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P664 Natural history of Crohn’s disease in elderly patients diagnosed over the age of 70 years: a population-based study

m. fumery*1, B. Pariente2, h. sarter3, C. Charpentier4, L. Armengol-Debeir4, J.-L. Dupas5, H. Coevoet6, L. Peyrin-biroulet7, C. Gower-Rousseau8, G. Savoye4

1Amiens University Hospital, Department of Gastroenterology and Hepatology, Amiens, France, 2CHRU Lille, Department of Gastroenterology, Lille, France, 3CHRU Lille, Department of Biostatistics EA 2694, Lille, France, 4CHU Rouen, Department of Gastroenterology and Hepatology, Rouen, France, 5Amiens University Hospital, Hepatogastroenterology, Amiens, France, 6Hopital Privé, Les Bonnettes, Arras, France, 7CHU Nancy, Department of Gastroenterology and Hepatology, Vandoeuvre-Lès-Nancy, France, 8CHRU Lille, Department of Epidemiology, EPIMAD Registry, Lille, France

Background

Elderly-onset (> 60 years at diagnosis) Crohn’s disease (CD) seems to be associated with a better outcome than when diagnosed earlier in life. The aim of this study was to compare the natural history of CD patients older than 70 years (yr) at diagnosis with that of elderly patients diagnosed between the age of 60 and 70 yr in the EPIMAD population-based registry.

Methods

In total, 377 patients with elderly-onset CD diagnosed between January 1988 and December 2006 were identified. Amongst them, 188 (63%) were older than 70 yr at diagnosis. Clinical presentation, disease location and behaviour at diagnosis, as well as natural history, surgery needs, and drug exposure, were recorded with a median follow-up of 4.5 yr (1.1; 8.3) in CD diagnosed after 70 yr, and 7.8 yr (3.3; 12.1) in CD diagnosed between 60 and 70 yr, respectively.

Results

CD incidence in elderly patients diagnosed over the age of 70 (≥ 70 yr) was 2.3/100 000 inhabitants, compared with 2.6/100 000 in elderly patients diagnosed below the age of 70 (60–69 yr). The proportion of males was lower in ≥ 70 y patients than in 60–69 yr patients (31% vs 45%, p = 0.006). Clinical presentation at diagnosis was similar in both groups with respect to symptoms such as bloody stools, perianal location and extraintestinal manifestations (EIM). Pure colonic location (L2) was more frequent amongst patients > 70 yr both at diagnosis (73% vs 57%, p = 0.004) and maximal follow-up (70% vs 47%, p < 0.0001). Disease extension (from L1 or L2 to L3) was less frequent amongst patients >70 y (7% vs 15%, p = 0.03). The most frequent behaviour in the 2 groups was inflammatory – both at diagnosis (75% vs 80%, p = 0.43) and at maximal follow-up (69% vs 70%, p = 0.55). There was no significant difference in patients >70 yr compared with 60–69 yr patients regarding treatment with 5-ASA (71% vs 76%, p = 0.27), oral corticosteroids (39% vs 45%, p = 0.86), and anti-TNF (4% vs 7%, p = 0.63). However, the use of immunosuppressants (IS) was significantly less frequent in patients >70 yr (12% vs 25%, p < 0.001). Risk for surgery was similar in both groups (29% vs 28% p = 0.35). EIM at diagnosis were significantly associated with an evolution to complicated behaviour (HR = 2.7 [1.0; 7.0], p = 0.045) and IS treatment (HR = 2.9 [1.4; 6.0], p = 0.006) in patients > 70 yr.

Conclusion

The natural history of CD in elderly patients diagnosed over the age of 70 yr seems to be milder than that in those diagnosed between 60 and 70 yr. This needs to be taken into account when establishing therapeutic strategies.