Elderly-onset Ulcerative Colitis Research Articles

Frailty risk and treatment strategy in elderly-onset inflammatory bowel disease. A Norwegian nationwide population-based registry study

Background/AimsTo determine real-world medical and surgical treatment patterns in elderly-onset inflammatory bowel disease in a nationwide cohort, and to investigate associations between frailty and treatment choices. MethodsNorwegian health registries were used to identify adult-onset (born 1950–1989) and elderly-onset (born 1910–1949) patients with Crohn's disease (CD) and ulcerative colitis (UC) diagnosed 2010–2017 (n = 13,006). Patients were classified as no, low and intermediate/high frailty risk after the Hospital Frailty Risk Score. Outcomes included use of medical and surgical treatment. ResultsWithin five years, elderly-onset patients received less biologics (13% [CD], 7% [UC]) and immunomodulators (24% [CD], 11% [UC]), and major surgery was more frequent (22% [CD], 9% [UC]) than in adult-onset. Respective log rank tests were significant (p < 0.01). Compared to no frailty risk groups, elderly-onset UC with intermediate/high frailty risk had lower probability of starting biologics (4% versus 9%), immunomodulators (7% versus 13%) and 5-aminosalisylic acids (66% versus 84%), and elderly-onset CD with intermediate/high frailty risk had higher probability of starting prednisolone (67% versus 49%). Respective log rank tests were significant (p < 0.05). ConclusionsElderly-onset patients received less biologics and immunomodulators and a larger proportion underwent major surgery. Frailty risk in elderly-onset patients was associated with increased use of prednisolone, and less use of 5-aminosalisylic acids, immunomodulators and biologics.

Frailty and pre-frailty with long-term risk of elderly-onset inflammatory bowel disease: A large-scale prospective cohort study

PurposeTo investigate the prospective association of frailty status with the long-term risk of elderly-onset IBD in a large prospective cohort. MethodsParticipants free of IBD and cancer at enrollment from the UK Biobank cohort were included. Baseline pre-frail and frail status was measured by Fried phenotype including weight loss, exhaustion, low grip strength, low physical activity and slow walking pace, defined as meeting one or two criteria and meeting three or more criteria. Primary outcome was elderly-onset IBD, including elderly-onset ulcerative colitis (UC) and Crohn’s disease (CD). Multivariable Cox regression was conducted to examine the related associations. ResultsOverall, 417,253 participants (aged 56.18 ± 8.09 years) were included. Of whom, 19,243 (4.6 %) and 188,219 (45.1 %) were considered frail and pre-frail, respectively. During a median of 12.4 years follow-up, 1503 elderly-onset IBD cases (1001 UC, 413 CD, and 89 IBD-Unclassified) were identified. Compared with non-frail, individuals with frail (HR=1.40, 95 %CI: 1.13–1.73) and pre-frail (HR=1.15, 1.03–1.28) showed significantly higher risk of elderly-onset IBD after multivariable adjustment (Ptrend<0.001). The positive association was more evident regarding risk of elderly-onset CD (HR=2.16, 1.49–3.13 for frail; HR=1.49,1.20–1.85 for pre-frail; Ptrend<0.001). Sensitivity analyses and subgroup analyses according to age, gender and body mass index (BMI) demonstrated similar results. ConclusionsFrailty and pre-frailty are associated with increased risk of elderly-onset IBD, particularly elderly-onset CD.

Comparison of Disease Phenotype and Course among Elderly- and Early-Onset Inflammatory Bowel Diseases in the Middle East.

