Late-onset Inflammatory Bowel Disease Research Articles

S923 Distinct Phenotypic and Treatment Differences in Late Onset Inflammatory Bowel Disease: A Large Population-Based Study

S923 Distinct Phenotypic and Treatment Differences in Late Onset Inflammatory Bowel Disease: A Large Population-Based Study

Obesity among those newly diagnosed with Crohn’s disease and ulcerative colitis compared with the general population

ObjectiveObesity is a potentially modifiable risk factor for inflammatory bowel disease (IBD). We aimed to evaluate the body mass index (BMI) of those diagnosed with IBD early versus late in...

Increased incidence of late-onset inflammatory bowel disease and microscopic colitis after a Cryptosporidium hominis outbreak

Objectives In 2010, 27,000 inhabitants (45% of the population) of Östersund, Sweden, contracted clinical cryptosporidiosis after drinking water contaminated with Cryptosporidium hominis. After the outbreak, local physicians perceived that the incidence of inflammatory bowel disease (IBD), including ulcerative colitis (UC), Crohn’s disease (CD), and IBD-unclassified, and microscopic colitis (MC) increased. This study assessed whether this perception was correct. Materials and methods This observational study included adult patients (≥18 years old) from the local health care region who were diagnosed with pathology-confirmed IBD or MC during 2006–2019. We collected and validated the diagnosis, date of diagnosis, age at diagnosis, and sex from the Swedish quality register SWIBREG and electronic patient records. Population data were collected from Statistics Sweden. The incidences for 2006–2010 (pre-outbreak) and 2011–2019 (post-outbreak) were evaluated by negative binomial regression analysis and presented as incidence rate ratios (IRRs). Data were analyzed for IBD, for UC and CD separately, and MC. Results During the study period, we identified 410 patients with new onset IBD and 155 new cases of MC. Overall, we found a trend toward an increased incidence of IBD post-outbreak (IRR 1.39, confidence interval (CI) 0.99–1.94). In individuals ≥40 years old, the post-outbreak incidence significantly increased for IBD (IRR 1.69, CI 1.13–2.51) and CD (IRR 2.23, CI 1.08–4.62). Post-outbreak incidence of MC increased 6-fold in all age groups (IRR 6.43, CI 2.78–14.87). Conclusions The incidence of late-onset IBD and MC increased after the Cryptosporidium outbreak. Cryptosporidiosis may be an environmental risk factor for IBD and MC.

P661 Pre-diagnostic vitamin D levels in Inflammatory Bowel Disease

Abstract Background Vitamin D has been implicated in the pathogenesis of inflammatory bowel disease (IBD), suggested by a geographical north-south gradient in risk for IBD. IBD patients have also been shown to have lower 25(OH) vitamin D (25(OH)D3) compared to healthy subjects. In contrast, prospective studies on pre-diagnostic samples, including one with late-onset IBD (n=241), have not found any differences. The aim of our study was to study 25(OH)D3 levels in subjects later developing IBD, including late-onset cases. Methods In this nested case-control study, 171 individuals who later developed IBD and 337 controls (matched for age, sex, and time and place for inclusion) were included. The study population was included from the Northern Sweden Health and Disease Study (NSHDS), and the Northern Sweden Maternity Cohort (RUB). Both with the catchment area being above latitude 63°N (based in Umeå, Sweden). 25(OH)D3 concentrations were analysed with LC-MS/MS on plasma collected at least one year before IBD diagnosis and compared between cases and controls using conditional logistic regression. Results Results are shown in tables 1–3. Baseline characteristics are presented separately for NSHDS (Table 1) and RUB (Table 2). For NSHDS and RUB cases, median ages were 50.1 and 25.3 years respectively, and median 25(OH)D3 levels 52.9 and 52.3 nmol/L respectively. There were no differences compared to matched controls. Conditional logistic regression (Table 3) for vitamin D levels and risk for developing IBD were made for NSHDS and RUB separately and combined. It was also made separately for Ulcerative Colitis and Crohn’s disease. No differences were shown for the whole group, nor for any of the subgroups. Conclusion In pre-diagnostic samples, 25(OH)D3 did not differ between those who later developed IBD and controls. In subgroup analysis separately for RUB (including younger, female individuals) and NSHDS (including late-onset IBD), no differences were seen in either subgroup. This study supports previous findings indicating that vitamin D is not associated with the risk of developing IBD, including late-onset IBD, and that there is no evidence for early malabsorption of vitamin D.

