Elderly Inflammatory Bowel Disease Patients Research Articles

Risk of Malignancy in a Nationwide Cohort of Elderly Inflammatory Bowel Disease Patients.

BackgroundManagement of elderly inflammatory bowel disease (IBD) patients (≥ 65 years of age) is complicated due to many factors, including a higher risk of cancer, which may impact therapeutic decisions.ObjectiveThe aim of this study was to determine the risk of cancer among elderly IBD patients compared with younger IBD patients. Additionally, the absolute risk of malignancy and factors contributing to it were evaluated, and therapeutic patterns among the elderly were assessed.MethodsThis retrospective cohort study extracted data from the Truven Health Analytics MarketScan® database. Among adult IBD patients who were free of cancer before starting on corticosteroids, immunomodulators, or biologics, a Cox model for time to cancer was fitted that adjusted for several covariates, including time-dependent treatment. Baseline results were evaluated by age group, as were the incidence of cancer and the distribution of cancer subtypes.ResultsThe elderly IBD cohort (n = 8788) had a higher prevalence of cancer and several other ailments before starting treatment, relative to the younger IBD cohort aged 18–64 years (n = 54,971). During follow-up, the elderly IBD cohort experienced a higher incidence of malignancy, confirmed by a hazard ratio (HR) of 3.04 (95% confidence interval [CI] 2.71–3.41) from the Cox model fit. The risk of cancer was also significantly associated with male sex (HR 0.82 female), duration of disease (HR 1.08), several comorbidities and corticosteroid use (HR 1.35), but not with the use of immunomodulators or biologics. Non-Hodgkin’s lymphoma, urinary tract malignancy, and prostate, lung, and female breast cancers were observed more commonly in this elderly IBD cohort when compared with the same age group in the Surveillance, Epidemiology, and End Results (SEER) database.ConclusionsThe elderly with IBD have a higher risk of malignancy when compared with younger IBD patients and the general age-matched population, with certain cancers being more common among these patients.

P368 Treatment of inflammatory bowel disease in the elderly

Background: Data on efficacy and safety of inflammatory bowel disease (IBD) treament in the elderly is sparse as they are often excluded from clinical trials. We aimed to analyse treatment options and adverse events in elderly IBD patients. Methods: Retrospective study including 345 IBD patients followed in our outpatient clinic from January 2008 to October 2016. Demographic and clinical data was analysed. Eldery was defined as patients over 60 years of age. Results: 173 (50.1%) Crohn's disease, 168 (48.7%) Ulcerative colitis and 4 (1.2%) Indetermined colitis patients were included, 56.2% were female and the median follow—up was 13 years (IQR 8–19). Mean age at diagnosis was 33.0 years (IQR 23.0–45.5), 36 (10.4%) patients had elderly-onset IBD and 106 (30.7) were ≥60 years at the time of the study analysis. Charlson comorbidity index (4.1±1.4 vs. 0.8±1.3, p<0.001) and total number of daily medications (4.3±3.5 vs. 1.6±1.6, p<0.001) were significantly higher in patients ≥60 years. This group received more frequently sulfasalazine or 5-aminossalicylates (84.6% vs. 72.0%, p=0.001) and less frequently azathioprine (19.8% vs. 51.5%, p=0.000) or tumor necrosis factor inhibitors (13.2% vs. 36.0%, p=0.000). There was no significant difference concerning the use of metotrexate or surgery. When comparing elderly with non-elderly, global incidence of adverse events was not significantly different (16.0% vs. 21.3%, p=0.253), neither was the sub-analysis of patients under sulfasalazine or 5-aminossalicylates (p=0.233), azathioprine or 6-mecaptopurine (p=0.786) or tumor necrosis factor inhibitors (p=0.549). Infection was not more frequently diagnosed in the elderly (p=0.784). Conclusions: One in each 10 patients has elderly-onset IBD. Although immunosuppression was used less frequently in this population, there was no significant differences in its safety profile.

Cancer in Elderly Onset Inflammatory Bowel Disease: A Population-Based Study.