It is unknown if the clinical manifestations and phenotype of disease are comparable between early- and elderly-onset inflammatory bowel disease (IBD). We aimed to seek differences in disease phenotype, course, complications, and treatment between early- and elderly-onset IBD patients. This retrospective cohort study on registered IBD patients in the Iranian Registry of Crohn's and Colitis (IRCC) compared demographics, disease phenotype, disease activity, IBD-related surgery and medications between early- and elderly-onset IBD. A generalized linear regression model was used to investigate the relative risk of age at diagnosis adjusted for gender and disease duration for the outcomes. From 10048 IBD patients, 749 with early-onset (7.5%), and 472 (4.7%) elderly-onset IBD were enrolled: 855 (63.1%) ulcerative colitis (UC) and 366 (26.9%) Crohn's disease (CD). Left-sided colitis was more frequent among elderly-onset UC patients (P<0.001). Ileum and ileocolonic locations were the most common types in elderly-onset and early-onset CD patients, respectively. In comparison with elderly-onset UC, early-onset cases more often used prednisolone (22.1% vs. 11.4%, P=0.001), immunomodulators (44.9% vs 25.2%, P<0.001) and anti-tumor necrosis factors (TNF) (20.1% vs 11.9%, P=0.002). Elderly-onset UC patients had 0.7 times lower risk of aggressive phenotype (95%CI:0.6‒0.9, P=0.005). Early-onset CD was associated with higher use of prednisolone (27.7% vs 8.1%, P<0.001), immunomodulators (58.7% vs 41.8%, P=0.005) and anti-TNF (49.6% vs 35.4%, P=0.006). Early-onset IBD was associated with a more aggressive phenotype and higher prednisolone, immunomodulators, and anti-TNF use.

Prevalence and Outcomes of No Treatment Versus 5-ASA in Ulcerative Colitis: A Nationwide Analysis From the epi-IIRN.

Data regarding patients with ulcerative colitis (UC) not receiving maintenance treatment are scarce. In this nationwide study, we aimed to explore the frequency and long-term outcomes of untreated patients with UC vs treated patients. We retrieved data from Israel's Health Maintenance Organizations, covering 98% of the population. No maintenance treatment (NMT) was defined as lack of treatment during the period from 3 to 6 months from diagnosis, allowing at most 3 months for induction treatment. A total of 15 111 patients have been diagnosed with UC since 2005, of whom 4410 (29%) have had NMT, with 36 794 person-years of follow-up. NMT was more likely in adults (31%) and in elderly-onset UC (29%) than in pediatric-onset UC (20%; P < .001) and decreased from 38% in 2005 to 18% in 2019 (P < .001). The probability of remaining without treatment was 78%, 49%, and 37% after 1, 3, and 5 years from diagnosis, respectively. In propensity score-matched analysis of 1080 pairs of treated (93% with 5-aminosalicylic acid) and untreated patients, outcomes were comparable for time to biologics (P = .6), surgery (P = .8), steroid dependency (P = .09), and hospitalizations (P = .2). Multivariable modeling indicated that failing NMT was less likely in adults or elderly-onset patients who received at most rectal therapy or antibiotics as induction therapy. Nowadays, 18% of patients with UC do not receive maintenance therapy, of whom half remain without treatment after 3 years. Matched pairs of patients on NMT and 5-aminosalicylic acid, representing the mildest patients of the latter, had similar outcomes. Prospective studies are needed to further explore the role of NMT in UC.

Clinical results following colonic resection for ulcerative colitis in elderly individuals (elderly-onset vs. nonelderly onset)

