Elderly-onset Inflammatory Bowel Disease Research Articles

Crohn's Disease of the Elderly: Unique Biology and Therapeutic Efficacy and Safety.

The incidence and prevalence of inflammatory bowel disease (IBD) is increasing in the elderly population. Compared with patients with onset during younger years, patients with elderly-onset IBD have a distinct clinical presentation, disease phenotype, and natural history. Genetics contribute less to pathogenesis of disease, whereas aging-related biological changes, such as immunosenescence and dysbiosis, are associated with elderly-onset IBD. Frailty is an increasingly recognized predictor of adverse outcomes. As an increasingly wider array of biologic and small molecule therapeutic options becomes available, data regarding efficacy and safety of these agents in patients are paramount given the unique characteristics of this population.

Emerging inflammatory bowel disease demographics, phenotype, and treatment in South Asia, South-East Asia, and Middle East: Preliminary findings from the Inflammatory Bowel Disease-Emerging Nations' Consortium.

Inflammatory bowel disease (IBD) is emerging in the newly industrialized countries of South Asia, South-East Asia, and the Middle East, yet epidemiological data are scarce. We performed a cross-sectional study of IBD demographics, disease phenotype, and treatment across 38 centers in 15 countries of South Asia, South-East Asia, and Middle East. Intergroup comparisons included gross national income (GNI) per capita. Among 10400 patients, ulcerative colitis (UC) was twice as common as Crohn's disease (CD), with a male predominance (UC 6678, CD 3495, IBD unclassified 227, and 58% male). Peak age of onset was in the third decade, with a low proportion of elderly-onset IBD (5% age>60). Familial IBD was rare (5%). The extent of UC was predominantly distal (proctitis/left sided 67%), with most being treated with mesalamine (94%), steroids (54%), or immunomodulators (31%). Ileocolic CD (43%) was the commonest, with low rates of perianal disease (8%) and only 6% smokers. Diagnostic delay for CD was common (median 12months; interquartile range 5-30). Treatment of CD included mesalamine, steroids, and immunomodulators (61%, 51%, and 56%, respectively), but a fifth received empirical antitubercular therapy. Treatment with biologics was uncommon (4% UC and 13% CD), which increased in countries with higher GNI per capita. Surgery rates were 0.1 (UC) and 2 (CD) per 100 patients per year. The IBD-ENC cohort provides insight into IBD in South-East Asia and the Middle East, but is not yet population based. UC is twice as common as CD, familial disease is uncommon, and rates of surgery are low. Biologic use correlates with per capita GNI.

