Elderly IBD Patients Research Articles

S1120 A Nationwide Analysis of Prevalence, Trends, and Cardiovascular Outcomes Associated With Metabolically Healthy and Unhealthy Obesity in Elderly IBD Patients (2016- 2020)

S1120 A Nationwide Analysis of Prevalence, Trends, and Cardiovascular Outcomes Associated With Metabolically Healthy and Unhealthy Obesity in Elderly IBD Patients (2016- 2020)

Safety and Effectiveness of Vedolizumab in Elderly Patients with Inflammatory Bowel Disease: A Systematic Review & Meta-Analysis.

There is limited data on Vedolizumab utilization in elderly patients. Our study aims to assess the effectiveness and safety of Vedolizumab in this subset population. Databases including Cochrane Central, Embase, Medline (via Ovid), Scopus, and Web of Science were searched in August 2022 to identify studies that assessed Vedolizumab therapy in elderly patients. Pooled proportion and risk ratios (RR) were calculated. Total 11 studies with 3546 IBD patients (1314 elderly and 2232 young) were included in the final analysis. Pooled rate of overall and serious infections in the elderly cohort was 8.45% (95% CI=6.27-11.29; I 2 23%) and 2.59% (95% CI=0.78-8.29; I 2 76%), respectively. However, there was no difference in overall infection rates between elderly and young patients. Pooled rate of endoscopic, clinical, and steroid-free remission for elderly IBD patients was 38.45% (95% CI=20.74-59.56; I 2 93%), 37.95% (95% CI=33.08-43.06; I 2 13%), and 38.8% (95% CI=31.6-46.4; I 2 77%), respectively. Elderly patients had lower steroid-free remission rates [RR 0.85, 95% CI=0.74-0.99; I 2 0%, P =0.03]; however, there was no difference in rates of clinical (RR 0.86, 95% CI=0.72-1.03; I 2 0%, P =0.10) or endoscopic remission (RR 1.06, 95% CI=0.83-1.35; I 2 0%, P =0.63) compared with younger patients. Pooled rate of IBD-related surgery and IBD-related hospitalizations was 9.76% (95% CI=5.81-15.92; I 2 78%) and 10.54% (95% CI=8.37-13.2; I 2 0%), respectively for the elderly cohort. There was no statistical difference in IBD-related surgeries between elderly and young IBD patients, RR 1.20 (95% CI=0.79-1.84; I 2 16%), P =0.4. Vedolizumab is equally safe and effective for clinical and endoscopic remission in elderly and younger populations.

DOP84 Colonic CD4+ T cell senescence is implicated in the progression of experimental colitis in aged mice

Abstract Background Evidence from recent epidemiological data suggests that the burden of IBD in the elderly is increasing globally. However, the mechanisms underlying the age-related IBD susceptibility remain elusive. Aging leads to a progressive functional decline of the immune system, rendering the elderly increasingly susceptible to autoimmune disease. Herein, we sought to determine the role of immunosenescence in age-dependent colitis and to explore the underlying mechanisms. Methods Young (2-3 months), middle-aged (10-12 months), and aged (20-24 months) mice were established models of colitis by 2% dextran sulfate sodium salt (DSS) treatment. Weight loss, colon length, disease activity indexes (DAI) and histological scores were evaluated to assess the severity of colitis. Using a second-generation fluorogenic substrate for β-galactosidase and multi-parameter flow cytometry, we detected the senescence-associated β-galactosidase (SA-βGal) activity in lymphocytes isolated from colon, including CD4+ T cells, CD8+ T cells, B cells, natural killer cells, microphages, neutrophils and dendritic cells. Based on the immunocytes that exhibit greatest age-related increases in SA-βGal activity, inflammatory cytokines such as TNF-α、IFN-γ、IL-17 were evaluated in senescent immunocytes through flow cytometry. Single-cell and bulk RNA-seq of colonic immune cells in mice with different ages were performed to further investigate the precise molecular mechanisms. Results Ageing increased the severity of DSS-induced colitis wherein aged mice exhibited worsened weight loss, shortened colon length, higher DAI and histological scores compared to young mice. The greatest age-associated increases of SA-βGal activity were observed in colonic CD4+ T cell populations. Additionally, aging resulted in systemic activation of CD4+ T cells, exhibiting an expansion of CD4+ effector memory T (TEM) cells in colon, as well as in spleen. Aged colonic CD4+ T cells generate higher levels of IFN-γ and IL-17 comparing to young colonic CD4+ T cells, especially in status of colitis. Moreover, the accumulated CD4+ TEM cells in the aged colon were the main source of IL-17 production. Single-cell analysis revealed that aging increased colonic CD4+ TEM cells, which were associated with T cell-mediated cytotoxicity and cytokine-mediated signaling pathway. Splenic CD4+ TEM cells isolated from aged colitis mice were confirmed to involve in cellular senescence, Th17 differentiation and inflammatory signaling pathway through bulk RNA-seq. Conclusion These results provide a significant insight into the contribution of senescent CD4+ T cells to age-dependent colitis and provide an attractive possibility that targeting T cell specifically might be a potential strategy to treat elderly IBD patients.