Perfluoroalkyl substances are increased in patients with late-onset ulcerative colitis and induce intestinal barrier defects ex vivo in murine intestinal tissue

Background Environmental factors are strongly implicated in late-onset of inflammatory bowel disease. Here, we investigate whether high levels of perfluoroalkyl substances are associated with (1) late-onset inflammatory bowel disease, and (2) disturbances of the bile acid pool. We further explore the effect of the specific perfluoroalkyl substance perfluorooctanoic acid on intestinal barrier function in murine tissue. Methods Serum levels of perfluoroalkyl substances and bile acids were assessed by ultra-performance liquid chromatography coupled to a triple-quadrupole mass spectrometer in matched samples from patients with ulcerative colitis (n = 20) and Crohn’s disease (n = 20) diagnosed at the age of ≥55 years. Age and sex-matched blood donors (n = 20), were used as healthy controls. Ex vivo Ussing chamber experiments were performed to assess the effect of perfluorooctanoic acid on ileal and colonic murine tissue (n = 9). Results The total amount of perfluoroalkyl substances was significantly increased in patients with ulcerative colitis compared to healthy controls and patients with Crohn’s disease (p < .05). Ex vivo exposure to perfluorooctanoic acid induced a significantly altered ileal and colonic barrier function. The distribution of bile acids, as well as the correlation pattern between (1) perfluoroalkyl substances and (2) bile acids, differed between patient and control groups. Discussion Our results demonstrate that perfluoroalkyl substances levels are increased in patients with late-onset ulcerative colitis and may contribute to the disease by inducing a dysfunctional intestinal barrier.

Elevated plasma cotinine is associated with an increased risk of developing IBD, especially among users of combusted tobacco.

Smoking has previously been associated with inflammatory bowel disease (IBD), but no study has reported on cotinine, an objective, biochemical measure of tobacco use. We aimed at testing the hypothesis that cotinine levels among healthy subjects are associated with an increased risk of developing IBD in later life. We analysed plasma cotinine and evaluated corresponding lifestyle questionnaires that included tobacco habits in subjects (n = 96) who later developed late-onset IBD (70 ulcerative colitis (UC) and 26 Crohn's disease (CD)) and in sex and age-matched controls (n = 191). Patients who later developed IBD had significantly higher plasma cotinine levels compared to controls. In multivariable analysis, higher log-cotinine was associated with a higher risk of developing IBD (OR 1.34 (95% CI 1.01-1.63)). After stratifying for time to diagnosis, the association was only significant in subjects with shorter time (< 5.1 years) to diagnosis (OR 1.45 (1.09-1.92)). The findings were similar for UC- and CD-cases, but did not reach statistical significance in CD-cases. Although plasma cotinine concentrations were higher in snuff users compared to combusted tobacco users, no increase in the risk of IBD and lower risk of developing IBD among subjects with shorter time (< 5.1 years) to diagnosis was seen among snuff users. Cotinine, a biomarker of tobacco use, is associated with increased risk of developing late-onset IBD in general, and UC in particular. No increased risk among snuff users indicates that other components in combusted tobacco than nicotine may be involved in the pathogenesis of IBD among smokers.

Effect of Age on the Initiation of Biologic Agent Therapy in Patients With Inflammatory Bowel Disease: Korean Common Data Model Cohort Study.

BackgroundThe Observational Health Data Sciences and Informatics (OHDSI) network is an international collaboration established to apply open-source data analytics to a large network of health databases, including the Korean common data model (K-CDM) network.ObjectiveThe aim of this study is to analyze the effect that age at diagnosis has on the prognosis of inflammatory bowel disease (IBD) in Korea using a CDM network database.MethodsWe retrospectively analyzed the K-CDM network database from 2005 to 2015. We transformed the electronic medical record into the CDM version 5.0 used in OHDSI. A worsened IBD prognosis was defined as the initiation of therapy with biologic agents, including infliximab and adalimumab. To evaluate the effect that age at diagnosis had on the prognosis of IBD, we divided the patients into an early-onset (EO) IBD group (age at diagnosis <40 years) and a late-onset (LO) IBD group (age at diagnosis ≥40 years) with the cutoff value of age at diagnosis as 40 years, which was calculated using the Youden index method. We then used the logrank test and Cox proportional hazards model to analyze the effect that age at diagnosis (EO group vs LO group) had on the prognosis in patients with IBD.ResultsA total of 3480 patients were enrolled. There was 2017 patients with ulcerative colitis (UC) and 1463 with Crohn’s disease (CD). The median follow up period was 109.5 weeks. The EO UC group was statistically significant and showed less event-free survival (ie, experiences of biologic agents) than the LO UC group (P<.001). In CD, the EO CD group showed less event-free survival (ie, experiences of biologic agents) than the LO CD group. In the Cox proportional hazard analysis, the odds ratio (OR) of the EO UC group on experiences of biologic agents compared with the LO UC group was 2.3 (95% CI 1.3-3.8, P=.002). The OR of the EO CD group on experiences of biologic agents compared with the LO CD group was 5.4 (95% CI 1.9-14.9, P=.001).ConclusionsThe EO IBD group showed a worse prognosis than the LO IBD group in Korean patients with IBD. In addition, this study successfully verified the CDM model in gastrointestinal research.

