. All IBD patients had biopsyproven colitis. Late-onset and early-onset was defined as IBD diagnosed after and before age 50, respectively. Results: A total of 447 patients were diagnosed with IBD during the 15-year study period. Of the 447 pts, 11% had documented atrial arrhythmias, of which: 9% of CD and 13% of UC patients (P=NS). Atrial arrhythmias were present in 17% of the late-onset IBD patients, compared to 5% of the earlyonset IBD patients (Diff: 12%; CI: 6% to 18%). IBD patients with atrial arrhythmias had significantly worse survivals than those without (at 33 years post diagnosis, 50% vs. 80% [HR: 2.5; CI: 1.2 to 5.0]). Conclusion: Compared to IBD patients without atrial arrhythmias, the IBD cohort with them have a significantly increased mortality that may not be due to underlying bowel disease. “Late-onset IBD” in patients with concurrent atrial arrhythmias may actually serve as a warning for underlying cardiovascular disease.Figure