COMPARISON OF THE INFLAMMATORY BOWEL DISEASES PHENOTYPE AND COURSE IN THE ELDERLY- AND EARLY-ONSET PATIENTS

Abstract BACKGROUND AND AIMS It is unknown if clinical phenotype and course of the disease are comparable between early- and elderly-onset inflammatory bowel diseases (IBD). There is also an ongoing dispute on whether elderly-onset IBD is a separate entity. We aimed to seek differences in disease phenotype, course, complications, and treatment between early- and elderly-onset IBD patients. METHODS This retrospective cohort study on registered IBD patients in the Iranian Registry of Crohn’s and Colitis (IRCC) compared demographics, extent of ulcerative colitis (UC), Crohn’s disease (CD) location and behavior, extraintestinal manifestations, disease activity during the previous six months, and two weeks, IBD-related surgery and medications between early- and elderly-onset IBD. We defined early-onset and elderly-onset IBD as 30 years or less and 60 years and above, respectively. We used univariable analysis to investigate the association between age of diagnosis and outcomes. Variables with P-value <0.1 were entered into the generalized linear model to study the relative risk of age of diagnosis adjusted for gender and disease duration for the outcomes. RESULTS From 8911 IBD patients that were recruited in the IRCC from December 2017 till June 2021, 4503 were enrolled, including 4134 (46.4%) early-onset and 369 (4.1%) elderly-onset cases. Among them, 3596 (79.8%) had UC, and 907 (20.2%) had CD. Figure 1 shows relative risk of outcomes in patients with UC based on patients’ age of diagnosis adjusted for disease duration and gender. The risk of left colitis was 1.7 times higher among elderly-onset UC patients (95%CI:1.4-2.1, P<0.001). Early-onset IBD cases had a higher prevalence of extraintestinal manifestations (p<0.001). Early-onset UC cases more often used prednisolone (p=0.031), immunomodulators (p<0.001) and anti-tumor necrosis factors (TNF) (p=0.002). Elderly-onset UC patients had 0.7 times lower risk of active disease in the past six months in comparison with elderly-onset cases (95%CI:0.5-0.9, p=0.003). Elderly-onset CD patients had 1.7 times the risk of ilium involvement (95%CI: 1.1-2.5, p=0.010), and elderly-onset CD cases had 0.2 times the risk of stricture formation compared to early cases (95%CI:0.1-0.8, p=0.028). Early-onset CD was associated with higher use of prednisolone (p=0.024), immunomodulators (p<0.001) and anti-TNF (p=0.024). Disease activity during the previous six months , two weeks and IBD-related surgery were similar between the two groups. Figure 2 demonstrates relative risk of outcomes in patients with CD based on patients’ age of diagnosis adjusted for disease duration and gender. CONCLUSION Early-onset IBD was associated with a more aggressive phenotype and higher prednisolone, immunomodulators, and anti-TNF use. There is a need for a more detailed investigation of treatment complications and surgery types in future studies.

P266 Elderly-onset Inflammatory Bowel Disease: a retrospective single-center study with current follow-up

Abstract Background Elderly-onset inflammatory bowel disease (IBD) will be seen more frequently with the ageing of the population and the increasing incidence of IBD. However, to date there are few studies focusing in the medical management of IBD in this patient population. The aim of our study was to describe the main clinical features of elderly-onset IBD. Methods Patients diagnosed with IBD after the age of 65 years (elderly-onset IBD) until December 2020 with current follow-up in a specialized IBD consultation in a tertiary hospital center (by June 2021) were included in this retrospective study. The hospital electronic medical records were searched in order to retrieve demographic and clinical data of the patients. Results A total of 61 patients were included, with mean age of 72.0 years (range 65–86); 34 (55.7%) were male. All patients were alive and with current follow-up. Mean follow-up duration was 84 months (interquartile range 35–97). The most common type was ulcerative colitis in 36 (59%) patients, whereas Crohn’s disease was diagnosed in 25 (41%). Among patients with ulcerative colitis, 14 (38.9%) had pancolitis, 11 (30.6%) left-sided colitis and 11 (30.6%) proctitis. Crohn’s disease was most often ileal in 48% of patients, followed by colonic in 44% and only 8% of patients presented ileocolonic disease. Non-stenosing non-penetrating behavior was present in 19 (76%) patients, followed by stenosing behavior in 6 (24%), with no case of penetrating phenotype; associated perianal disease was detected in 5 (20%) patients. Salicylates were used as single maintenance therapy in 44 (72.1%) of all patients with IBD; 11 (18%) patients required immunosuppressant therapy with biological agents including infliximab (n=5), vedolizumab (n=5) or ustekinumab (n=1) whereas 4 (6.6%) patients required no specific treatment. Surgery was necessary in only 3 (4.9%) patients: 2 performed total colectomy for refractory ulcerative colitis, whereas the other required right ileocolectomy for stenosing Crohn’s disease. At the time of diagnosis, anemia was present in 23 (37.7%) patients. In 21 (34.4%), levels of C-reactive protein were significantly elevated (>10 mg/L) and hypoalbuminemia was present in 12 (19.7%). Vitamin D levels were measured in 44 patients, among these 41 (93.2%) presented abnormally low levels. Conclusion Patients with elderly-onset IBD appear to have a mild disease course, with low use of biological agents and surgery. Ileocolonic involvement and penetrating phenotype in Crohn’s disease appear to be rare. Nevertheless, other comorbidities are often present and IBD may contribute to a higher prevalence of laboratory abnormalities including anemia and vitamin D deficiency.