Management of inflammatory bowel disease in the elderly: A review.

The burden of Inflammatory Bowel Disease (IBD) is increasing worldwide, with a particular increase in the prevalence in the elderly population, due to the ageing of young-onset IBD as well as to the increasing incidence in elderly patients. Elderly IBD patients present specific challenges to the treating physician, as they have comorbidities, lower functional reserves, and higher risk of treatment-related complications. The diagnosis of IBD in the elderly may be difficult due to a more subtle disease presentation and to a wide range of differential diagnosis. Moreover, as these patients are often excluded from clinical trials, there is a lack of high-quality evidence to inform on the most appropriate management. Despite an increasing prevalence, the management of IBD in the elderly is still hindered by frequent misconceptions by physicians treating these patients. Due to a erroneous notion of a milder disease course and fear of adverse events, elderly IBD-patients are managed with frequent and continuous use of steroids and undertreated with effective medical therapies. In this review, we describe the principles of management of IBD in the elderly, which is a topic of increasing importance to IBD clinics, that will have to progressively adapt to care for an ageing population.

P896 Inflammatory Bowel Disease in the elderly, a survey of elderly patient demographics, disease-related complications and compliance with vaccination and screening services

Abstract Background Inflammatory Bowel Disease (IBD) in the elderly (>60yrs) is becoming more prevalent in concordance with the ageing population and the rising incidence of IBD. An increasing number of patients are receiving a diagnosis of IBD in later years in addition to those with known IBD transitioning to elderly. The presentation, disease course, risk of complications and choice of medical therapies differ in this group from younger cohorts. We aimed to examine patient demographics and the incidence of adverse effects/complications amongst elderly IBD patients. We also sought to identify appropriate vaccination rates and uptake with screening services. Methods In a single tertiary centre, IBD patients aged >60 attending the outpatient clinic or admitted acutely were invited to complete an anonymous written survey. Results 28 patients surveyed to date. 61% (n=17) had a diagnosis of UC. 54% were female (n=15). Mean age was 67.5, while mean age at diagnosis was 50 (range 19-65). 25% (n=7) received a diagnosis of IBD after 60 years, of which 57% were female. Mean BMI was 25.9. 25% (n=7) reported an infection in the last 6 months, all of whom required treatment with antibiotics. There was only one case of infection requiring hospitilisation, a patient on biologic therapy who developed a clostridium difficile infection. COVID-19 affected 39% (n=11), none required hospitilisation. 21% (n=6) report 2 or more comorbidities, of which 50% report a recent infection requiring treatment. All patients who required IBD surgery (n=5) had a high BMI. 57% (n=16) had a smoking history, with 14% (n=4) being active smokers. Infliximab and salofalk granules were the most prescribed IBD treatments. 46% were on biologics (n=13), with anti-TNF being the most common (29%). 25% (n=7) reported steroid use in the last year while 14% were not currently on IBD treatment. 21.4% (n=6) reported prior malignancy, skin cancer being most common. 50% of cancer sufferers were smokers. 100% have had a minimal of two COVID-19 vaccines. 64% (n=18) have had a flu-vaccine in the last 12 months with 75% (n=21) report annual flu-vaccine uptake. 61% (n=17) had the pneumococcal vaccine. Bowel screening participation was 46.5% (n=13). Conclusion Smoking, high BMI and multiple comorbidities were common in elderly IBD patients. Infections were common in this cohort and typically required treatment with antibiotics, however, were rarely severe or required hospitalisation. Severe infections were seen in those on biologic therapy. Biologics were commonly prescribed to elderly IBD patients. Skin cancer was the most common malignancy. There was suboptimal uptake with vaccinations and bowel screening.

