A comparison of inflammatory bowel disease patients aged with disease and those diagnosed late in life

Abstract

Background: Australia has one of the highest incidences of inflammatory bowel diseases (IBD). Previous findings from our cohort have shown no reduction in life expectancy in patients with IBD compared to the general population. In an aging population this will lead to an increase prevalence of IBD in the elderly. Currently, there is limited data addressing disease progression and therapeutic interventions in the older IBD population. Aims: The aim of this study was to describe IBD in the elderly and compare those aged with disease and those diagnosed late in life. Methods: The Sydney IBD Cohort database (1942–2012) was interrogated. All patients older than 60 years at the time of last follow-up were included in the analysis. Patient demographics, disease characteristics, drug treatments and information on any surgical procedures were reviewed. Continuous variables are presented as medians and ranges. Categorical variables are presented as percentages and comparison of frequencies was made by the chi square test. Results: A total of 205 elderly patients (51.2% females) were recruited with mean age of 71.2 years (IQR: 64–79). Of these, 121 (61.5%) were diagnosed before the age of 60 years. The mean length of follow-up was 16.5 years (IQR: 6–22) and there were 3,380 patient-years of follow-up. Crohn’s disease (CD) was found in 38% at diagnosis, ulcerative colitis (UC) in 54% and indeterminate colitis (IC) in 8%. In the diagnosis before 60 years-old group, CD-related surgery (P = 0.017) and immunomodulator use (P = 0.016) were significantly higher than the late-in life diagnosis group. No differences were found in the sex, disease location or disease behaviour at diagnosis, presence of perianal involvement at diagnosis, smoking, use of 5-ASA or use of biological agents in the two groups. In the UC group, the use of 5-ASA was significantly higher in patients diagnosed before 60 years old (P = 0.02). Immunomodulator use was higher but did not reach statistical significance (P = 0.06). No significant differences were observed in the sex, disease location at diagnosis, smoking and the use of biological agents. Conclusion: In elderly IBD patients, younger age of onset was associated with increased prevalence of surgery and immunomodulator use in CD, as well as increased use of 5-ASA drugs and likely immunomodulators in UC. Disease severity in patients diagnosed after 60 is observed to be milder and less complicated compared to patients with an early age of diagnosis.