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

COMPARISON OF THE INFLAMMATORY BOWEL DISEASES PHENOTYPE AND COURSE IN THE ELDERLY- AND EARLY-ONSET PATIENTS

It is unknown if clinical phenotype and course of the disease are comparable between early- and elderly-onset inflammatory bowel diseases (IBD). There is also an ongoing dispute on whether elderly-onset IBD is a separate entity. We aimed to seek differences in disease phenotype, course, complications, and treatment between early- and elderly-onset IBD patients.

The Incidence Rate and Risk Factors of Malignancy in Elderly-Onset Inflammatory Bowel Disease: A Chinese Cohort Study From 1998 to 2020.

BackgroundPatients suffering from inflammatory bowel disease (IBD) have an increased risk of cancer. However, the risk of malignancy in patients with elderly-onset IBD (≥60 years) remains controversial. Hence, we aimed to identify and compare the dissimilarities in morbidity and related risk factors between patients with elderly-onset and adult-onset (18–59 years) IBD in a Chinese cohort.MethodsPatients with confirmed IBD, diagnosed at age ≥18 years, between January 1998 and December 2020 at the Peking Union Medical College Hospital were enrolled. The yearly incidence rates (IRs) for cancer were calculated, and the characteristics were analyzed in these patients.ResultsA total of 1,480 patients suffering from adult-onset IBD and 129 patients suffering from elderly-onset IBD with a median follow-up period of 4.9 years and 4.8 years, respectively, were included. Patients in the elderly-onset IBD group demonstrated an increased overall incidence of cancer than that demonstrated by patients in the adult-onset group (IR 26.9 versus 9.51, respectively, per 1,000 person-years; relative risk [RR], 2.83). Colorectal cancer was the most common malignancy in the two groups, and patients suffering from elderly-onset IBD demonstrated a higher incidence of the malignancy (IR, 7.07 versus 3.34, respectively, per 1,000 person-years; RR, 2.12). Among the extraintestinal cancers, hematological malignancies and urinary tract cancers (including renal and urinary bladder carcinoma) were common in the elderly-onset group (IR, 4.24 and 4.24 per 1,000 person-years, respectively), whereas thyroid cancer was more common in the adult-onset group (IR, 1.36 per 1,000 person-years). Analysis of clinical characteristics revealed that patients with elderly-onset IBD who developed cancer were more likely to have diabetes and urinary lithiasis (p = 0.041 and 0.035, respectively). In addition, patients in the elderly-onset group had a shorter course from IBD to cancer, less exposure to immunosuppressants, less extraintestinal manifestations, and higher cancer-related mortality. Cox proportional risk regression analysis in the elderly-onset IBD group revealed that diabetes was an independent risk factor for the progression to cancer (hazard ratio [HR], 12.53 [2.379–65.994], P = 0.003).ConclusionThe risk of malignancy in patients suffering from elderly-onset IBD increased significantly as compared with those with adult-onset disease. Therefore, cancer monitoring should be initiated earlier for patients in the elderly-onset group.