Safety and effectiveness of ustekinumab in elderly Crohn's disease patients.

Anti-tumour necrosis factor (TNF) agents are associated with increased infection risk among elderly IBD patients, but little is known about non anti-TNF biologics in this cohort. We examined the safety and effectiveness of ustekinumab in elderly Crohn's patients. This retrospective multi-centre cohort study included Crohn's patients ≥60-years old who commenced ustekinumab. We recorded Harvey-Bradshaw index (HBI), concomitant steroid therapy, treatment persistence and new infections or malignancies. Primary outcome was serious infections requiring hospitalisation. Seventy patients were included, with median age of 68 years. 43 (61.4%) had prior anti-TNF exposure, and 15 (21.4%) vedolizumab. Median treatment duration was 12 months, totalling 84 patient-years. Nine serious infections were reported, incidence 106.7/1000 patient-years. Systemic steroids were associated with increased risk of serious infections [odds ratio (OR) 7.83, 95% confidence interval (CI): 1.44-44.32, P = 0.02]. There were 27 "non-serious" infections; 321.4/1000 patient-years. Charlson co-morbidity index (OR 1.49, 95% CI: 1.05-2.12, P = 0.03) and steroid exposure (OR 44.10, 95% CI: 1.75-1112.10, P = 0.02) increased non-serious infection risk (P < 0.05). Mean HBI improved from 8.13 to 4.64 at 6 months and 4.10 at last follow up (P < 0.0001). 12-month treatment persistence was 55.7% (N = 39); 34 (48.6%) were steroid-free. Ustekinumab was safe and effective in a cohort of elderly Crohn's disease patients. Infections were mostly mild, not resulting in therapy discontinuation. Serious infection risk was comparable to previously reported rates with anti-TNF agents. Steroid exposure was associated with an increased serious infection risk.

Safety of Biological Therapies in Elderly Inflammatory Bowel Diseases: A Systematic Review and Meta-Analysis.

Background and Aim: Newer biologics appeared safer in landmark clinical trials, but their safety is understudied in vulnerable populations. The aim of the present study was to perform a systematic review and meta-analysis to assess the safety of available biologicals in the elderly IBD population. Methods: We systematically searched PubMed/Medline and conference proceedings between 1 April 1969 and 1 June 2021 to identify eligible studies that examined the safety of biologics in elderly patients with IBD. Of the 2885 articles and 12 congress abstracts identified, 12 peer reviewed papers and 3 abstracts were included after independent evaluation by two reviewers. The identified studies collected safety data on anti-TNF, vedolizumab (VDZ) and ustekinumab (UST). Results: Rates of AE and infections were not different among the biologics (AE mean rate: 11.3 (CI 95% 9.9–12.7)/100 pts-years; p = 0.11, infection mean rate: 9.5 (CI 95% 8.4–10.6)/100 pts-years; p = 0.56) in elderly IBD patients on anti-TNF, VDZ or UST. Infusion/injection reaction rates were more common on anti-TNFs (mean rate: 2.51 (CI 95% 1.7–3.4/100 pts-years; p = 0.02). and malignancy rates were higher on VDZ/UST (mean rate: 2.14 (CI 95% 1.6–2.8)/100 pts-years; p = 0.01). Conclusions: Rates of AEs and infections were not different among biologicals. Infusion/injection reactions were more common on anti-TNFs. Current data are insufficient to suggest the sequencing of biologicals in elderly patients based on safety.

Effectiveness and safety of vedolizumab in a matched cohort of elderly and nonelderly patients with inflammatory bowel disease: the IG-IBD LIVE study.

