Search in the Abstract Database

Search Abstracts 2015

* = Presenting author

P170 Comparison between elderly onset and adult onset inflammatory bowel disease

C. Ricci*1, C. Pirali2, F. Lanzarotto1, G. Romanelli2, A. Lanzini1

1University of Brescia, Department of Molecular and Translational Medicine, Gastroenterology Unit, Spedali Civili, Brescia, Italy, 2University of Brescia, Department of Molecular and Translational Medicine, Geriatric Unit, Spedali Civili, Brescia, Italy

Background

As the population ages the incidence of elderly onset inflammatory bowel disease (IBD) is expected to increase. In this study we compared clinical presentation and disease behaviour of IBD diagnosed in geriatric age (65 ≥ yrs ) vs adulthood (40-64 years).

Methods

From January 2000 to May 2014 all patients diagnosed with IBD after the age of 65 were enrolled (elderly-onset IBD), each case was matched 1:1 by disease (UC or CD), gender and year of diagnosis with a control with IBD onset from 40 to 64 years (adult-onset IBD).

Results

Table 1 shows characteristics of UC and CD by age.

Table 1 shows characteristics of UC and CD by age.

elderly UCadults UCelderly CDadults CD
Patients, N°=17865652424
Mean age at diagnosis yrs (SD)71.3(5)48.6(6)71.6(4.9)47.1(6.5)
Female N(%)35(54)35(54)15 (62.5)15 (62.5)
Follow up length, yrs mean(SD)4.9(3.3)5.4(3.6)6.1(3.2)6.4 (3.4)
Time from symptoms onset to diagnosis yrs, mean (SD)0.7(1.5)0.5(1.2)2.7(4.6)3.0(4.8)
Comorbidity Index (CIRS), mean (SD)3.7(2)1.5(0.9)4(2)1.5(0.6)

Characteristics of UC and CD by age

>

Symptoms at the presentation of UC and CD where similar between elderly and adults except for weight loss which was more common in elderly-onset UC and for constipation which was more frequent in elderly-onset CD. At the diagnosis of UC, higher proportion of elderly were classified as E2 and less as E1 according to Montreal Classification (65% vs 43%, p=0.02), while disease progression at maximum follow up was similar. For CD there were no differences between extension, phenotypes and histological activity between elderly and adults; disease progression was negligible. Therapy at the diagnosis and clinical behavior of UC and CD were similar between groups . Kaplan Meier analysis for time to first relapse showed no differences between elderly and adults neither for UC, nor for CD. Elderly onset UC, had a tendency to higher surgical approach (18% vs 8%, p=0.07). For CD, in both groups, about 50% of patients received surgical intervention but elderly onset CD were more likely to be operated early in the course of the disease; mean time to the surgical intervention was 1.5±1.9 months and 18.5 ±22.8 months, p=0.02 in elderly and adults respectively. Complications were more likely to occur among elderly-onset UC, we recorded an higher number of systemic infections (28% elderly VS 9% adults, p=0.027), deep vein thrombosis (14% elderly vs 1.5% adults, p= 0.003), intestinal complication (17% elderly vs 5% adults, p=0.022). Iatrogenic complications like steroidal diabetes, hypertension and osteoporosis occurred more frequently among elderly (17% vs 8%, p=0.029)

Conclusion

Elderly-onset IBD seems to have similar presentation and clinical behaviour when compared to adult-onset IBD. Elderly IBD patients presents more comorbidities and are more likely to develop complications; these aspects needs to be taken into account when treating these patients