Cardiac functions and aortic elasticity in children with inflammatory bowel disease: effect of age at disease onset

Childhood onset inflammatory bowel disease is more aggressive and has rapidly progressive clinical course than adult inflammatory bowel disease. Early-onset inflammatory bowel disease has more severe clinical progression as a subspecialised group of monogenic inflammatory bowel disease. We studied cardiac functions and aortic elasticity in children with early- and late-onset inflammatory bowel disease in remission period. Thirty-three paediatric patients were divided into subgroups according to age of disease onset (<10 and >10 years of age). Twenty-five healthy children were admitted as control group. M-Mode echocardiography and pulsed wave Doppler echocardiography were performed. Strain, distensibility, stiffness index of ascending, and abdominal aorta were evaluated. Interventricular septum (mm) and left ventricular end-systolic diameter were higher (6.9 ± 1.2, 26.2 ± 4.6) in early-onset inflammatory bowel disease patients than control patients (6.1 ± 1.27, 22.7 ± 4.12) (p = 0.050, p = 0.050). Mitral E/E' ratio and myocardial performance index were increased in inflammatory bowel disease and early-onset inflammatory bowel disease groups than control group (p = 0.046, p = 0.04; p = 0.023, p = 0.033). Diastolic functions were found to beimpaired in inflammatory bowel disease and early-onset inflammatory bowel disease groups according to control group, while there was no difference between late-onset inflammatory bowel disease and control groups in terms of diastolic functions. Mitral E/A ratio was lower in inflammatory bowel disease patients and early-onset inflammatory bowel disease patients (1.46 ± 0.32, 1.4 ± 0.21) than control patients (1.70 ± 0.27) (p = 0.013, p = 0.004). Aortic elasticity did not differ between groups. Chronic low-grade inflammation has effects on left ventricular diameters and diastolic function in remission period. Aortic elasticity is not affected in our study groups.

P018 Per- and polyfluoroalkyl substances (PFAS) are significantly increased in patients with late-onset of ulcerative colitis

Abstract Background Environmental factors have been implicated in the pathogenesis of inflammatory bowel disease (IBD), particularly late onset disease. Per- and polyfluoroalkyl substances (PFAS) are man-made chemicals with a long biological half-life that have been extensively used since the 1950s and have been proposed to interfere with the bile acid synthesis. Therefore, to investigate if late onset IBD correlates with higher PFAS levels, we measured serum levels of PFAS and bile acids in patients diagnosed with IBD later in life. Methods Serum samples were collected from patients diagnosed with ulcerative colitis (n = 20) and Crohn’s disease (n = 20) at the age of ≥55 years. Blood donors (n = 20) were used as healthy controls and were matched by gender and age. The levels of PFAS and bile acids were assessed by ultra performance liquid chromatography coupled to a triple quadrupole mass spectrometer. Results The total amount of PFAS was significantly higher in patients with ulcerative colitis compared with healthy controls (p = 0.021) or patients with Crohn’s disease (p = 0.015). No difference was found in total PFAS levels between Crohn’s disease patients and healthy controls (p = 0.841). Seven out of 30 bile acids correlated to the total PFAS level. Conclusion Our results demonstrate that PFAS levels are increased in patients with late-onset of ulcerative colitis compared with Crohn’s disease patients and healthy controls. This finding indicates that PFAS might represent an environmental risk factor for ulcerative colitis. However, additional studies assessing the functional consequences of increased PFAS in late-onset ulcerative colitis are required to confirm this hypothesis.

