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P242 Phenotypic characterisation of elderly – onset inflammatory bowel disease – IBD at the extremes

Nosegbe U.*1, Scott J.A.2, Crooks B.2, Miller B.2, Limdi J.2,3

1The Pennine Acute Hospitals NHS Trust, Manchester UK, Gastroenterology Dept, Bury, United Kingdom 2The Pennine Acute Hospitals NHS Trust, Manchester, United Kingdom 3University of Manchester, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, Manchester, United Kingdom

Background

The incidence of Inflammatory bowel disease (IBD) is increasing globally at a rate outpacing what genetic influences alone could instigate. Data on elderly onset IBD (age 60 and over) are limited. The aim of our study was to study the phenotypic characteristics of elderly-onset IBD.

Methods

We conducted a retrospective analysis of 140 patients diagnosed with IBD at 60 years or above at our institution between 1995 and 2016. We collected data including demographics, disease characteristics (Montreal classification) and treatment using electronic case records.

Results

Of 140 patients, 70 were male. Median age was 71 years (range 62–91) and median age at diagnosis was 65 years (range 60–85). 49 patients had Crohn's disease (CD) (35.0%), 80 had Ulcerative colitis (UC) (57.1%) and 11 (7.9%) had IBD-unspecified (IBDU).

Disease classification for UC was: E1 (27), E2 (30) and E3 (21) and 2 patients with UC proctosigmoiditis have not yet been classified. Montreal classification for CD was L1 B2 (18): L2 B1 (14)and L2 B2 disease in 4. L3 disease was found in 12 (7 B1 and 5 B2).

At diagnosis 88 patients were prescribed 5ASA's (18 topical and 6 in combination with oral preparations). Steroid induction at diagnosis occurred in 44 (31.4%) patients. Azathioprine was used in 3 (2 E3 and 1 L2B2) and 3 patients commenced Infliximab at diagnosis (L3B1 & L1B2 CD and E3 UC). Median CRP at diagnosis was 32.0mg/L

At most recent follow up 26 patients were on corticosteroids, 35 were on immunomodulation (26 on Azathioprine, 5 on 6MP and 4 on Methotrexate) with a mean time to immunomodulation being 29.4 months (range 0–137). 14 were on biologic therapy (12 Infliximab and 2 Adalimumab) with a mean time to therapy of 37.1 months (range 0–189 months). 15 patients (10.7%) had surgery related to IBD: 2 UC vs 13 CD with median time to surgery 20 months (range 0–132). 2 patients were diagnosed with CD at emergency surgery. Colon cancer was diagnosed in 1 patient with L2B1 and curative resection undertaken. 4 deaths occurred: 1 from CLL (not on immunomodulation), 1 Klebsiella pneumonia on Azathioprine, 1 from cryptococcal meningitis on Azathioprine and Infliximab and 1 from metastatic prostate cancer.

Conclusion

We noted a higher prevalence of UC with left sided and pancolonic disease and a colonic phenotype in CD corroborating with data from the EPIMAD registry [1]. A large proportion of patients received immunomodulation, which is an area of concern and needs careful consideration. There is an urgent need for more data on disease presentation, natural history and treatment paradigms for the considered and optimal management of elderly patients with IBD.

References:

[1] Charpentier C et al, (2014), Natural history of elderly-onset inflammatory bowel disease: a population-based cohort study, Gut, 423–32