Cancer may be a complication of inflammatory bowel disease (IBD) or its treatment. In elderly onset IBD patients the risk of malignancy is of particular concern. We studied this risk in a population-based cohort of elderly onset IBD patients. In a French population-based cohort, we identified 844 patients aged >60 years at IBD diagnosis from 1988 to 2006, including 370 Crohn's disease (CD) and 474 ulcerative colitis (UC). We compared incidence of cancer among IBD patients with that observed in the French Network of population-based Cancer Registries (FRANCIM). Confidence interval (CI) was estimated assuming a Poisson-specific law for rare events. Results were expressed using the standardized incidence ratios (SIRs) and their CI 95%. Median age at IBD diagnosis was 70 (65-76) years in CD and 69 (64-74) in UC. Median follow-up was 6 (2-11) years for both diseases with a number of person-years of 5,598. Among the 844 elderly onset IBD cases, 98 (11.6%; 42 CD and 56 UC) developed a cancer after IBD diagnosis (67 men and 31 women) corresponding to an overall SIR of 0.97 (0.80-1.18). These cancers occurred at a median age of 77 years (71-80) and 75 years (71-81) in patients with CD and UC, respectively. Median time between IBD diagnosis and cancers was 78 months (40-121). There was no significant increased risk of colorectal cancer in IBD (SIR=1.03 (0.62-1.70), CD (SIR=1.20 (0.57-2.52) nor in UC (SIR=0.91 (0.45-1.82) without significant protective role of 5-aminosalicylic acid (hazard ratio (HR)=0.7 (0.2-2.6)). No significant risk for other intestinal cancers was found, especially for small bowel carcinoma. An increased risk of malignant lymphoproliferative disorders was found in all IBD and in CD: SIR=2.49 (1.25-4.99) and SIR=3.09 (1.16-8.23), respectively. An increased risk of myeloproliferative disorders was found in all IBD (SIR=2.18 (1.09-4.35)). Thiopurines exposure, using a time-dependant Cox model, was not found as associated with an increased risk to develop cancer, HR=0.90 (0.48-1.68). There is no increased risk for developing intestinal cancer among patients with elderly onset IBD in this population-based cohort. There are increased risks of developing lymphoproliferative and myeloproliferative disorders in all IBD. Thiopurines exposure was not found as associated with an increased risk to lymphoproliferative disorders. These data reinforce the difference between elderly onset IBD as compared with patients with younger age at IBD onset.

PGI34 - PATIENT CHARACTERISTICS AND TREATMENT AMONG ELDERLY INFLAMMATORY BOWEL DISEASE PATIENTS: A RESTROSPECTIVE DATABASE ANALYSIS

There is paucity of guidelines addressing the management of inflammatory bowel disease (IBD) among elderly patients (≥ 65 years old). This study aims to assess the demographic features of elderly patients with IBD and treatment modalities employed to manage the disease in this cohort while comparing to 18-64 year-old adult patients. Retrospective study using MarketScan database in adults with ulcerative colitis(UC) or Crohn’s disease(CD) during 2010-2014. UC or CD diagnoses were confirmed with at least two diagnostic claims ≥30 days apart. The index date was the date of initiation of corticosteroids(CS), immunomodulators or biologic therapy after the IBD diagnosis. Descriptive summary statistics were used to compare baseline demographic and clinical factors and IBD treatment between patients 18-64 and ≥ 65 years old. Among 63,770 IBD patients (28,328 CD and 35,442 UC patients) identified, 8,790 (13.8%) were ≥ 65 years old. Compared to 18-64 year olds, the elderly had more multiple comorbidities (mean Charlson score -1.00 vs. 0.29,P<0. 0001), osteoporosis (6% vs. 1.6%,P<0. 001), baseline cancer (16.5% vs. 4.4%,P<0. 0001) and used ≥5 concomitant medications at baseline (53.8% vs. 24%,P<0. 0001). Overall, significantly higher proportion (all P<0. 0001) of elderly patients (92.6%) were initiated on CS compared to 18-64 year olds (83.9%), which is consistent among UC (95.4% vs. 91.0%) and CD (88.2% vs. 75.3%) subgroups. In contrast, immunomodulator (4.8% elderly, 8.4% 18-64) and biologics, mainly anti-TNFs (2.5% elderly, 7.8% 18-64) were initiated less frequently among elderly than the 18- 64 year-olds. This study indicates that CS use is more prevalent in the elderly than younger IBD patients, despite a higher potential of exacerbating comorbid conditions in older patients. The utilization rates for CS-sparing biologic and immunomodulator drugs were lower among elderly IBD patients indicating potential gaps in the treatment of elderly IBD patients.