Adult-onset inflammatory bowel disease and rate of serious infections compared to the general population: a nationwide register-based cohort study 2002–2017

Objectives To investigate absolute and relative risk of serious infections in adult/elderly inflammatory bowel disease (IBD) diagnosed 2002–2017. Methods Nationwide, register-based cohort study of Swedish patients with IBD compared with general population matched reference individuals with regard to time to first serious infection, equal to hospital admission. Multivariable Cox regression estimated hazard ratios (HRs) for any serious infection. Secondary outcomes included site-specific infections, opportunistic infections and sepsis. Results We identified 47 798 individuals with IBD. During a follow-up of 329 000 person-years, they had 8752 first serious infections (26.6 per 1000 person-years). This compared with an incidence rate of 10.7 per 1000 person-years in matched reference individuals, corresponding to a 2.53-fold increased hazard of serious infections (95%CI = 2.47–2.59). The HR for serious infection in elderly-onset IBD was 2.01 (95%CI = 1.95–2.08). The relative hazard of serious infection was somewhat higher in Crohn’s disease (2.94; 95%CI = 2.81–3.06) than in ulcerative colitis (2.24; 95%CI = 2.17–2.31). The HR for serious infections was high in the first year of follow-up (5.17; 95%CI = 4.93–5.42). Individuals with IBD were at a particularly high relative hazard of gastrointestinal and opportunistic infections. The HR for sepsis was 2.47 (95%CI = 2.32–2.63). The relative rates for serious infections in IBD increased in recent years. Conclusions Patients with adult-onset IBD are at increased risk of serious infections, particularly gastrointestinal and opportunistic infections. Relative rates were highest just after IBD diagnosis, and seem to have increased in recent years.

P640 Characteristics of elderly onset Inflammatory Bowel Disease in a cohort of Hispanics

Abstract Background The incidence and prevalence of elderly-onset Inflammatory Bowel Disease (EO-IBD), defined as diagnosed >60 y/o, is increasing. The natural history of this cohort is unclear. Disease behavior in elderly patients may differ between adult onset IBD (AO-IBD) and EO-IBD. Comorbidities, age-related frailty and side effects of medications are challenges. We compare a cohort of Hispanic EO-IBD and elderly AO-IBD patients in the IBD Registry, a database collecting demographic and medical data of patients since 1995. Methods Of 1345 subjects,122 were ≥60 y/o at recruitment, including AO and EO subjects. Variables included age at diagnosis, gender, IBD type, family history of ulcerative colitis (UC) and Crohn’s disease (CD), disease extent, extraintestinal manifestations (EIM), surgery, and medications. Descriptive statistics were calculated for interval and ratio variables. Frequencies and percentages were calculated for nominal variables cross-tabulated by age of diagnosis. The study is approved by the IRB. Results Of the 122 subjects, 59 (48.4%) had AO-IBD and 63 (51.6%) EO-IBD. Mean age of diagnosis was 49.6 y/o for the AO group and 66.4 y/o for the EO group, disease duration was 15.37 yr for AO and 3.73 yr for EO (P<.001). Female gender was more frequent (52.5%: AO, 55.6%: EO-IBD). Most were non-smokers (AO: 57.6%, EO:54%). UC was more common (AO: 62.7%, EO: 60.3%). Family history of CD was low (AO: 6.8%, EO: 6.4%), while family history of UC was more frequent in AO-IBD (18.6% vs 12.7 % in EO-IBD). Small bowel CD was the most frequent (48%) in both groups. UC extension was most commonly pancolitis (AO:58%, EO: 41%. Corticosteroid and biologic use were higher in AO-IBD (see table). EIMs were reported by 41% of AO and 27% of EO, the most frequent was joint involvement (17% AO and 16% EO). Cancer was reported in 3.4% of AO-IBD and 1.6% of EO-IBD. Osteoporosis was reported on 14% of AO-IBD and only 2% in EO-IBD. Surgery was more frequent in the AO group, 41% (n = 24) vs 24% (n = 15) in EO. Conclusion Baseline characteristics, disease location and behavior were similar in AO and EO IBD groups. Use of corticosteroids, biologics and surgery were less frequent in the EO-IBD group (not significant). Whether these findings are related to a shorter disease duration, less severe disease or a more conservative management dictated by age and co-morbidities needs to be explored. Selecting the appropriate treatment option for elderly individuals is an important clinical issue.

Treatment of Inflammatory Bowel Disease in Elderly Patients - What Are Different and What Should We Know?