BackgroundThe incidence of ulcerative colitis (UC) is increasing, but there are few reports comparing elderly UC patients undergoing colectomy for elderly-onset UC (EO) and nonelderly-onset UC (NEO). The aim of this study was to analyze the differences between EO and NEO patients who underwent UC-related surgery.MethodsWe identified 1973 patients with UC who underwent colectomy at Hyogo College of Medicine between January 1, 1984, and December 31, 2018. Only patients aged 65 years old and older who underwent colectomy were enrolled in this study (n = 221, 11.2%), and their clinical records were retrospectively reviewed. Patients were divided into two groups according to their age at disease onset: those with onset at younger than 60 years old (NEO) and at 60 years old or older (EO).ResultsIn the 221 UC patients who underwent colectomy at 65 years old or older, there were 155 cases of EO and 66 cases of NEO. The main surgical indication in NEO patients was colitis-associated cancer/dysplasia (32/66, 47%). In contrast, refractory to medical treatment was the leading cause of surgery in EO patients (80/155, 52%). The distributions of surgical indications were different between the two groups (p < 0.01). The preoperative daily dose of steroids was significantly higher in the EO group than in the NEOgroup (0 mg vs. 10 mg, p < 0.01). The rates of immunosuppressant, infliximab (IFX) and adalimumab use did not differ significantly between the groups. Significantly more patients underwent emergency surgery in the EO group than in the NEO group (14% vs. 35%, p < 0.01). The proportions of patients with postoperative morbidity (Clavien-Dindo grade III or higher) were 17.4% (27/155) in the EO group and 13.6% (9/66) in the NEO group. There was no significant difference between the two groups (p = 0.48). The prognosis of the EO patients who underwent UC-related emergency surgery was worse than that of the NEO patients (p < 0.01). In the EO group, 8 (14.8%) of 54 patients died within 30 postoperative days, while there were no deaths in the NEO group.ConclusionAmong elderly UC patients undergoing UC-related surgery, EO patients undergoing emergency surgery had very poor outcomes, and the mortality rate was 14.8%. In such cases, it is important for physicians and surgeons to begin communication at an early stage so that the optimal surgical timeframe is not missed.

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 &amp;lt;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&amp;lt;0.001). Early-onset IBD cases had a higher prevalence of extraintestinal manifestations (p&amp;lt;0.001). Early-onset UC cases more often used prednisolone (p=0.031), immunomodulators (p&amp;lt;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&amp;lt;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.

Clinical Characteristics and Long-term Prognosis of Elderly-Onset Ulcerative Colitis in a Population-Based Cohort in the Songpa-Kangdong District of Seoul, Korea.

Background/AimsWe aimed to evaluate the clinical characteristics and long-term prognosis of elderly-onset ulcerative colitis (EOUC) in Korean patients over a 30-year period using a well-established population-based cohort in the Songpa-Kangdong district of Seoul, Korea.MethodsClinical characteristics and prognosis were compared between two groups EOUC, defined as UC diagnosed in individuals aged ≥60 years and non-EOUC (N-EOUC), defined as UC diagnosed in individuals aged 18 to 59 years.ResultsWe identified 99 patients with EOUC (10.3%) and 866 patients with N-EOUC (89.7%) between 1986 and 2015. During the median follow-up of 104.5 months, the overall exposure to medications was comparable between patients with EOUC and N-EOUC (p=0.091 for corticosteroids, p=0.794 for thiopurines, and p=0.095 for anti-tumor necrosis factor agents). The cumulative risks of disease outcomes were also comparable between patients with EOUC and N-EOUC (22.4% vs 30.4% for proximal disease extension [p=0.351], 11.9% vs 18.1% for hospitalization [p=0.240], and 2.3% vs 1.8% for colectomy [p=0.977]) at 10 years after diagnosis. Multivariate Cox regression analysis revealed that corticosteroid use at diagnosis was an independent predictor of proximal disease extension (hazard ratio [HR], 6.216; 95% confidence interval [CI], 1.314 to 28.826) and hospitalization (HR, 11.241; 95% CI, 3.027 to 41.742) in patients with EOUC.ConclusionsIn this population-based study from Korea, the pattern of medication use seemed comparable between the EOUC and N-EOUC groups. Moreover, patients with EOUC and those with N-EOUC have a similar disease course in terms of proximal disease extension, hospitalization, and colectomy. (Gut Liver 2021;15-751)

Characteristics and management of elderly-onset ulcerative colitis

Characteristics and management of elderly-onset ulcerative colitis

Relation of geriatric nutritional risk index with clinical risks in elderly-onset ulcerative colitis.