Elderly patients and inflammatory bowel disease.

The incidence and prevalence of inflammatory bowel disease (IBD) is increasing globally. Coupled with an ageing population, the number of older patients with IBD is set to increase. The clinical features and therapeutic options in young and elderly patients are comparable but there are some significant differences. The wide differential diagnosis of IBD in elderly patients may result in a delay in diagnosis. The relative dearth of data specific to elderly IBD patients often resulting from their exclusion from pivotal clinical trials and the lack of consensus guidelines have made clinical decisions somewhat challenging. In addition, age specific concerns such as co-morbidity; loco-motor and cognitive function, poly-pharmacy and its consequences need to be taken into account. In applying modern treatment paradigms to the elderly, the clinician must consider the potential for more pronounced adverse effects in this vulnerable group and set appropriate boundaries maximising benefit and minimising harm. Meanwhile, clinicians need to make personalised decisions but as evidence based as possible in the holistic, considered and optimal management of IBD in elderly patients. In this review we will cover the clinical features and therapeutic options of IBD in the elderly; as well as addressing common questions and challenges posed by its management.

Drug Management in the Elderly IBD Patient.

Managing inflammatory bowel disease (IBD) in a world of immunomodulators and biologics is complex enough, but managing the elderly IBD patient is further confounded by multiple comorbidities, polypharmacy with drug-drug interactions, and cognitive mobility/motility disturbances. Social and insurance coverage issues also always lurk in the background. All of these factors summate into a daunting challenge for the clinician. In this review, we aim to describe important considerations when prescribing to an elderly patient with IBD, taking into account costs of medications, drug interactions, the aging body's effect on pharmacokinetics, and the effect of aging on the immune system. Adverse effects and drug-drug interactions are expounded upon in detail specific for the aging adult with IBD in an effort to assist the clinician in the decision-making process.

Characterization of inflammatory bowel disease in elderly hospitalized patients in a large central Canadian Health region.

To determine differences in phenotype and treatment among hospitalized elderly and young patients with inflammatory bowel disease (IBD), and the utility of International Classification of Diseases, 10th Revision (ICD)-10 codes in hospital discharge abstracts in diagnosing IBD in elderly patients. A large Canadian health region hospitalization discharge database was used to identify elderly (>65 years of age) and young (19 to 50 years of age) patients with IBD admitted between April 1, 2007 and March 31, 2012, and a random sample of elderly patients with other colonic conditions. Medical records were reviewed to confirm IBD diagnosis and extract clinical information. The characteristics of elderly versus young hospitalized IBD patients and accuracy of ICD-10 IBD discharge codes in the elderly were assessed. One hundred forty-three elderly and 82 young patients with an IBD discharge diagnosis, and 135 elderly patients with other gastrointestinal discharge diagnoses were included. Elderly IBD patients were less likely to have ileocolonic Crohn disease (21.4% versus 50.9%; P=0.001), more likely to be prescribed 5-aminosalicylates (61% versus 43%; P=0.04), and less likely to be prescribed biologics (6% versus 21%; P=0.016) or immunomodulators (21% versus 42%; P=0.01). The sensitivity, specificity and positive predictive value of a single ICD code for CD were 98%, 96% and 94%, respectively, and for ulcerative colitis (UC) were 98%, 92% and 70%, respectively. Treatment approaches in elderly patients were different than in younger IBD patients despite having disease sufficiently severe to require hospitalization. While less accurate in UC, a single ICD-10 IBD code was sufficient to identify elderly CD and UC hospitalized patients.

