NSAIDs and Hormone Replacement Therapy in Geriatric Crohnʼs Disease

Abstract

Purpose: The US population is aging and the burden of patients with geriatric Crohn's disease (CD) is increasing. Studies have suggested that inflammatory bowel disease (IBD) including CD in elderly patients is different from the disease in young patients, arguing for two variant disease phenotypes. Treatment patterns may differ between geriatric and young IBD, with elderly patients receiving medications for concomitant illness and prophylaxis of cardiac, vascular and bone health. Nonsteroidal antiinflammatory drugs (NSAIDs) and hormone replacement therapy (HRT) have been associated with initial onset of IBD and reactivation of quiescent disease in IBD. Data describing NSAIDs and HRT treatment in elderly CD is limited. Methods: We performed a comprehensive analysis of CD patients age ≥ 65 followed in a tertiary care center. We determined patterns of CD activity over an 18 month time period and its relationship with treatment patterns of NSAIDs and HRT therapy. CD activity was categorized by retrospective chart review, with active disease defined by physician global assessment, clinical impression, symptoms of diarrhea and abdominal pain, and endoscopic and/or radiographic evidence of activity. Patients were labeled as active disease if they had ≥ 1 relapse during the study period and inactive patients remained in remission the entire time. Results: There were 90 geriatric CD patients, with 35.6% (n = 32) showing evidence of active CD during the study time period. The mean age for active CD was 71.4 ± 6.4 (years ± S.D.) and for inactive CD was 72.8 ± 6.8 (years ± SD). Among geriatric patients with active CD, 9.4% were on NSAIDs while the inactive CD cohort had 15.5% receiving NSAIDs. Female constituted 54% of the geriatric CD patients (n=49) and HRT was identified in only 7 patients (8% of the total and 14% of the female geriatric cohort). Among female CD patients with active disease 19% were on HRT, while 11% of inactive CD geriatric females were on HRT (p=NS). Conclusion: Our study of geriatric CD patients suggests that use of NSAIDs and HRT did not correlate with increased rates of disease activity during an 18 month time period. Further prospective studies evaluating the use of NSAIDs and HRT in geriatric CD are warranted.