Worldwide increasing aging societies have many elderlies with intractable diseases including ulcerative colitis (UC). Reportedly, each patients' frailty as well as chronological age is a clinical risk factor of elderly-onset UC (EOUC). Because malnutrition is one of the major manifestations of frailty, we aimed to investigate the effect of malnutrition on the prognosis of EOUC with geriatric nutritional risk index (GNRI), a prognostic tool for several diseases in the elderly to estimate malnutrition, and to evaluate clinical risks among EOUC patients in Japan, the world-leading aging society. The EOUC patients (≥65years at diagnosis, n=2778) in the previous nationwide survey were classified by age and GNRI, and odds ratios (ORs) of hospitalization and UC-related surgery were determined to evaluate the effects of malnutrition on the EOUC patients as well as aging. The risks of hospitalization and surgery were elevated as age advanced. The value of GNRI, negatively correlated with disease activity (r=-0.53), could distinguish severe activity (cutoff≤86.82, sensitivity=0.79, and specificity=0.77) and discriminate the EOUC patients suffering from surgery and hospitalization. In a multivariate analysis, GNRI≤86.82 was a higher risk of hospitalization (OR: 4.0, 95% CI, 2.5-6.5) and surgery (OR: 2.7, 95% CI, 0.98-7.4) than cutoff age≥75years old (OR of hospitalization and surgery were 1.4 [95% CI, 0.99-2.0] and 2.3 [95% CI, 0.8-6.3], respectively). Malnutrition estimated by GNRI was significantly related with poor clinical courses of the EOUC patients, suggesting that evaluation of nutritional status at the onset might be useful for predicting risks of clinical courses.

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.

Mortality in Elderly Onset Ulcerative Colitis: A Population-Based Cohort Study

Introduction: Elderly-onset inflammatory bowel disease (IBD) composes up to 20% of new cases of IBD, and ulcerative colitis (UC) is up to twice as common as Crohn's disease (CD) among the elderly. Some, but not all, studies have shown a modest increase in mortality among all patients with IBD. To our knowledge, no studies have evaluated the long-term mortality among patients with elderly-onset UC in the United States. Methods: We conducted a retrospective cohort study to evaluate the all-cause mortality and survival among patients with elderly-onset UC vs. non-IBD patients in the US National VA health care system from January 1, 2000 to June 30, 2016 using data from the VA Informatics and Computing Infrastructure. We included individuals with new-onset UC in the exposure group (UC group) if they met the following conditions: 1) ≥2 UC diagnoses and no diagnoses of CD or other diseases of the anus/rectum; 2) age>60 at the time of first UC diagnosis; 3) ≥1 year of pre-diagnosis VA care; 4) ≥5 VA visits prior to UC diagnosis 5) ≥ 4 pharmacy claims for aminosalicylates. For each elderly-onset UC patient, up to 4 non-IBD veterans were selected, matching on: 1) date of birth; 2) first VA visit; 3) VA location and 4) gender. Time to death was the outcome of interest. We estimated the incidence rate of death in the exposed and unexposed groups, respectively. Cox regression was used to determine the hazard ratio for time to death associated with elderly-onset UC. Results: The mean age was 70.7 (SD 7.4) years among the UC group and 70.3 (SD 7.4) in the non-IBD group. As expected, there was male predominance in the groups (97.6%). Elderly-onset UC patients had worse survival compared to matched non-IBD patients (Figure, log-rank test p value<0.0001). The incidence rate of death after UC diagnosis among the exposed group (N= 4,327) was 106.8 deaths per 1000 patient-years (95% CI 106.7 - 106.9) compared with 74.5 (95% CI 74.5- 74.6) in the matched non-IBD comparison group (N= 17,164). Compared with the non-IBD group, the hazard ratio for death associated with elderly-onset UC was 1.49 (95% CI: 1.42 - 1.55). Conclusion: We report a novel population-based mortality rate among elderly-onset UC patients. In addition, we observed that elderly-onset UC is associated with significantly increased risk of mortality compared to an age and sex matched non-IBD population. These prognostic data would be of great interest to patients and health policy makers.576 Figure 1. Death after UC Diagnosis vs. Matched Date in UC and non-IBD cohorts.

