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P303. Ulcerative colitis (UC) in the elderly - Moderate at onset but then a milder course? An IG-IBD study

W. Fries1, A. Viola1, N. Mannetti2, M. Coppola2, I. Frankovic3, R. Monterubbianesi4, L. Cantoro4, D. Pugliese5, A. Aratri6, M. Cappello7, S. Saibeni8, M. Principi9, P. Naccarato10, G. Mocci11, F. Castiglione12, F. Callela13, A. Magarotto14, F. Caprioli15, A. Belvedere1, G. Casella16, L. Samperi17, A.C. Privitera18, G. Inserra17, S. Danese10, C. Papi19, A. Armuzzi20, A. Kohn4, R. D'Incà21, V. Annese22, F. Manguso23, 1University of Messina, Dept. of Clinical and Experimental Medicine, Messina, Italy, 2Careggi, University Hospital, Gastroenterology Unit, Florence, Italy, 3Gastroenterologia, Departimento di Medicina, Padova, Italy, 4San Camillo-Forlanini, UOC Gasteroenterologia, Roma, Italy, 5Complesso Integrato Columbus, Catholic University, IBD UNIT, Roma, Italy, 6ACO San Filippo Neri, UOC Gastroenterologia ed Epatologia, Roma, Italy, 7A.O.U. Policlinico, UOC Gastroenterologia ed Epatologia, Palermo, Italy, 8AO Fatebenefratelli e Oftalmico, UOC di Medicina Interna ed Epatologia, Milano, Italy, 9University of Bari, Gastroenterology Section (D.E.T.O.), Bari, Italy, 10Istituto Humanitas, Gastroenterologia, Milano, Italy, 11Ospedale Brodzu, UOC di Gastroenterologia, Cagliari, Italy, 12Università “Federico II” di Napoli, Gastroenterologia, Napoli, Italy, 13Ospedale San Giuseppe, UOC Gastroenterologia, Empoli (FI), Italy, 14Fondazione IRCCS Cá Grande Ospedale Policlinico di Milano, UO Gastroenterologia, Milano, Italy, 15Fondazione IRCCS Cá Grande Ospedale Policlinico di Milano, Dipartimento di Fisiopatologia medico-chirurgica e dei trapianti, Milano, Italy, 16Ospedale Desio, Dipartimento di Medicina, Desio (MB), Italy, 17University of Catania, Dip. di Scienze Mediche e Pediatriche, UO Medicina Interna, Catania, Italy, 18A.O. per l'Emergenza Cannizzaro, IBD UNIT, Catania, Italy, 19AOU Policlinico Federico II of Naples, Gastroenterology, Naples, Italy, 20Catholic University, Rome, Complesso Integrato Columbus, IBD UNIT, Roma, Italy, 21Dip. di Medicina, OC Padova, Gastroenterologia, Padova, Italy, 22Careggi, University Hospital, Gastroenterology Unit, Firenze, Italy, 23AORN A. Cardarelli, Napoli, UOC of Gastroenterology, Napoli, Italy

Background

Epidemiology of IBD shows a second incidence peak in subjects over 60 years, especially in UC. The aim of the present study was to investigate disease behaviour in older patients with UC by comparing it with age groups with earlier onset.

Methods

In this multicentre retrospective analysis demographic and disease-specific data were collected in 3 groups. Group 1: patients with diagnosis over age 65 years, group 2: patients matched for age and gender but with diagnosis before 65 years, and group 3: gender-matched patients diagnosed before 40 years. Comparisons were performed with Fisher's exact and chi square testing.

Results

A total of 898 patients were included; group 1: 241 patients (147 M) age at diagnosis 71.4±0.6 years, group 2: 218 (135 M) aged 54.7±1.1 yrs, and group 3: 439 (228 M) aged 26.3±1.7 yrs. Extension of UC at diagnosis was comparable in the three groups (E1: 13%, 14%, 12%, E2: 59%, 66%, 53%, and E3: 28%, 19%, 33%, respectively, in group 1, 2, 3), as well as disease severity at onset, prevailing moderate activity according to the Mayo score.

A median time to diagnosis of 3 months was observed in all three groups. Mean haemoglobin and CRP levels were not statistically different at diagnosis.

Treatments were comparable in the 3 groups in the first year after diagnosis for steroids and 5-ASA, but in the following years, treatments with immunomodulators (IMM) and biologics (BIO) were significantly less frequent in groups 1 and 2 compared to group 3 (2nd year: IMM 12%, 14%, 29%, BIO: 4%, 3%, 10%; 3rd year: IMM 8%, 16%, 29%, BIO 3%, 1%, 11%, respectively, in groups 1, 2, 3; p < 0.001). The frequency of hospitalizations was comparable in the first 3 years in all groups (49%, 39%, 48% in groups 1, 2, 3, respectively) and the median lengths of in-hospital stays were equal (10, 11, and 10 days, respectively). More frequent therapy-related adverse events were reported in the first year after diagnosis in group 1 (p < 0.03).

The need for UC-related surgery was not significant different in the first 3 years after diagnosis. As expected UC-unrelated cancer and UC-unrelated death were more frequent in group 1 (p < 0.001 and 0.006, respectively).

Conclusion

Presentation of UC at diagnosis in terms of severity and extension and time to diagnosis were similar in patients over 65 years compared to younger age groups. The probability of receiving IMM or biologics was lower in elder patients, reflecting a milder disease course or concerns of adverse events in this age group. More frequent adverse events due to therapy were reported in the high age group.