SummaryBackgroundVedolizumab registration trials were the first to include elderly patients with moderate‐to‐severe ulcerative colitis (UC) or Crohn’s disease (CD), but few real‐life data have been reported in this population.AimsWe investigated the effectiveness and safety of vedolizumab in matched cohorts of elderly and nonelderly UC and CD patients.MethodsThe Long‐term Italian Vedolizumab Effectiveness (LIVE) study is a retrospective‐prospective study including UC and CD patients who started vedolizumab from April 2016 to June 2017. Elderly patients (≥65 years) were matched clinically 1:2 to nonelderly patients (18–64 years); the 2 groups were followed until drug discontinuation or June 2019.ResultsThe study included 198 elderly (108 UC, 90 CD) and 396 matched nonelderly patients (205 UC, 191 CD). Nonelderly UC patients had a significantly higher persistence on vedolizumab compared to elderly patients (67.6% vs. 51.4%, p = 0.02). No significant difference in effectiveness was observed between elderly and nonelderly CD patients (59.4% vs. 52.4%, p = 0.32). Age ≥65 years was associated with lower persistence in UC; for CD, previous exposure to anti‐TNF‐α agents, Charlson comorbidity index >2 and moderate‐to‐severe clinical activity at baseline were associated with lower persistence. There were recorded 130 adverse events, with comparable rates between the two groups. A Charlson comorbidity index >2 was associated with an increased risk of adverse events.ConclusionVedolizumab can be considered a safe option in elderly IBD patients. Its effectiveness in elderly UC patients may be reduced, while no age‐dependent effect on effectiveness was observed in CD.

P427 Exploring phenotype and treatment of inflammatory bowel disease in the elderly

Abstract Background On a background of an ageing population, approximately, 10–15% of new cases of IBD are diagnosed in patients over the age of, 60.1,2 Studies show IBD in the elderly is increasing, including both the groups of patients diagnosed at a younger age, and de novo elderly IBD. Older patients are more likely to have other co-morbidities and be concurrently prescribed other medications, which may impact the choice and timing of therapies for their disease. It is not clear if IBD in older age is different phenotypically from that in younger counterparts, and whether current management algorithms can be used safely in this cohort. Aims of the study were to evaluate the IBD phenotype and use of therapies in the elderly (≥75 years) and younger (18–74 years) patients, and to assess for differences in adverse outcomes between both cohorts on immunosuppressants (IMs) and/or biologics. Methods A retrospective study was performed on, 173 IBD patients at Imperial College Healthcare NHS Trust over a two-year period., 91 elderly IBD patients were compared with, 82 younger patients, matched by gender and IBD subtype. Analysis included chi-squared tests with Fisher’s correction. Results There were, 55 elderly patients and, 51 younger matched patients with ulcerative colitis (UC) where no differences in disease extent, remission or surgeries were seen. There were, 36 elderly patients and, 31 younger matched patients with Crohn’s disease (CD). There was less ileocolonic disease in the older CD cohort compared to younger patients (27.8% versus, 51.6%, p=0.046) (figure 1). Medication use in UC was the same regardless of age. There was significantly higher use of IMs and biologics in younger patients with CD (51.6%) versus the older cohort (25%, p=0.047) (figure 2). In elderly patients with CD, a significantly greater mortality was seen in patients on IMs/biologics (27.3%) than those not on these medications (8%, p=0.023) (figure 3). The rate of VTE was higher (18.2% versus, 0%) in those on these treatments with a trend towards significance. Conclusion Overall, this retrospective study demonstrated that elderly IBD patients in this cohort appear to be mostly phenotypically similar to younger patients. However, elderly Crohn’s patients were less likely to be escalated to IMs/biologic treatments than their younger comparators. In view of the higher rate of adverse events recorded in the Crohn’s group managed with these treatments, this may be justified. Further, larger studies in the long-term outcomes of these patients are required. Reference 1. Charpentier C et al. Natural history of elderly-onset inflammatory bowel disease: a population-based cohort study. Gut., 2014;63(3),423–432

Switching to a Second Thiopurine in Adult and Elderly Patients With Inflammatory Bowel Disease: A Nationwide Study From the ENEIDA Registry.