P516 Daily consumers of drip-filtered coffee have a decreased risk of developing late-onset Crohn’s disease

Abstract Background Coffee is known to impact on colon motility, alter gut-related immune response, and to affect symptoms among inflammatory bowel disease (IBD) patients. In spite of this, the role of coffee as a determinant of IBD is unclear. The aim of this study was to investigate how coffee correlates to the risk of developing late-onset IBD in general, and subdivided into Crohn’s disease and ulcerative colitis. Methods This nested case-control study within the large, population-based Northern Sweden Health and Disease Study (NSHDS), included data from 78 patients with IBD and 311 controls matched for age, sex, time and area of sample collection. Cases were included in NSHDS at least one year prior to IBD diagnosis. Coffee consumption was assessed by questionnaire-data, differing between drip-filtered and boiled unfiltered coffee. Risk associations were estimated through conditional logistic regressions. Results Results differed between different subgroups of IBD and coffee. Our main finding was a decreased risk of Crohn’s disease in subjects with a daily intake of drip-filtered coffee in comparison with subjects with a less frequent intake (Table). After adjustments for smoking, body-mass-index, educational level and marital status the results remained. Adjusted OR for Crohn’s disease was 0.22; 95% CI 0.07–0.76 Conclusion Our results indicate potential biochemical differences depending on coffee preparation technique on IBD risk, with possible implications for prevention or treatment. Further studies are warranted.

SUPPRESSION OF GHRELIN SIGNALING EXACERBATES ULCERATIVE COLITIS IN OLDER MICE

The aging process is characterized by increased chronic low-grade inflammation, aka inflamm-aging, which offend is accompanied by ‘leaky gut’ syndrome. Inflamm-aging is a highly significant risk factor for both morbidity and mortality in the older adult population (>65 years of age). In addition, there is a growing prevalence of inflammatory bowel disease (IBD), a chronic inflammatory condition of the gastrointestinal tract in the older adult population. The pathogenesis of late-onset IBD is suggested to be more complex compared with younger IBD patients; the causes determining the age of IBD onset remain unexplained. Ghrelin is a 28-amino-acid peptide hormone mainly produced by X/A-like cells of the stomach, with well-characterized functions in growth hormone secretion, food intake, adiposity and insulin resistance. Ghrelin’s biological relevant receptor is Growth Hormone Secretagogue Receptor (GHS-R). Ghrelin and ghrelin mimetics have been considered viable candidates for treating cachexia, sarcopenia, and gastrointestinal disorders. As expected, we observed that the expression of tight junction proteins in colon mucosal layer decreases with age. When challenged with dextran sulfate sodium (DSS) to induce experimental ulcerative colitis, 18-months old male C57BL/6 mice exhibited exacerbated disease activity scores compared to young male mice (5-months), showing worsened pathology such as rectal bleeding and difficulty in defecation. DSS-induced colitis was exacerbated in both ghrelin-deficient (Ghrl-/-) and ghrelin receptor-deficient (Ghsr-/-) mice. Together, these data suggest endogenous ghrelin signaling contributes to susceptibility to colitis, and ghrelin signaling pathway may present a novel target for prevention and treatment of leaky gut syndrome in aging.

Laboratory values in Japanese children with newly diagnosed inflammatory bowel disease

Laboratory data in children with newly diagnosed inflammatory bowel disease (IBD) have been reported from Europe and North America, but not Asia. The aim of this study was to clarify laboratory data in Japanese children with newly diagnosed IBD, and to compare them with those in Western reports. We retrospectively reviewed patients <16years old, newly diagnosed with ulcerative colitis (UC) or Crohn's disease (CD) at Kurume University Hospital between January 2008 and December 2015. UC and CD patients numbered 31 and 15, respectively. The percentages of patients with normal values for hemoglobin (Hb), platelet count (Plt), albumin (Alb), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) in the UC and CD groups were 45% and 47%; 68% and 53%; 84% and 40%; 81% and 7%; and 35% and 0%, respectively. The frequency of normal results for these five tests were similar to Western findings except for the greater frequency of normal CRP in UC. Alb and ESR differed significantly between UC and CD in both mild and moderate-severe cases. Plt, Alb, CRP, and ESR differed significantly between diseases in late-onset IBD, whereas early onset IBD showed no differences. In UC, ESR correlated positively, while Hb and Alb correlated negatively, with disease activity. In CD, CRP and ESR correlated positively with activity. The proportion of Japanese children with IBD having normal values at diagnosis was mostly similar to that in Western reports. In early onset cases, UC parameters may be similar to CD. Of the five tests, ESR was particularly indicative of disease activity at diagnosis in both pediatric UC and CD.