As the incidence of inflammatory bowel disease (IBD) are increasing with an ageing population, the incidence and prevalence of IBD in the elderly continue to increase. Older IBD patients can be classified into two groups; elderly-onset IBD patients and elderly IBD patients who were diagnosed at a young age and transitioning into advanced age. Clinicians must consider elderly-onset specific phenotypes or prognosis and age-related concerns in the treatment of elderly IBD patients. There is a paucity of evidence whether there is a different disease process when IBD occurs in older age yet. Clinicians may expect similar therapeutic effects in older and younger patients in drug selection, but since older patients are often excluded from clinical trials, evidence to support this assumption is currently lacking. Also, the risk of side effects may be higher in elderly patients. Therefore, when making management decisions in the elderly, clinicians should assess an individual's frailty rather than only considering an individual's chronological and biological age. Knowing specific requirements for managing older IBD patients may help to make an appropriate therapeutic strategy for this patient group.

Advanced therapies in inflammatory bowel disease: Special considerations.

Advanced therapies in inflammatory bowel disease: Special considerations.

Age at Diagnosis Is Determinant for the Outcome of Inflammatory Bowel Disease: Is It a Myth?

INTRODUCTION:Patients with elderly-onset inflammatory bowel disease were previously associated with a less aggressive course of the disease. However, there are conflicting data that need further validation. We aimed to determine the association between age at diagnosis and the development of progressive disease in patients with Crohn's disease (CD) and ulcerative colitis (UC).METHODS:This cohort study included patients with CD and UC followed in 6 secondary and tertiary care centers in mainland Portugal. Patients were divided into a derivation (80%) cohort and a validation (20%) cohort. The primary outcome was progressive disease. Logistic regression analysis, receiver operating characteristic curves, and the areas under the curve (AUC) were performed. Odds ratios with 95% confidence intervals (CIs) were estimated.RESULTS:The derivation cohorts included 1245 patients with CD (68% with progressive disease) and 1210 patients with UC (37% with progressive disease), whereas the validation cohorts included 302 patients with CD and 271 patients with UC, respectively, with similar outcome proportions. In our final model, age at diagnosis older than 60 years was significantly associated with a lower risk of developing progressive disease (odds ratio 0.390, 95% CI 0.164–0.923, P = 0.032), with a high discriminative power (AUC 0.724, 95% CI 0.693–754) in patients with CD. However, according to this model, no significant associations were found between age at diagnosis and the risk of developing progressive disease in patients with UC. No differences were observed in the AUC values between the validation and the derivation cohorts.DISCUSSION:Patients with elderly-onset CD, but not patients with UC, were associated with a less progressive course of the disease.

The elderly IBD patient in the modern era: changing paradigms in risk stratification and therapeutic management.

The incidence and prevalence of inflammatory bowel disease (IBD) is rising in the elderly population. Compared with patients with onset during their younger years, patients with elderly onset IBD have a distinct clinical presentation, disease phenotype, and natural history. Genetics contribute less to pathogenesis of disease, whereas biological changes associated with aging including immunosenescence, dysbiosis, and frailty have a greater impact on disease outcomes. With the advent of an increasingly wider array of biologic and small-molecule therapeutic options, data regarding efficacy and safety of these agents in elderly IBD patients specifically are paramount, given the unique characteristics of this population.

Disease- and Treatment-related Complications in Older Patients With Inflammatory Bowel Diseases: Comparison of Adult-onset vs Elderly-onset Disease.

