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P542. Crohn's Disease (CD) in the elderly - an IG-IBD study

A. Viola1, L. Cantoro2, R. Monterubbianesi2, F. Castiglione3, M. Principi4, I. Frankovic5, D. Pugliese6, F. Callela7, S. Saibeni8, A. Aratri9, S. Orlando10, M. Cappello11, G. Costantino12, N. Mannetti13, G. Mocci14, L. Samperi15, G. Inserra15, A.C. Privitera16, F. Caprioli17, V. Annese18, C. Papi19, A. Armuzzi20, R. D'Incà21, A. Kohn2, F. Manguso22, W. Fries1, 1University of Messina, Dept. of Clinical and Experimental Medicine, Messina, Italy, 2San Camillo-Forlanini, UOC Gasteroenterologia, Roma, Italy, 3Università “Federico II” di Napoli, Gastroenterologia, Napoli, Italy, 4University of Bari, Gastroenterology Section (D.E.T.O.), Bari, Italy, 5Gastroenterologia, Departimento di Medicina, Padova, Italy, 6Complesso Integrato Columbus, Catholic University, IBD UNIT, Roma, Italy, 7Ospedale San Giuseppe, UOC Gastroenterologia, Empoli (FI), Italy, 8AO Fatebenefratelli e Oftalmico, UOC di Medicina Interna ed Epatologia, Milano, Italy, 9ACO San Filippo Neri, UOC Gastroenterologia ed Epatologia, Roma, Italy, 10Fondazione IRCCS Cá Grande Ospedale Policlinico di Milano, UO Gastroenterologia, Milano, Italy, 11A.O.U. Policlinico, UOC Gastroenterologia ed Epatologia, Palermo, Italy, 12Università di Messina, Dept. of Clinical and Experimental Medicine, Messina, Italy, 13Careggi, University Hospital, Gastroenterology Unit, Florence, Italy, 14Ospedale Brodzu, UOC di Gastroenterologia, Cagliari, Italy, 15University of Catania, Dip. di Scienze Mediche e Pediatriche, UO Medicina Interna, Catania, Italy, 16A.O. per l'Emergenza Cannizzaro, IBD UNIT, Catania, Italy, 17Fondazione IRCCS Cá Grande Ospedale Policlinico di Milano, Dipartimento di Fisiopatologia medico-chirurgica e dei trapianti, Milano, Italy, 18Careggi, University Hospital, Gastroenterology Unit, Firenze, 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, 22AORN A. Cardarelli, Napoli, UOC of Gastroenterology, Napoli, Italy

Background

Epidemiology of IBD shows a second incidence peak in subjects over 60 years. Little is known about disease localization, behaviour, surgery rates, and therapy in CD patients diagnosed over age 65 years.

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, but with diagnosis before 65 years, and group 3: sex-matched patients diagnosed before 40 years.

Results

a total of 469 patients were included; group 1: 113 patients (48 M) diagnosed at age 69.9±4.3 years, group 2: 116 (58 M) at 51.5±10.5 yrs, and group 3: 240 (128 M) at 25.5±7.4 yrs. A median time to diagnosis of 3 months was observed in all three groups. Mean Hb levels and CRP levels were not statistically different. Distribution of disease localization was similar in all three groups for L1, L2, and L3. A fistulazing behaviour (B3) was more frequent (p < 0.035) in patients diagnosed before 40 years, whereas stenosing (B2) or inflammatory disease (B1) was equally distributed. Despite this finding, resective surgery was not statistically different. 5-ASA was employed with a similar frequency in all three groups in the 3 years follow-up after diagnosis, whereas steroids were used significantly more frequent in group 3 in the first year following diagnosis (group 1: 42%, group 2 42%, and group 3: 66%, p < 0.005). Thereafter, steroids use halved in groups 1 and 2, whereas in group 3 it was reduced by 60%. The use of immunomodulators (IMM) and of biologics (BIO) was significantly more frequent in group 3 compared to groups 1 and 2 in the first three years after diagnosis (table).

The number of therapy-related adverse events AE) was similar in the first 2 years, but was significantly increased in the the younger patients in the third year following diagnosis (p < 0.019); most AE were due to IMM representing 54% of all AE, followed by BIO with 25% of all AE.

Extraintestinal manifestations were equally distributed in the 3 groups. Neoplasias during follow-up were diagnosed in 15 (group 1), 8 (group 2), and 2 (group 3) patients (p < 0.000) and death occurred during follow-up in 8 (group 1), 5 (group 2), and 0 (group 3) patients.

Table: Therapy with immunomodulators and biologics in the 3 age groups
65 yrs; n = 11365 yrs long; n = 116<40 yrs; n = 240p-value
IMM
1st year, n (%)10 (9%)23 (20%)80 (33%)0.000
2nd year, n (%)17 (15%)23 (20%)97 (40%)0.000
3rd year, n (%)16 (14%)19 (16%)88 (37%)0.000
BIO
1st year, n (%)2 (2%)9 (8%)25 (10%)0.028
2nd year, n (%)5 (4%)6 (5%)50 (21%)0.000
3rd year, n (%)5 (4%)13 (11%)64 (27%)0.000

Conclusion

Crohn's disease in elder patients seems to follow a milder course, when considering the necessity to use steroids, IMM, and BIO, although the rate of surgery was similar compared to young patients. Our study confirms also the finding of a high incidence of neoplasia in elder patients with Crohn's disease.