P089 Disease course, phenotype, and medication use in elderly-onset Crohn's disease patients - A population-based IBD-SL cohort study
S. Jeuring*1, 2, T. Van den Heuvel1, 2, M. Zeegers3, 4, W. Hameeteman1, M. Romberg-Camps5, L. Oostenbrug6, A. Masclee1, 2, D. Jonkers1, 2, M. Pierik1, 2
1Maastricht University Medical Center+, Internal Medicine - Division Gastroenterology-Hepatology, Maastricht, Netherlands, 2Maastricht University Medical Center+, NUTRIM, School for Nutrition, Toxicology and Metabolism, Maastricht, Netherlands, 3University of Birmingham, Public Health, Epidemiology and Biostatistics, Birmingham, United Kingdom, 4Maastricht University Medical Center+, Complex Genetics, Cluster of Genetics and Cell Biology, Maastricht, Netherlands, 5Orbis Medical Center, Gastroenterology and Hepatology, Sittard, Netherlands, 6Atrium Medical Center, Internal Medicine and Gastroenterology, Heerlen, Netherlands
Population ageing is a demographic phenomenon seen in many Western countries. This may result in an increased prevalence of elderly-onset Crohn's disease (CD) patients in our outpatient clinics. For optimal patient information and treatment, insight in the disease course of elderly-onset CD is mandatory. However, data are scarce and often derived from small, selected populations. Therefore, we aimed to study the disease course of elderly-onset CD compared to adult-onset CD in our population-based IBD-SL cohort.
Since 1991, incident IBD cases in the South-Limburg (SL) area are included in our population-based IBD-SL cohort, with over 93% completeness. CD patients were divided in two groups, based on their age at diagnosis: adult-onset (AO) CD (<60 years at diagnosis) and elderly-onset (EO) CD (≥ 60 years at diagnosis). Disease behaviour was classified according to the Montreal classification as B1 (non-stricturing, non-penetrating), B2 (stricturing), or B3 (penetrating). The disease course of CD was compared between groups for progression to B2 or B3 phenotype, need for immunomodulators or biologicals, hospitalisation and surgery. Data were analysed with a Kaplan-Meier survival curve, and hazard ratios (HR) were calculated using a Cox regression model.
In total, 136 EO and 1026 AO CD patients were included. Mean follow-up was 6.4 (SD 4.9) and 9.0 (SD 5.8) years, respectively. At diagnosis, B1 phenotype was most common in both groups (79.4% and 77.2%) and no difference was found in behaviour distribution (p=0.49). More EO patients than AO patients underwent surgery at diagnosis (14.7% vs. 5.9%, HR 2.49; 95%CI 1.40-4.43). During follow-up, the risk of progression from B1 to B2 or B3 phenotype (47.8% vs. 49.7%, HR 0.92; 95%CI 0.68-1.26), hospitalisation (71.4% vs. 73.1%, HR 0.99; 0.77-1.29) and two or more hospitalisations (36.5% vs. 39.1%, HR 0.87; 95%CI 0.56-1.35) did not differ between groups, nor did the risk of surgery during follow-up (33.1% vs. 37.3%, HR 0.91; 95%CI 0.58-1.43). EO patients were less often treated with immunomodulators (61.8% vs. 77.1%, HR 0.71; 95%CI 0.54-0.95) and biological agents (25.1% vs. 55.2%, HR 0.59; 95%CI 0.37-0.93).
In this population-based IBD cohort, disease presentation was different in elderly-onset CD patients as more surgery was performed at diagnosis. Although elderly-onset CD patients less often used immunomodulators and biologicals, rates of disease progression, hospitalisation and surgery during disease course were similar to adult-onset CD.
“Risk of surgery in elderly-onset and adult-onset Crohn’s disease patients”