The incidence and prevalence of inflammatory bowel diseases (IBD) in older adults are rising. There is a limited comparative assessment of risk of disease- and treatment-related complications in older patients (older than 60 years) with adult-onset (age at disease onset, 18-59 years; AO-IBD) vs elderly-onset IBD (age at disease onset, older than 60 years; EO-IBD). We compared clinical outcomes in older patients with IBD with AO-IBD vs EO-IBD. We conducted a retrospective cohort study comparing risk of disease-related complications (IBD-related surgery, hospitalization, treatment escalation, clinical flare, or disease complication) and treatment-related complications (serious infection, malignancy, or death) in older patients with AO-IBD vs EO-IBD through Cox proportional hazard analysis, adjusting for age at cohort entry, disease phenotype, disease duration, prior surgery and/or hospitalization, medication use, disease activity at cohort entry, and comorbidities. We included 356 older patients with IBD (AO-IBD, 191 patients, 67 ± 5 y at cohort entry; EO-IBD, 165 patients, 72 ± 8 y at cohort entry). No significant differences were observed in the risk of disease-related complications in older patients with prevalent vs incident IBD (adjusted hazard ratio [aHR], 0.85; 95% CI, 0.58-1.25), although risk of IBD-related surgery was lower in older patients with prevalent IBD (aHR, 0.47; 95% CI, 0.25-0.89). Older patients with prevalent IBD were significantly less likely to experience treatment-related complications (aHR, 0.58; 95% CI, 0.39-0.87). Patients with AO-IBD have lower risk of treatment-related complications as they age compared with patients with EO-IBD, without a significant difference in risk of disease-related complications.

Progression of Elderly Onset Inflammatory Bowel Diseases: A Systematic Review and Meta-Analysis of Population-Based Cohort Studies

The incidence of inflammatory bowel diseases (IBDs) in older adults is increasing. We performed a systematic review and meta-analysis to evaluate progression of elderly onset (EO) IBD in population-based cohorts and compared it with adult onset (AO) IBD. In a systematic review through June 1, 2019, we identified population-based cohort studies of EO IBD reporting the cumulative risk of hospitalization, surgery, mortality, treatment patterns, escalation, and/or malignancy. Data were synthesized using random-effects meta-analysis as cumulative risk of events at 1 year, 5 years, and 10 years, and compared with data from patients with AO IBD in the same cohorts. We identified 9 studies, comprising 14,765 patients with EO IBD. In patients with EO Crohn's disease (CD), the cumulative 5-year risk of surgery was 22.6% (95% CI, 18.7-27.2) and was similar to that of patients with AO CD (relative risk [RR], 1.04; 95% CI, 0.80-1.34). Overall exposure to corticosteroids was comparable between patients with EO CD vs AO CD (5-year risk: 55.4%; 95% CI, 53.4-57.4; RR, 0.88; 95% CI, 0.78-1.00), but exposure to immunomodulators (31.5%; 95% CI, 29.7-33.4; RR, 0.62; 95% CI, 0.51-0.77) or biologic agents (6.5%; 95% CI, 5.6-7.6; RR, 0.36; 95% CI, 0.25-0.52) was significantly lower for patients with EO CD than for patients with AO CD. Similarly, in patients with EO ulcerative colitis (UC), the cumulative 5-year risk of surgery was 7.8% (95% CI, 5.0-12.0), similar to the risk for patients with AO UC (RR, 1.29; 95% CI, 0.79-2.11). Overall exposure to corticosteroids was comparable between patients with EO UC vs AO UC (5-year risk: 57.2%; 95% CI, 55.6-58.7; RR, 0.98; 95% CI, 0.91-1.06), but exposure to immunomodulators (16.1%; 95% CI, 15.0-17.2; RR, 0.58; 95% CI, 0.54-0.62) or biologic agents (2.0%; 95% CI, 1.6-2.5; RR, 0.36; 95% CI, 0.24-0.52) was significantly lower for patients with EO UC than for patients with AO UC. Patients with EO IBD appeared to have increased mortality, but not malignancy, compared with the general population. There were few data on comorbidities or adverse effects of medications. In a systematic review and meta-analysis, we found that patients with EO IBD have a similar risk of surgery as patients with AO IBD. However, patients with EO IBD are less likely to receive treatment with immunomodulators or biologic agents.