Impact of age at diagnosis on natural history of patients with elderly-onset ulcerative colitis: A French population-based study

BackgroundRecent population-based study of elderly-onset Crohn’s disease patients reported age-related differences in disease phenotype and outcome. AimsThe aim was to assess the impact of age at diagnosis on natural history of elderly-onset ulcerative colitis patients with emphasis on disease presentation, phenotype and treatment. MethodsElderly-onset patients with ulcerative colitis (≥60 years at diagnosis) registered in a French population-based Registry EPIMAD (1988–2006) were included. Demographic and clinical data at diagnosis and at maximal follow-up were collected using predefined questionnaire. ResultsFour-hundred and sixty-five elderly-onset ulcerative colitis patients were included (median follow-up 6.2 years); 276 (59%) were <70 and 189 (41%) ≥70 years at diagnosis. Patients aged <70 years presented with more rectal bleeding (86% vs. 79%, p = .06) and abdominal pain (44% vs. 34%, p = .04) while those ≥70 years had higher rate of left-sided colitis (62% vs. 49%; p = .02). Cumulative exposure to 5-ASA, corticosteroids and immunosuppressants was similar between the groups as well as surgery rate. However, patients <70 years were significantly more steroid-resistant than older individuals (12% vs. 3%, p < .05) while no significant difference in steroid-dependency was observed. ConclusionPatients with elderly-onset ulcerative colitis differed in presentation, disease phenotype and response to medication with respect to age at diagnosis.

Clinical characteristics and long-term prognosis of elderly onset ulcerative colitis.

The aim of this study was to investigate the clinical characteristics and prognosis of patients with elderly onset ulcerative colitis (EOUC), a new growing subgroup of UC. This study retrospectively analyzed 3060 South Korean UC patients diagnosed between 1977 and 2014. The clinical characteristics and prognosis of EOUC, defined as UC in those aged ≥60years at diagnosis, were compared with those of non-EOUC (NEOUC). Among the 3060 patients, 226 were diagnosed with EOUC (7.4%, median age at diagnosis 65.9years [interquartile range, 62.9-68.7years], 58.4% male). The frequency of EOUC increased from 3.9% in the interval 1977-1999 to 9.7% in the interval 2008-2014 (P<0.001). There were more ex-smokers in the EOUC than in the NEOUC group (44.2% vs 19.9%, P<0.001). In the EOUC group, extensive colitis at diagnosis, and the maximum extent thereof, was less than in the NEOUC group (13.7% vs 22.6%, P=0.002, and 34.5% vs 42.5%, P=0.011, respectively). The 10-year cumulative colectomy rate was significantly higher in the EOUC than in the NEOUC group (12.6% vs 7.7%, P=0.015). UC-related and all-cause mortality were higher in the EOUC than in the NEOUC group (3.5% vs 0.6%, P<0.001, and 12.4% vs 1.8%, P<0.001, respectively). Elderly onset ulcerative colitis patients are likely to exhibit distinct features both at diagnosis and during follow-up. It is necessary to pay more attention to, and to conduct further studies on, this particular group of patients.

Extra-intestinal Manifestations at Diagnosis in Paediatric- and Elderly-onset Ulcerative Colitis are Associated With a More Severe Disease Outcome: A Population-based Study.