P193 Prediagnostic markers in late onset inflammatory bowel disease

BackgroundWe aimed to determine whether patients who later develop IBD show signs of inflammatory activity in blood measured with high-sensitivity CRP, calprotectin and albumin before clinical onse ...

Treatment of Inflammatory Bowel Disease in the Older Patient.

The incidence of inflammatory bowel disease (IBD) is increasing, and as our population ages, there is a growing number of IBD patients who are transitioning into advanced age; 15% to 20% of IBD patients are classified as late-onset (between 60-65 years of age). This has led clinicians to treat a large number of older patients with IBD. The principles of management of IBD in older patients are the same as those who are younger. There are, however, phenotypic differences that are unique to late-onset IBD and age-related concerns that clinicians must consider when initiating therapy for their older patients with IBD. Given the increasing number of older IBD patients, the aim of this article is to present an updated, evidence-based review of the therapeutic options and issues that arise in this unique patient population.

Characteristics and Behavior of Elderly-onset Inflammatory Bowel Disease

Existing data conflict regarding differences in inflammatory bowel disease (IBD) characteristics between adult-onset and elderly-onset IBD. IBD extent and behavior are strong predictors of IBD-related surgery and complications. The aim of this study was to compare disease characteristics and behavior of adult- and elderly-onset IBD in a multi-center US study. We performed a multi-center retrospective cohort study of patients with IBD. Chart review was performed to confirm IBD diagnoses and extract data regarding IBD characteristics, medications, surgery, cancer, and death. Patients were classified based on age at IBD diagnosis as adult onset (18-64 years) or elderly onset (≥65 years). A total of 1665 patients were confirmed to have IBD; 272 patients were ≥65 years at IBD diagnosis. Whites were more likely than non-whites to have elderly-onset IBD (adjusted odds ratio 2.26, 95% confidence interval 1.36-3.76). Patients with ulcerative colitis were more likely than CD patients to have elderly-onset IBD (aOR 1.50, 95% confidence interval 1.11-2.03). Compared with patients with adult-onset CD, patients with elderly-onset CD were more likely to have isolated colonic disease and nonstricturing, nonpenetrating phenotype, but less likely to have perianal complications or receive immunosuppressants. Rates of bowel resection, and both colonic and extra-colonic malignancies did not differ based on age of IBD onset. There are several significant differences in the disease characteristics between adult- and late-onset IBD; these differences may reflect differences in natural history of IBD and influence approaches to management among patients with elderly-onset IBD.

P483. Differences in biologic therapy utilisation amongst early and late-onset inflammatory bowel disease

P483. Differences in biologic therapy utilisation amongst early and late-onset inflammatory bowel disease

Pulmonary Manifestations of Inflammatory Bowel Disease (IBD) in Patients With Late-Onset IBD

Background: pulmonary manifestations are uncommon in IBD. We report 3 different pulmonary manifestations in patients with late onset IBD to show that they may be more prone to pulmonary complications. Patient #1: A 45 year old male developed frequent loose stools with streaks of blood. Colonoscopy demonstrated diffuse colitis extending from the distal colon to the distal ascending colon. Biopsy demonstrated chronic active colitis with extensive ulceration and inflammation. The patient was diagnosed with Ulcerative Colitis and started Mesalamine. Over a 3 month period the patients symptoms continue to worsen despite increased doses of Mesalamine and a trial of oral corticosteroids. The patient was started Azathioprine. Two weeks later the patient presented for dyspnea and was diagnosed with a pulmonary embolus. He was discharged from the hospital on Warfarin. He continued Warfarin therapy for 12 months with no further reported evidence of thrombus formation. Patient # 2: A 71 year old male developed hematochezia. 71. A flexible sigmoidoscopy demonstrated ulcerated mucosa concerning for IBD. He was started on mesalamine for 3 months without benefit, so it was stopped. He then developed a perianal fistula, requiring fistulotomy 14 months later. Colonoscopy showed segmental colitis in the sigmoid. The patient developed dyspnea and was referred to the pulmonary clinic. Pulmonary function tests showed mild restrictive disease and a CT chest showed bibasilar and right middle lobe honeycombing. The patient remained off medications for colitis and had spontaneous symptomatic improvement of his shortness of breath. A chest x-ray 16 months later showed no evidence of interstitial disease. Patient #3: A 51 year old male, with ulcerative colitis, was on prednisone and mesalamine for approximately for 7 years with good control. Because of a flare he was started on azathioprine, but developed fever and dyspnea. A chest x-ray showed bibasilar consolidation and a CT chest showed extensive ground glass opacities bilaterally in the upper lobes. He underwent broncho-alveolar lavage (BAL) and transbronchial biopsies. The BAL cultures showed Staph aureus without symptoms; the transbronchial biopsies showed cryptogenic organizing pneumonia. Azathioprine was stopped, prednisone and mesalamine were continued. Prednisone was tapered and follow up CT chest showed a near resolution of his organizing pneumonia Discussion: Patients #1 and #2 developed pulmonary symptoms close to diagnosis. Patient #3 developed symptoms nearly 7 years after diagnosis, during a flare. These cases demonstrate the importance of looking for pulmonary symptoms in older patients diagnosed with IBD, especially during onset and acute flares.

