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Clinical course is mild in elderly-onset inflammatory bowel disease

The latest issue of Gut examines the natural history of elderly-onset inflammatory bowel disease.

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Data on the natural history of elderly-onset inflammatory bowel disease (IBD) are scarce.

In a French population-based cohort, Professor Jean-Frédéric Colombel and colleagues from France identified 841 IBD patients >60 years of age at diagnosis from 1988 to 2006, including 367 Crohn's disease, and 472 ulcerative colitis patients.

Median age at diagnosis was similar for Crohn's disease and ulcerative colitis.

The research team reported that median follow-up was 6 years for both diseases.

At diagnosis, in Crohn's disease, pure colonic disease and inflammatory behavior were the most frequent phenotype.

At maximal follow-up digestive extension and complicated behavior occurred in 8% and 9%, respectively.

Ulcerative colitis cumulative probabilities of receiving corticosteroids were 40% 
Gut

In ulcerative colitis, 29% of patients had proctitis, 45% left-sided and 26% extensive colitis without extension during follow-up in 84%.

In Crohn's disease cumulative probabilities of receiving corticosteroids, immunosuppressants and anti tumor necrosis factor therapy were respectively 47%, 27% and 9% at 10 years.

The research team found that in ulcerative colitis cumulative probabilities of receiving corticosteroids and immunosuppressants were 40% and 15%, respectively at 10 years.

Cumulative probabilities of surgery at 1 year and 10 years were 18% and 32%, respectively in Crohn's disease and 4% and 8%, respectively in ulcerative colitis.

The team observed that in Crohn's disease complicated behavior at diagnosis was associated with an increased risk for surgery while corticosteroids was associated with a decreased risk.

In ulcerative colitis corticosteroids was associated with an increased risk for colectomy.

Professor Colombel's team concludes, "Clinical course is mild in elderly-onset IBD patients."

"This information would need to be taken into account by physicians when therapeutic strategies are established."

Gut 2014; 63: 423-432
18 February 2014

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