Medical and surgical complications of inflammatory bowel disease in the elderly: a systematic review.

The complications of therapy, hospitalization, and surgery related to inflammatory bowel disease (IBD) in the elderly are not well described. While multiple reviews have described the management and complications of elderly patients with IBD, none have been performed in a systematic fashion. We performed a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to evaluate the association between elderly patients with IBD and complications from therapy, hospitalizations, and surgery. Eligible studies were identified via structured keyword searches in PubMed and manual literature searches. A total of 5,644 publications were identified. Of these, fourteen studies met inclusion criteria, encompassing 963 elderly IBD patients (113 Crohn's disease and 850 ulcerative colitis patients), over 37,000 hospitalizations of elderly IBD patients and over 4,500 controls. Consistent associations were observed between increased age and higher nocturnal stool frequency post-ileal pouch anal anastomosis. Only two studies met inclusion criteria for medication-related complications, one observed an increased mortality and infection risk among elderly patients treated with tumor necrosis factor antagonists and the other observed increased hospital-related complications among elderly patients treated with steroids. Elderly patients with IBD are at an increased risk of hospital- and therapy-related complications. We found a paucity of high-quality studies evaluating outcomes in elderly patients with IBD. Further studies of elderly patients with IBD are needed to further evaluate the effect of age on medical and surgical complications.

963 Sources of Concern Over Time in IBD: A Prospective Study of the Complex Relationship Between Symptomatic Disease Activity and Perceived Stress

Background: The incidence of Crohn's disease (CD) and ulcerative colitis (UC) in the elderly population is reported to be increasing. Comorbid diseases, which are more prevalent with advanced age, may impact the natural history of inflammatory bowel disease (IBD) and treatments. We sought to characterize the population-based burden and outcomes of elderlyonset CD and UC in comparison to IBD of younger onset. Methods: We identified incident cases of IBD in Ontario, Canada between 1999 and 2008 from health administrative databases at the Institute for Clinical Evaluative Sciences using algorithms that were validated specifically in Ontario. The primary outcomes were hospitalizations and first IBD-related surgery. We compared groups defined by age at diagnosis: young adult (18-44y); middle-adult (45-64y); and elderly (≥65y) in univariate and regression analysis. Comorbidity was assessed using the validated Johns Hopkins Adjusted Clinical Group (ACG) case-mix system. Results: There were 8,985 incident cases of CD and 12,233 incident cases of UC during the study period. Of these, 725 new cases of CD and 1,749 new cases of UC occurred in the elderly. There was a slightly greater female predominance among the elderly group. More than a quarter of elderly IBD patients (29% of CD; 26% of UC) were in the top quartile for ACG comorbidity score, which was about twice as frequent as the middle-adult group. The incidence of IBDrelated hospitalization adjusted for sex, ACG comorbidity, and geographic region was lower for elderly IBD subjects when compared with young adults in both CD (incidence rate ratio [IRR], 0.76; 95% CI: 0.69 0.83) and UC (IRR, 0.88; 95% CI: 0.82 0.96). The KaplanMeier survival curves for bowel surgery for UC and CD stratified by age at diagnosis are shown in Figure 1. The cumulative risk of CD-related bowel resection at 2, 5, and 10 years were 18%, 24%, and 31%, respectively for elderly CD patients which were similar to the 15%, 23%, and 30% cumulative risks observed in young adults with CD. In contrast, the cumulative risk of colectomy among elderly UC patients at 2, 5, and 10 years (9%, 14%, and 18%, respectively) was higher than that of middle-age adults (8%, 11%, and 15%, respectively) and young adults (7%, 10%, and 13%, respectively). The adjusted hazard ratio for colectomy among elderly UC patients compared with their young adult counterparts was 1.36 (95% CI: 1.18 1.57). Conclusion: In this population-based study, UC patients who were diagnosed after age 65 years incurred increased risk of colectomy compared to those diagnosed as young, or middle-age adults. It is unclear whether this was due to more a more aggressive disease course or a lower threshold for colectomy due to the potential adverse effects of immunosuppressive medical therapy.