Variation in care of patients with elderly-onset inflammatory bowel disease in Ontario, Canada: A population-based cohort study.

BackgroundVariation in health care, when not based on patient preference, may result in poorer care. We determined whether variation in health services utilization, gastroenterologist care and outcomes existed among patients with elderly-onset inflammatory bowel disease (IBD).MethodsPatients with IBD (diagnosed ≥65 years) were identified from population-based health administrative data from Ontario, Canada (1999 to 2014). We assessed variation across multispecialty physician networks in gastroenterologist care and outcomes using multilevel logistic regression. Median odds ratios (MOR) described variation. We evaluated the association between gastroenterologist supply, specialist care and outcomes.ResultsIn 4806 patients, there was significant variation in having ever seen a gastroenterologist (MOR 3.35, P < 0.0001), having a gastroenterologist as the primary IBD care provider (MOR 4.16, P < 0.0001), 5-year colectomy risk in ulcerative colitis (MOR 1.38, P = 0.01), immunomodulator use (MOR 1.47, P = 0.001), and corticosteroid use (MOR 1.26, P = 0.006). No variation in emergency department visits, hospitalizations or intestinal resection (Crohn’s) was noted. Patients in networks with fewer gastroenterologists were less likely to see a gastroenterologist (odds ratio [OR] 0.29, 95% confidence interval [CI] 0.15 to 0.56), have a gastroenterologist as their primary care provider (OR 0.27, 95% CI 0.12 to 0.59), be hospitalized within 5 years (OR 0.82, 95% CI 0.69 to 0.98), and be prescribed biologics within 1 year (OR 0.50, 95% CI 0.28 to 0.89).ConclusionsUtilization of gastroenterology care in patients with elderly-onset IBD varies greatly. Patients treated by gastroenterologists and in networks with more gastroenterologists have better outcomes. There is a need to ensure all individuals with IBD have equal access to and utilization of specialist care to ensure the best possible outcomes.

P239 Elderly-onset inflammatory bowel disease is associated with higher risks of infections, cancers and hospitalisation: Results from a territory-wide Hong Kong IBD registry

Abstract Background Incidence of elderly-onset inflammatory bowel disease (IBD), defined as age ≥ 60 at diagnosis, is increasing rapidly worldwide. We aimed to compare the clinical characteristics and natural history of elderly onset IBD patients to non-elderly onset IBD patients. Methods Patients with a confirmed diagnosis of IBD from 1981 to 2016 were identified from a territory-wide Hong Kong IBD registry involving 13 hospitals. Demographics, comorbidities, clinical features and outcomes of elderly-onset IBD patients were compared with non-elderly onset IBD patients. Results Total 2413 patients were identified, of whom 270 (11.2%) had elderly-onset IBD during 21805 person-years follow-up. Median follow-up duration was 111 months (Interquartile range [IQR]: 68–165 months). The ratio of ulcerative colitis (UC): Crohn’s disease (CD) was higher in elderly-onset IBD than non-elderly onset IBD patients. (3.82:1 vs. 1.39:1; p &amp;lt; 0.001). Elderly-onset Crohn’s disease (CD) had less perianal involvement (5.4% vs. 25.4%; p &amp;lt; .001) but more stricturing phenotype (32.1% vs. 20.5%; p = 0.04) than non-elderly onset. There was no difference in the rate of cumulative use of biologics (p = 0.49), but significantly lower use of immunosuppressants in elderly-onset IBD patients (p = 0.001). Cumulative risk of IBD-related surgeries was similar (p = 0.89). Elderly-onset IBD was associated with higher risks of cytomegalovirus colitis (Odds ratio [OR]: 3.07; 95% Confidence Interval (CI) 1.92–4.89; p &amp;lt; 0.001); herpes zoster infections (OR: 2.42; 95% CI: 1.22–4.80; p = 0.12) and all cancer development (Hazard ratio: 2.97; 95% CI: 1.84–4.79; p &amp;lt; 0.001). Elderly-onset IBD was also associated with increased number of overall hospitalisation (OR: 1.14; 95% CI 1.09–1.20; p &amp;lt; 0.001), increased number of infections-related hospitalisation (OR: 1.87; 95% CI 1.47–2.38; p &amp;lt; 0.001) and longer hospitalisation (OR: 1.004; 95% CI: 1.001- 1.007; p = 0.007) compared with non-elderly onset IBD. Conclusion Elderly-onset IBD has less perianal CD. However, they have significantly more comorbidities and are associated with increased risk of infections, cancer development and increased and prolonged hospitalisations. Specific therapeutic strategies are needed in this special group of patients.

