Epidemiology and Long-term Outcome of Inflammatory Bowel Disease Diagnosed at Elderly Age: An Increasing Distinct Entity?

Steven F. G. Jeuring*, Tim R. A. van den Heuvel, Maurice P. Zeegers, Wim H. Hameeteman, Marielle J. L. Romberg-Camps, Liekele E. Oostenbrug, Ad A. M. Masclee, Daisy M. A. E. Jonkers, Marieke J. Pierik

*Corresponding author for this work

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Abstract

BACKGROUND: Elderly onset (EO) inflammatory bowel disease (IBD) may become a more common entity as a result of population aging and the rising IBD incidence. Its management is challenging, because of multimorbidity, polypharmacy, and frailty. Insight into the long-term outcome is essential for optimal patient counseling and treatment. We studied the incidence and disease outcome of elderly-onset IBD in direct comparison to adult-onset (AO) IBD. METHODS: All 2823 cases with IBD from the Dutch population-based IBD South Limburg cohort, diagnosed between 1991 and 2011, were included. Long-term outcome (hospitalization, surgery, and disease phenotype) was compared between AO (<60 years at diagnosis) and EO (>/=60 years at diagnosis) disease, for Crohn's disease (CD) and ulcerative colitis (UC) separately. RESULTS: In total, 1162 patients with CD (136 EO/1026 AO) and 1661 patients with UC (373 EO/1288 AO) were included. The EO IBD incidence increased from 11.71 per 100,000 persons in 1991 to 23.66 per 100,000 persons in 2010, P < 0.01. Immunomodulators were less often used in EO CD (61.8% versus 77.1%, P = 0.03) and EO UC (22.8% versus 35.4%, P < 0.01), even as biologicals (25.1% versus 55.1%, P = 0.03 and 7.8% versus 18.0%, P < 0.01, respectively). No differences were observed in surgery risk (CD: hazard ratio [HR] 1.19; 95% confidence interval [CI], 0.85-1.67 and UC: HR, 0.88; 95% CI, 0.53-1.46), or in CD phenotype progression (HR, 0.81; 95% CI, 0.52-1.25), but more patients with EO UC required hospitalization (HR, 1.29; 95% CI, 1.01-1.63). CONCLUSIONS: EO IBD is rising, warranting physicians' alertness for IBD in elderly patients. The long-term outcome was not different from AO disease, despite a less frequent use of immunomodulators and biologicals.
Original languageEnglish
Pages (from-to)1425-1434
Number of pages10
JournalInflammatory Bowel Diseases
Volume22
Issue number6
DOIs
Publication statusPublished - Jun 2016

Keywords

  • inflammatory bowel disease
  • elderly
  • epidemiology
  • natural history
  • ADULT PATIENTS
  • MANAGEMENT
  • CROHNS-DISEASE
  • ULCERATIVE-COLITIS
  • RISK
  • CLINICAL-FEATURES
  • PREVALENCE
  • GREEK PATIENTS
  • EVIDENCE-BASED CONSENSUS
  • POPULATION-BASED COHORT

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