Systematic review with meta‐analysis: inflammatory bowel disease in the elderly

Elderly patients represent an increasing proportion of the inflammatory bowel disease (IBD) population. To critically review available data regarding the care of elderly IBD patients. Bibliographic searches (MEDLINE) up to June 2013. Approximately 10-15% of cases of IBD are diagnosed in patients aged >60 years, and 10-30% of the IBD population are aged >60 years. In the elderly, IBD is easily confused with other more common diseases, mainly diverticular disease and ischaemic colitis. The clinical features of IBD in older patients are generally similar to those in younger patients. Crohn's disease (CD) in elderly patients is characterised by its predominantly colonic localisation and uncomplicated course. Proctitis and left-sided ulcerative colitis are more common in patients aged >60 years. Infections are associated with age and account for significant mortality in IBD patients. The treatment of IBD in the elderly is generally similar. However, the therapeutic approach in the elderly should be 'start low-go slow'. The benefit of thiopurines in older CD patients remains debatable. Although the indications for anti-tumour necrosis factors in the elderly are generally similar to those for younger patients, lower response and higher adverse events have been reported in the elderly. Surgery in elderly patients does not generally differ. Ileal pouch-anal anastomosis can be successful, provided the patient retains good anal sphincter function. Management of the older IBD patient differs from that of younger patients; therefore, conventional practice algorithms may have to be modified to account for advanced age.

Effect of Aging on Healthcare Costs of Inflammatory Bowel Disease

Population aging is expected to result in a substantial additional burden on healthcare resources in the near future. We aimed to assess the current and future impact of aging on direct healthcare costs (DHC) attributed to inflammatory bowel disease (IBD). Patients with IBD from a Dutch multicenter cohort filled out 3-monthly questionnaires for 2 years. Elderly (≥60 yr) and younger patients (18-60 yr) IBD were analyzed for differences in 3-monthly DHC, productivity losses, and out-of-pocket costs. Prevalence rates were obtained from a health insurance database. Estimates of annual DHC and prevalence rates were applied to the total Dutch adult population in 2011 and then projected to 2040, using predicted changes in population demography, prices, and volume. IBD-attributable DHC were lower in elderly than in younger patients with IBD with respect to 3-monthly DHC (&OV0556;359 versus &OV0556;978, P < 0.01), productivity losses (&OV0556;108 versus &OV0556;456, P < 0.01), and out-of-pocket costs (&OV0556;40 versus &OV0556;57, P < 0.01). Between 2011 and 2040, the percentage of elderly IBD patients in the Netherlands has been projected to rise from 24% to 35%. Between 2011 and 2040, DHC of the total IBD population in the Netherlands are projected to increase from &OV0556;161 to &OV0556;661 million. Population aging accounted for 1% of this increase, next to rising prices (29%), and volume growth (70%). Population aging has a negligible effect on IBD-attributable DHC of the IBD population in the near future, because the average costs incurred by elderly patients with IBD are considerably lower than those incurred by younger patients with IBD.

P-111 Geriatric Patients with Inflammatory Bowel Disease are Less Likely to be Treated with Immunomodulating Agents