Although commonly used in inflammatory bowel disease [IBD], thiopurines frequently cause intolerance, and switching to a second thiopurine has only been reported in some small series. Ours aims in this study were to evaluate the safety of switching to a second thiopurine in a large cohort, and to assess the impact of age on tolerance. Adult IBD patients from the ENEIDA registry, who were switched to a second thiopurine due to adverse events [excluding malignancies and infections], were identified. At the beginning of thiopurine treatment, patients were divided by age into two groups: 18-50 and over 60 years of age. The rate and concordance of adverse events between the first and second thiopurines, treatment intolerance, and persistence with the second thiopurine were evaluated. A total of 1278 patients [13% over 60 years of age] were switched to a second thiopurine. At 12 months, the cumulative probability of switch intolerance was 43%, and persistence with treatment was 49%. Independent risk factors of switch intolerance were age over 60 years (odds ratio [OR] 1.49; 95% confidence interval [CI] 1.07-2.07; p = 0.017) , previous gastrointestinal toxicity [OR 1.4; 95% CI 1.11-1.78; p = 0.005], previous acute pancreatitis [OR 6.78; 95% CI 2.55-18.05; p <0.001], and exposure to the first thiopurine <6 months [OR 1.59; 95% CI 1.14-2.23; p = 0.007]. In a large series in clinical practice, switching to a second thiopurine proved to be a valid strategy. Tight monitoring of elderly IBD patients switching to a second thiopurine because of adverse events is recommended.

2909 Vedolizumab Safety Profile in Treatment of Elderly IBD Patients

INTRODUCTION: Vedolizumab is an anti-integrin therapy for IBD. It is a monoclonal antibody that selectively inhibits the interaction between the MAdCAM-1 receptor and α4β7 integrin in the gut. Vedolizumab, in comparison to other biologics, has a smaller pool of literature designating it's safety profile, specifically in the elderly (age &gt;65 years of age) population of IBD patients. The GEMINI post-hoc trials have indicated an acceptable rate of infections, adverse reactions leading to hospitalization, and rate of malignancy in patients older than 55 years of age. The elderly subset of patients, designated as those 60-65 years of age or older by prior literature, is a growing population in need of effective and safe treatment of their IBD. METHODS: We searched the Epic database for Lahey patients with a diagnosis of inflammatory bowel disease, searching for patients who had been prescribed vedolizumab for this diagnosis. Of the compiled list of patients collected with these criteria, we searched the patient charts for the occurrence of flares, infections, development of malignancy, and death. Reasons for exclusion from the study include discontinuation of vedolizumab before completion of induction dosing, not being on vedolizumab, and lack of gastroenterology follow-up at Lahey Medical Center by a Lahey gastroenterologist. RESULTS: Of a total of 86 patients with IBD, ages ranging from 23-81 years of age, there was no significant difference found in the time to flare, time to remission from flare, incidence of infections, arthralgias, or malignancy in patients with IBD &gt;65 after starting vedolizumab. Non-melanomatous skin cancer was the most common malignancy diagnosed after starting vedolizumab in both groups. CONCLUSION: Our data indicated no statistical difference between the adverse reactions leading to hospitalization, time to flare, and malignancy between the elderly and non-elderly IBD patients undergoing treatment with vedolizumab. However, our current data is primarily limited by small sample size and unequal study arm size. Also, our sample is primarily Caucasian, limiting our data's application to non-white IBD patient populations. We are currently working to combine our data with that of other hospital populations to overcome this limitation.

Increased risk of thiopurine-related adverse events in elderly patients with IBD.

Thiopurines are the most widely used immunosuppressants in IBD although drug-related adverse events (AE) occur in 20%-30% of cases. To evaluate the safety of thiopurines in elderly IBD patients METHODS: Cohort study including all adult patients in the ENEIDA registry who received thiopurines. Patients were grouped in terms of age at the beginning of thiopurine treatment, specifically in those who started thiopurines over 60years or between 18 and 50years of age. Thiopurine-related AEs registered in the ENEIDA database were compared. Out of 48752 patients, 1888 started thiopurines when over 60years of age and 15477 under 50years of age. Median treatment duration was significantly shorter for those who started thiopurines >60years (13 [IQR 2-55] vs 32 [IQR 5-82] months; P <.001). Patients starting >60years had higher rates of all types of myelotoxicity, digestive intolerance and hepatotoxicity. Thiopurines were discontinued due to AEs (excluding malignancies and infections) in more patients starting >60years (67.2% vs 63.1%; P <.001). Elderly age and female sex were independent risk factors for most AEs. In elderly IBD patients, thiopurines are associated with an increased risk of non-infectious, non-neoplastic, AEs.