Data on extra-intestinal manifestations [EIM] and their impact on the disease course of ulcerative colitis [UC] in population-based cohorts are scarce, particularly in paediatric- and elderly-onset UC patients. The aims of this population-based study were to assess: 1] the occurrence of EIM in paediatric- and elderly-onset UC; 2] the factors associated with EIM; and 3] their impact on long-term disease outcome. Paediatric-onset [< 17 years at diagnosis] and elderly-onset UC patients [> 60 years at diagnosis] from a French prospective population-based registry [EPIMAD] were included. Data on EIM and other clinical factors at diagnosis and at maximal follow-up were collected. In all, 158 paediatric- and 470 elderly-onset patients were included [median age at diagnosis 14.5 and 68.8 years, median follow-up 11.2 and 6.2 years, respectively]. EIM occurred in 8.9% of childhood- and 3% of elderly-onset patients at diagnosis and in 16.7% and 2.2% of individuals during follow-up [p < 0.01], respectively. The most frequent EIM was joint involvement [15.8% of paediatric onset and 2.6% of elderly-onset]. Presence of EIM at diagnosis was associated with more severe disease course [need for immunosuppressants or biologic therapy or colectomy] in both paediatric- and elderly-onset UC (hazard ratio [HR] = 2.0, 95% confidence interval [CI]: 1.0-4.2; and HR = 2.8, 0.9-7.9, respectively). Extensive colitis was another independent risk factor in both age groups. Elderly-onset UC patients had lower risk of EIM either at diagnosis or during follow-up than paediatric-onset individuals. EIM at diagnosis predicted more severe disease outcome, including need for immunosuppressive or biologic therapy or surgery, in both paediatric- and elderly-onset UC.

Risk of Surgery and Mortality in Elderly-onset Inflammatory Bowel Disease: A Population-based Cohort Study.

As the prevalence of inflammatory bowel disease (IBD) increases in the elderly population, we sought to characterize IBD-related outcomes in this population. We identified incident IBD cases in Ontario, Canada between 1999 and 2008 and categorized subjects by age at diagnosis as young adults (18-40 yr); middle-age adults (41-64 yr); and elderly (≥65 yr) from within population-based health administrative data. We determined the risk of IBD-related surgery and mortality in those with elderly-onset IBD compared with other age groups. Of 21,218 persons with IBD, there were 1749 cases of elderly-onset ulcerative colitis (UC) and 725 cases elderly-onset Crohn's disease (CD). Elderly UC had higher rates of IBD-related surgery than those with young-adult UC (adjusted hazard ratio, 1.34; 95% CI, 1.16-1.55), although there was no difference in surgical rates between age groups in CD. IBD-specific mortality was higher in elderly-onset CD (33.1/10,000 person-year) compared with that in middle-age CD (5.6/10,000 person-year, P < 0.0001) and young adult CD (1.0/10,000 person-year) but was not different by age in UC. The leading cause of death in elderly UC and CD was solid malignancies accounting for 22.9% and 26.4% of deaths, respectively, whereas IBD was third most frequent cause of death accounting for 6.3% and 9.1% of deaths, respectively. Elderly-onset patients with UC were more likely to undergo surgery while elderly-onset patients with CD exhibited higher IBD-specific mortality than those with younger-onset disease. These findings should prompt more optimized disease management in elderly IBD.

P203 Factors associated with restless legs syndrome in patients with ulcerative colitis: a study in a tertiary care center in Romania