Inflammatory bowel disease (IBD) is a lifelong illness that affects approximately 1.4 million in the United States. While there is an increasing geriatric population in the nation, there is limited published data on older IBD patients. The effect of aging physiology on IBD manifestations is unknown. Small prior studies have shown decreased use of immunomodulating agents in elderly IBD patients. However, the effect of age upon treatment regimens in elderly IBD patients is unknown. This study evaluated the use of immunomodulator therapy in geriatric IBD patients. A retrospective chart review of inflammatory bowel disease patients cared for in a 18-month period at a university medical center was performed. There were no exclusion criteria. Patient age, gender, race, disease type and treatment regimen were obtained. Geriatric age was defined as ≥65 years. A database, maintaining patient confidentiality, was created. Statistical analysis was performed using Fisher’s exact test with statistical significance set at P < 0.05. The study was approved by the university institutional review board. 293 medical records of IBD patients were reviewed. There were 175 women and 118 men. One hundred fifty-six patients had Crohn’s disease, 135 had ulcerative colitis and 2 had indeterminate colitis. The mean age was 41.04. Two hundred seventy-one (163 women, 108 men) were <65 years. Twenty-two (14 women, 8 men) were ≥65 years. One hundred sixty-one of the 293 (55%) patients were on immunomodulating therapy. One hundred fifty-six of the 271 (57.6%) patients <65 and 5 of 22 (22.7%) of geriatric patients were on immunomodulating therapy. Geriatric IBD patients were found to be significantly less likely (P = 0.0029) to be treated with immunomodulating agents than non-geriatric patients. There was no significant difference in the use of immunomodulating therapy in women <65 and women ≥65 or (P = 0.0847) or in men <65 and men ≥65 (P = 0.1503). The importance of recognizing disease presentation and prescribing patterns in elderly IBD patients is increasingly important. This study revealed that immunomodulating agents are used less frequently in geriatric IBD patients. The decreased utilization of immunomodulator therapy in geriatric patients may reflect less severe disease, patient preference or prescriber caution due to co-morbidities and the potential for adverse medication reactions. Further study should be performed to evaluate the influence of aging upon inflammatory bowel disease management.

Surgical Outcomes in the Elderly with Inflammatory Bowel Disease are Similar to Those in the Younger Population

Inflammatory bowel disease (IBD) has a bimodal distribution with approximately 15 % of patients manifesting after age 65. Previous reports suggest an increased risk of surgical complications in the elderly. To compare surgical outcomes in elderly IBD patients (≥ 65 years at the time of surgery) to matched younger IBD cohorts. This was a retrospective cohort study at a single academic center of patients who underwent surgery for IBD. Forty-two elderly patients (≥ 65 years) were matched at least 1:1 (median 1:5) to patients in each of three control groups [18-35 years (n = 71); 36-49 years (n = 62); 50-64 years (n = 58)] according to gender, disease type/location, and type of surgery. Postoperative complications were compared. Patient characteristics were used in multivariate risk models. Analysis was performed using ordinary logistic regression. Twenty ileal or ileocolonic resections, 12 partial or total colectomies, four stricturoplasties, and six laparoscopic partial or total colectomies were performed in the elderly group. The post-operative complication rate was not statistically different between the elderly and younger cohorts (38 % vs. 39 % vs. 40 % vs. 48 % in the 18-35, 36-49, 50-64, and ≥ 65 years groups, respectively, p = 0.26). The only significant risk factors for complication were Charlson comorbidity index (p = 0.0002), preoperative hemoglobin (p = 0.0065), total parenteral nutrition use (p = 0.024), and failed medical therapy (as the indication for surgery) (p = <0.0001). The surgical complication rate among elderly and younger IBD patients was similar. Advanced age by itself should not be considered a risk factor for adverse operative outcome.

6-Mercaptopurine Side Effect Profile in the Elderly Inflammatory Bowel Disease Patient