Su1837 – Higher Discontinuation Rates of Anti-TNF Therapy in Elderly IBD Patients Compared to a Younger Age Group: Results from a Prospective Registry

Su1837 – Higher Discontinuation Rates of Anti-TNF Therapy in Elderly IBD Patients Compared to a Younger Age Group: Results from a Prospective Registry

P626 Higher discontinuation rates of anti-TNF therapy in elderly IBD patients compared with a younger age group: results from a prospective registry

P626 Higher discontinuation rates of anti-TNF therapy in elderly IBD patients compared with a younger age group: results from a prospective registry

Post-operative complications in elderly onset inflammatory bowel disease: a population-based study.

IBD diagnosed after the age of 60 is increasing. Data on post-operative complications in elderly onset IBD are scarce. To describe the incidence of and factors associated with post-operative complications in elderly onset IBD, diagnosed after the age of 60. Using EPIMAD Cohort (1988-2006), among 841 incident IBD patients, 139 (17%) underwent intestinal surgery, including 100 Crohn's disease (CD) and 39 ulcerative colitis (UC). After a median post-operative follow-up of 6years (2-10), 50 (36%) patients experienced at least 1 complication with a total of 69. During the first 30 post-operative days, the mortality rate was 4%. Thirty-two early complications (<30days) were observed in 23 patients (17%), with 15 infectious, without significant difference between CD and UC. More than half early post-operative complications (n=19, 59%) were severe (>grade 2) without significant difference between CD and UC (P=0.28). Thirty-seven long-term adverse effects of surgical therapy (≥30days) were observed in 33 patients (24%). Multivariate analysis found (1) acute severe colitis (OR=7.84 [2.15-28.52]) and emergency surgery (OR=4.46 [1.75-11.36]) were associated with early post-operative complications, and (2) Female gender (HR=2.10 [1.01-4.37]) and delay before surgery >3months (HR=2.09 [1.01-4.31]) with long-term adverse effects of surgical therapy. One-third of elderly IBD patients experienced at least 1 post-operative complication. Half of the early complications were severe, and infectious. Emergency surgery was the key driver for post-operative complication.

P336 Safety of anti-TNF treatment in older IBD patients: a systematic review and meta-analysis

Background: Anti-tumour necrosis factor (Anti-TNF) therapy is effective for both inducing and maintaining remission in IBD patients. Recent meta-analyses have demonstrated their safety in the general IBD population. However, little is reported about the safety of these drugs in elderly patients. Therefore, we aimed to investigate the safety of management of IBD in elderly patients using anti-TNF treatment by systematic review and meta-analysis of available data. Methods: A literature search was conducted for papers and conference proceedings through November 2016 regarding elderly IBD patients and anti-TNF therapy. All studies were appraised using the adapted Newcastle-Ottawa Scale (NOS), which contains 9 criteria for cohort studies and is adapted to 6 criteria for case series and case reports. Three reviewers independently extracted data on anti TNF-exposed older and younger patients, with number of serious infections, dead during follow-up and cessation of therapy due to adverse events as outcomes of interest. Poisson regression was used to compare the occurrence of outcomes of interest per patient year follow up between older and younger IBD patients. Results: From 454 found titles, four papers and 5 conference abstracts were included, totalling 1276 patients: 470 older and 806 younger patients. Data on combined steroid use was provided in 2 papers, data on IM combo-therapy in 5 papers. Papers used either 60 years or 65 years as cut off. The rate ratio for serious infections was similar between older and younger IBD patients (2.1, p=0.084) and was not influenced by IM use (rate ratio 2.8, p=0.054). However, when steroid use was added to the model, the rate ratio for serious infections was 2.35 (p<0.001, 95% CI 2.3–2.4 and use of steroid increased the risk (p<0.001). Risk of death did not significantly differ between older and younger patients during follow (risk ratio 10.4, p=0.19) and was not affected by use of IM (p=0.5). When use of steroids was added to the model, there was a trend towards an increased risk of death in older IBD patients during anti-TNF exposure (p=0.06, ratio 3.3, 95% CI 0.94–11.8) Older patients were 3.1 x more likely to stop anti-TNF therapy due to AE (p=0.008, 95% CI 1.34–7.4) compared to younger patients, and this was not influenced by use of IM. Too few data were available on steroid use. Conclusions: Although anti-TNF therapy is more often discontinued in older IBD patients due to adverse events, the use of anti-TNF was only associated with an increased risk for serious infections when combined with steroids. More data on safety of anti-TNF in elderly are needed, with special attention to indices of physical, frailty and mental and social impairment. This would enable a more personalised assessment of risk.