Background: Ulcerative colitis (UC) is a lifelong systemic multifactorial disease with a negative impact on health-related quality of life (HRQoL). Restless Legs Syndrome (RLS) as an extraintestinal manifestation of UC is not very common. This association has been investigated in a small number of studies but results remain controversial. The primary aim of the current study was to investigate the prevalence and association between RLS and UC. Methods: 120 subjects (man/female: 67/53, age at diagnosis: 39.3 years, SD: 16.2) with biopsy confirmed UC and 120 age and gender matched controls were included in this prospective single-center study. All patients with diabetes, peripheral neuropathy, renal failure and those who underwent treatment with antipsychotic drugs and antidepressants that increase serotonin were excluded from the study. Basic demographic data, clinical information and laboratory findings were collected and comprehensively reviewed. All subjects were prospectively evaluated using the International Restless Legs Syndrome Study Group criteria (IRLSSG). The IRLSSG ten-item severity scale was also used. Gender, age at diagnosis, family history, occupation, smoking status, caffeine intake, BMI, iron, vitamine B12, folate and hemoglobin levels were analyzed as potential impact factors. Results: Based on our findings, the prevalence of RLS in UC patients is 24.1% compared with 5% in the control group (p=0.001). Symptom severity in the RLS group (according to the IRLSSG rating scale) was mild in 4 patients (13.7%), moderate in 10 patients (34.4%), severe in 13 patients (44.8%) and very severe in 2 patients (5.8%). In a multivariate analysis performed by binary logistic regression, elderly onset UC (age at diagnosis >60 years), BMI ≥30kg/m2 and caffeine intake were the strongest predictors of RLS in patients with UC. There was no significant correlation between RLS and occupation, iron, folate, hemoglobin and vitamin B12 levels. RLS was significantly correlated with sleep disorders (86.2%), fatigue (60.9%) and anxiety (31.03%) in patients with UC (p<0.001). Conclusions: Our study demonstrates that RLS is rather common in patients with UC. The results of our research are limited by the small number of patients enrolled in the study. Further investigations are needed to confirm RLS as an extraintestinal manifestation of UC.

Clinical Course of Patients with a New Age Threshold for Elderly Onset Ulcerative Colitis

Clinical Course of Patients with a New Age Threshold for Elderly Onset Ulcerative Colitis

Su1826 Prevalence of Anemia in Nationwide Cohort of Elderly Onset Ulcerative Colitis Patients

Su1826 Prevalence of Anemia in Nationwide Cohort of Elderly Onset Ulcerative Colitis Patients

P205. Prevalence of anaemia in a nationwide cohort of elderly onset ulcerative colitis patients

P205. Prevalence of anaemia in a nationwide cohort of elderly onset ulcerative colitis patients

Natural History of Elderly-onset Ulcerative Colitis: Results from a Territory-wide Inflammatory Bowel Disease Registry.

Data on the natural history of elderly-onset ulcerative colitis [UC] are limited. We aimed to investigate clinical features and outcomes of patients with elderly-onset UC. Patients with a confirmed diagnosis of UC between 1981 and 2013, from 13 hospitals within a territory-wide Hong Kong Inflammatory Bowel Disease Registry, were included. Clinical features and outcomes of elderly-onset patients, defined as age ≥ 60 years at diagnosis, were compared with those of non-elderly-onset disease [< 60 years at diagnosis]. We identified 1225 patients, of whom 12.8% [157/1225; 56.1% male] had elderly-onset UC. Median duration of follow-up was 11 years [interquartile range, 6-16 years]. Age-specific incidence of elderly-onset UC increased from 0.1 per 100000 persons before 1991 to 1.3 per 100000 persons after 2010. There were more ex-smokers [32.2% vs. 12.2%, p < 0.001] and higher proportion of comorbidities [p < 0.001] in elderly-onset than non-elderly-onset patients. Disease extent, corticosteroids, immunosuppressants use, and colectomy rates were similar between the two groups. Elderly-onset disease was an independent risk factor for cytomegalovirus infection [odds ratio 2.9, 95% confidence interval 1.6-5.2, p < 0.001]. More elderly-onset patients had Clostridium difficile infection [11.0% vs. 5.4%, p = 0.007], hospitalisation for UC exacerbation [50.6% vs. 41.8%, p = 0.037], colorectal cancer [3.2% vs. 0.9%, p = 0.033], all-cause mortality [7.0% vs. 1.0%, p < 0.001], and UC-related mortality [1.9% vs. 0.2%, p = 0.017] than non-elderly-onset patients. Elderly-onset UC patients are increasing in number. These patients have higher risk of opportunistic infections, hospitalisation, colorectal cancer, and mortality than non-elderly-onset patients. Management and therapeutic strategies in this special group need careful attention.