A total of 77 million baby boomers will join the category of elderly over the next 19 years, at a rate of 4 million per year. The elderly inflammatory bowel disease patient is under represented in clinical trials and often clinicians make decisions using data from such trials involving a much younger patient populations. We set out to investigate the safety of 6-Mercaptopurine in our elderly patient population. Using an electronic search database we identified 41 patients with Inflammatory Bowel disease on 6-Mercaptopurine/Azathioprine with either Ulcerative colitis (UC) or Crohn's disease (CD). A comparison of the dosage, side effect profile, and duration of therapy was examined. Of 41 patients with inflammatory bowel disease, 26 were female and 25 were male. The mean age of the patient population was 70.4 years old. Twenty-five patients were diagnosed with CD and 16 with UC. The dosage of 6-MP ranged from 25 mg to 150 mg. The average duration of therapy was 48.5 months. Thirty patients experienced a single side effect, whereas 8 had multiple occurrences. Four patients had to discontinue therapy (1 rash, 1 hepatitis & rash, 1 pancytopenia, 1 infection) secondary to a severe side effect. The other 26 patients continued their therapy at the current dose, or tolerated therapy after lowering dosage. Two patients developed malignancies while on 6-MP(1 Basal Cell Carcinoma& Squamous Cell Skin Cancer, 1 Bladder Cancer & Prostate Cancer). Our experience demonstrates of 41 patients with inflammatory bowel disease 37/41 (90.2%) were able to tolerate the medication without having to discontinue treatment. Of those with side effects 26/30 (86.7%) were able to continue 6-MP/Azathioprine In our elderly IBD patient population taking immunomodulators that with periodic measurement of CBC, creatinine, and hepatic profile long-term therapy remained beneficial.

Geriatric Inflammatory Bowel Disease: Phenotypic Presentation, Treatment Patterns, Nutritional Status, Outcomes, and Comorbidity

The U.S. population is aging and the burden of geriatric inflammatory bowel disease (IBD) patients has increased. Systematic data describing phenotypic presentation, treatment regimens, outcomes and comorbidities in elderly IBD patients is limited. We performed a retrospective observational study of IBD patients age ≥65 followed in a 20-hospital system to determine patterns of phenotypic presentation, treatment, polypharmacy, nutritional status and comorbidity. Data were extracted from electronic medical record based on ICD-9 coding/indexed terms on Crohn's disease (CD) and ulcerative colitis (UC) patients. A total of 393 geriatric IBD patients were identified (49.1% males; 50.9% females; 61.8% UC; 38.2% CD; 73.4 ± 6.6 years old). Younger age at diagnosis of CD (≤64) was associated with greater prevalence of small bowel surgeries (63.6%) compared with those diagnosed after age ≥65 (20.9%) (p < 0.005). Fistulizing/penetrating disease was frequent in patients diagnosed with CD at a younger age (43.6% compared to 7%) (p < 0.005). IBD maintenance treatment included: 44% 5-ASA agents; 31.6% maintenance prednisone (defined as ≥6 months treatment duration); 4.8% steroid suppositories; 5.6% 6MP/azathioprine; 1.3% methotrexate; 1.3% adalimumab; 1.3% infliximab; 9.4% loperamide/diphenoxylate/atropine; 0.5% had no IBD medications. Longer duration of CD disease correlated with vitamin B12, vitamin D and iron deficiency. Geriatric patients diagnosed with CD earlier in life had greater small bowel involvement compared with new onset geriatric CD. There is low utilization of immunomodulator and biologic agents in geriatric IBD patients. Duration of CD correlates with nutrient deficiency. Prospective studies are warranted in this respect.

Clinical features of elderly Inflammatory bowel disease patients in Japan

Clinical features of elderly Inflammatory bowel disease patients in Japan

Prevalence of metabolic syndrome is comparable between inflammatory bowel disease patients and the general population

Metabolic syndrome (MS) is associated with an increased risk of cardiovascular disease. However, its prevalence in inflammatory bowel disease (IBD) patients remains largely unknown. This study was planned to determine the prevalence of MS in Japanese IBD patients. The prevalence of MS among outpatients with IBD aged 18 or older was studied using the modified National Cholesterol Education Program Adult Treatment Panel III definition. A total of 107 quiescent IBD patients, including 76 ulcerative colitis (UC) patients and 31 Crohn's disease (CD) patients, were studied. Sufficient data were collected from a total of 102 patients. Prevalence of MS was significantly higher in UC (23.0%) patients compared to CD patients (7.1%). MS prevalence was substantially higher among male IBD patients (21.1%) compared to female IBD patients (12.9%), particularly in patients over 30 years of age. No difference was observed in the prevalence of MS between our IBD cohort and the general population in both males and females aged 40 years and older (P = 0.707 in males, P = 0.328 in females). IBD patients with MS were also older than those without (50.2 ± 15.0 vs. 38.0 ± 11.9 years, P = 0.013). In a logistic regression analysis, age was the statistically significant predictor of MS among IBD patients. The odds ratio (95% confidence interval) was 1.064 (1.017-1.114). Prevalence of metabolic syndrome in our IBD patients was comparable to that of the general population. Because age was the independent risk factor for developing MS, evaluation for MS is needed for elderly IBD patients.