P740 Age determines the risk of familial IBD: A nationwide case–control study

Abstract Background A family history of inflammatory bowel disease (IBD) is a proxy for an individual’s genetic and, in part, environmental risk of developing IBD, and is one of the strongest known risk factors for developing IBD. Although a familial aggregation is a well-established concept, data on its strength and nature are sparse. Therefore, to provide precise estimates of the familial aggregation, we performed a nation-wide, case-control study and examined the relative risk for patients with IBD (vs. population controls) to have a first-degree relative (FDR) with IBD, by age of onset, type of family history, and IBD subtype. Methods Individuals diagnosed with IBD between 1 January 2003 and 31 December 2017 with at least one first degree relative (FDR) were identified from Swedish national registers and compared with non-IBD controls, with at least one FDR, from the general population. We used logistic regression to calculate odds ratios (ORs) as estimates of relative risk for IBD in FDRs taking age at IBD onset, sex, county, and year of IBD diagnosis into account. Results We identified 50,667 incident cases with IBD (CD, n = 14,927; UC, n = 27,221 and IBD-U, n = 8519) and 506,720 controls, matched for age, sex, birth year and county of residence. The overall familial relative risk estimate of IBD for siblings (OR 3.6 [95% CI 3.4–3.8]) was similar to that between generations (OR 3.5 [95% CI 3.3–3.7] for mothers and OR 3.5 [95% CI 3.3–3.7] for fathers). Half-siblings conferred a lower yet elevated relative risk (OR 2.0 [95% 1.8–2.2]). The familial relative risk estimates of IBD increased with number of affected FDRs (Figure 1). Pronounced differences were seen between subtypes of IBD in the index case and also across age of onset in the index case and in the FDR (Figure 2). Lowest odds ratios were seen for having an FDR with elderly onset IBD among cases who were diagnosed with elderly onset Crohn’s disease (OR 1.9 [95% CI 1.4–2.5]) or ulcerative colitis (OR 1.9 [95% CI 1.5–2.3]). Highest odds ratios were seen for having an FDR with paediatric onset IBD among cases who were diagnosed with paediatric Crohn’s disease (OR 10.6 [95% CI 8.2–13.5]) or paediatric ulcerative colitis (OR 8.4 [95% CI 6.4–10.9]). Conclusion The relative risk of familial IBD varies by IBD subtype as well as by age of onset in the index patient with IBD and the FDR, pointing to differences in genetic predisposition and environmental risks between different phenotypes of IBD.

206 – Increased Emergency Department Visits and Hospitalizations for Infectious Diseases in Patients with Elderly-Onset Inflammatory Bowel Disease: A Population-Based Matched Cohort Study

206 – Increased Emergency Department Visits and Hospitalizations for Infectious Diseases in Patients with Elderly-Onset Inflammatory Bowel Disease: A Population-Based Matched Cohort Study

207 – Increased Incidence of Malignancy in Patients with Elderly-Onset Inflammatory Bowel Disease: A Population-Based Matched Cohort Study

207 – Increased Incidence of Malignancy in Patients with Elderly-Onset Inflammatory Bowel Disease: A Population-Based Matched Cohort Study