Systematic Review and Meta-analysis: Phenotype and Clinical Outcomes of Older-onset Inflammatory Bowel Disease.

Little is known of the clinical outcome of patients with older-onset inflammatory bowel disease [IBD]. We performed a systematic review to determine phenotype and outcomes of older-onset IBD compared with younger-onset subjects. A systematic search of Embase and Medline up to June 2015 identified studies investigating phenotype and outcomes of older-onset [diagnosed at age ≥ 50 years] Crohn's disease [CD] and ulcerative colitis [UC] subjects. Pooled analyses of disease phenotype, medication use, and disease-related surgery were calculated. We analysed findings from 43 studies comprising 8274 older-onset and 34641 younger-onset IBD subjects. Compared with younger-onset patients, older-onset CD patients were more likely to have colonic disease (odds ratio [OR] 2.56, 95% confidence interval [CI] 1.88 - 3.48) and inflammatory behaviour [OR 1.19, 95% CI 1.07 - 1.33], and less likely to have penetrating disease or perianal involvement. More older-onset UC patients had left-sided colitis [OR 1.49, 95% CI 1.18 - 1.88]. Although fewer older-onset IBD patients received immunomodulators [CD: OR 0.44; UC: OR 0.60] or biologicals [CD: OR 0.34; UC: OR 0.41], older-onset CD was similar in the need for surgery [OR 0.70, 95% CI 0.40 - 1.22] whereas more older-onset UC patients underwent surgery [OR 1.36, 95% CI 1.18 - 1.57]. Elderly IBD patients present with less complicated disease, but have similar or higher rates of surgery than non-elderly patients. Whether this reflects a non-benign disease course, physicians' reluctance to employ immunomodulators, or both, merits further study which is essential for improving the care of IBD in the elderly.

Anaemia in the Elderly IBD Patient.

Anaemia is a common multifactorial extraintestinal manifestation in IBD patients. Moreover, anaemia represents an important health problem among the elderly population and has a significant impact on healthcare utilisation and costs. Data on the prevalence, diagnosis and management of anaemia in elderly IBD patients are scarce, since clinical trials have largely excluded this population. In this review, we reconsider anaemia in older IBD patients in the light of new diagnostic and therapeutic tools.

Is Advanced Age in Elderly IBD Patients a Predictor of Infectious Complications?

Is Advanced Age in Elderly IBD Patients a Predictor of Infectious Complications?

P622 Health care consumption and treatment of Crohn's disease in Stockholm County

conducted using chi-square test for categorical variables. P value <0.05 was considered for statistical significance. Results: In our study group there were 157 patients with elderly onset IBD (14.7%), with similar sex distribution as in non-elderly IBD patients. There were significantly less active smokers among elderly-onset IBD patients (5.9% vs 18.3%, p = 0.0007) and patients resided rural areas more frequently (33.8% vs 25.4% p = 0.02). Ulcerative colitis (UC) is more frequently encountered in elderly IBD patients (67.1% vs 57.5% p = 0.02). Colonic Crohn’s Disease (CD) L2 is more prevalent in our elderly cohort (61.2% vs 39.1% p = 0.003) whereas extensive ileocolonic CD (L3) was less frequent (24.5% vs 41.4%, p = 0.02). No significant association with extent of colonic involvement for elderly UC patients was identified. Malignization occurred 6 times more frequently in elderly IBD patients (1.9% vs 0.3% p = 0.01). With regard to therapeutic management, a significantly higher number of elderly-onset patients were treated with 5ASA (77.6% vs 49.9% p = 0.0002) whereas no significant differences were identified for corticosteroids or azathioprine treatments. There was no difference with regard to severity of disease flare in elderly vs. non-elderly IBD patients. Conclusions: In Romania elderly IBD patients have distinct epidemiological and phenotypical characteristics: higher frequency of UC and colonic CD phenotype and higher risk of malignization that requires active surveillance.