Factors Affecting Surgical Risk in Elderly Patients With Inflammatory Bowel Disease

The operative treatment of elderly patients with inflammatory bowel disease (IBD) has often been avoided in favor of medical management because of a perceived increase in surgical risk. This study sought to define the following in the elderly IBD patient population: (1) the risk of surgical management and (2) those factors affecting risk. Thirty patients with IBD, aged 60 years or more, who were surgically managed by a single surgeon over a 10-year period, were retrospectively matched to 75 patients with IBD who were less than 60 years of age; patients were matched according to sex, date of surgery, and type of surgery performed. Regression analysis using generalized estimating equation methodology to account for the matched clusters of patients was performed to evaluate the effect of age group on the complication rate, operating room time, and length of hospital stay. Presence of comorbid conditions, surgical indications, prior surgery for IBD, and the use of immunosuppressive medications were studied in multivariate models, adjusting for age group. By means of univariate analysis, the odds of complications in elderly IBD patients were shown to be statistically higher than the odds seen in younger patients (47% vs. 20%, P = 0.01). Also observed in the elderly group were a longer length of hospital stay (11.5 days vs. 7.1 days, P = 0.001) and longer operating room time (249 minutes vs. 212 minutes, P = 0.02). Multivariate analysis revealed that the effect of age remained statistically significant, even when adjusted for potential confounding variables such as comorbidity, medications, date of diagnosis of IBD, and indications for surgery. The complication outcome was significantly associated with the surgical indication, with obstruction, fistula, and bleeding having increased odds of complications as compared with other indications (odds ratio = 1.7 vs. 4.2 vs. 7.2, respectively, P = 0.02). The length of hospital stay similarly was significantly associated with the surgical indication (fistula, 10.5 days vs. bleeding, 9.8 days vs. obstruction, 7.4 days vs. other, 9.3 days; P = 0.04) and a history of prior surgery. A significant interaction for length of hospital stay was present between age group and prior surgery status (with prior surgery: old, 18 days vs. young, 6.4 days, P = 0.0001; without prior surgery: old, 9.5 days vs. young 7.3 days, P = 0.10). Elderly patients with IBD have an increased rate of postoperative complications along with an increased length of hospital stay and increased operating room time. This effect of age persists when adjusted for comorbidity and immunosuppressive therapy. Complications are most dependent on surgical indications, with obstruction being the least and bleeding the worst predictive factors. The longest hospital stay is associated with patients who require surgery for fistulous disease and patients who have undergone previous surgery. The fact that the higher complication rate seen in older patients with IBD is associated with disease-defined surgical indications suggests that IBD in elderly patients may be more aggressive than what is observed in younger individuals. ( J Gastrointest Surg 2002;6:606–613.)

Inflammatory bowel disease

Although inflammatory bowel disease (IBD) usually presents in adolescents and young adults, both ulcerative colitis and Crohn's disease can also present in older adults. The diagnosis of IBD in the elderly is often difficult and can easily be confused with diverticulitis or ischaemic colitis. The symptoms and complications of IBD in the elderly are similar to those found in younger patients. However, when IBD presents later in life the disease is often less extensive and milder. Older IBD patients are treated with the same medications as younger patients, although the risk for drug toxicity is greater, especially with corticosteroid therapy. Co-morbid illness in older patients often has a significant impact on the outcome of medical and surgical therapy for IBD but, in the absence of significant co-morbid disease, most elderly IBD patients can expect a good response to therapy.