Difference in the Timing of Initiation of Biologic Therapy in Early-Onset Versus Late-Onset Inflammatory Bowel Disease (IBD): A Single Tertiary Center Experience

Difference in the Timing of Initiation of Biologic Therapy in Early-Onset Versus Late-Onset Inflammatory Bowel Disease (IBD): A Single Tertiary Center Experience

Sa1216 Management Differences Between Early and Late-Onset Inflammatory Bowel Disease

Background: As our population has aged more patients are being diagnosed with inflammatory bowel disease (IBD) at a later age. Despite the limited literature on the subject, clinical observation suggests that patients with late-onset IBD (LOIBD) have a different severity of disease compared to younger patients and, therefore, may have different management requirements. The primary objective of this study was to perform a retrospective analysis of the disease severity and therapy requirements of patients with a LOIBD as compared to those diagnosed at an earlier age. Methods: Patients were selected at random from a list of those billed for diagnosis codes attributed to inflammatory bowel disease. Of our initial list of 350 patients, we excluded 88 patients who were inappropriately coded as having IBD leaving us with a final list of 262 patients. We separated our list into three cohorts: those diagnosed with IBD before the age of 45, but who are currently younger than 45 (Group 1); those diagnosed with IBD before the age of 45, but who are currently older than 45

Is IBD in the Elderly a Manifestation of Ischemia Precipitated by Underlying Cardiac Arrhythmias?

Purpose: Inflammatory bowel disease (IBD) is a chronic inflammatory disease of the bowel, comprising ulcerative colitis (UC) and Crohn's disease (CD). It is thought that IBD has a bimodal peak of incidence, often occurring in the 2nd decade of life and again after the 5th decade of life; interestingly, over 15% of atrial arrhythmias are also estimated as being diagnosed over age 65. While both UC and CD have distinct characteristics, their pathogenesis remains poorly understood. We questioned whether late-onset IBD was actually a marker of vascular ischemic disease rather than a primary disease of the intestine, and whether the focus of attention should be on underlying cardiovascular co-morbidities that predispose these patients to ischemic events. The goal of this study was 1.) to determine the prevalence of atrial arrhythmias in patients diagnosed with IBD, 2.) to compare the rates in CD and UC, 3.) to compare the rates in late-onset IBD to those with early-onset IBD, and 4.) to determine whether the presence of atrial arrhythmias in IBD influences long-term survival. Methods: We reviewed in detail the medical records of all patients at Hines VA who underwent a complete GI investigation between 1996 and 2011, and were diagnosed with UC or CD. All IBD patients had biopsyproven colitis. Late-onset and early-onset was defined as IBD diagnosed after and before age 50, respectively. Results: A total of 447 patients were diagnosed with IBD during the 15-year study period. Of the 447 pts, 11% had documented atrial arrhythmias, of which: 9% of CD and 13% of UC patients (P=NS). Atrial arrhythmias were present in 17% of the late-onset IBD patients, compared to 5% of the earlyonset IBD patients (Diff: 12%; CI: 6% to 18%). IBD patients with atrial arrhythmias had significantly worse survivals than those without (at 33 years post diagnosis, 50% vs. 80% [HR: 2.5; CI: 1.2 to 5.0]). Conclusion: Compared to IBD patients without atrial arrhythmias, the IBD cohort with them have a significantly increased mortality that may not be due to underlying bowel disease. “Late-onset IBD” in patients with concurrent atrial arrhythmias may actually serve as a warning for underlying cardiovascular disease.Figure