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P780 Medical treatment and surgery in patients with elderly-onset inflammatory bowel disease: 3-year follow-up of Epi-IBD 2010–2011 cohorts

V. Hernandez*1, J. Martinez-Cadilla1, E. Langholz2, D. Christodoulou3, S. Turcan4, D. Valpiani5, P. L. Lakatos6, Z. Vegh6, A. Goldis7, E. Belousova8, K. Ladefoged9, G. Kiudelis10, D. McNamara11, O. Shonova12, Z. Krznarić13, F. Magro14, E. S. Bjornsson15, S. Almer16, M. Fumery17, D. Duricova18, A. Kievit19, I. Kaimakliotis20, P. Ellul21, O. Niewiadomski22, M. Giannotta23, S. Odes24, N. Pedersen25, J. F. Dahlerup26, J. F. Dahlerup26, R. Salupere27, R. D'Incà28, R. D'Incà28, J. Halfvarson29, P. Oksanen30, N. Arebi31, K. R. Nielsen32, V. Andersen33, S. Shaji34, P. Munkholm35, J. Burisch35, Epi-IBD-group1

1Instituto de Investigación Sanitaria Galicia Sur. Hospital Alvaro Cunqueiro. EOXI Vigo, Gastroenterology, Vigo, Spain, 2Gentofte Hospital, Medical Gastroenterology, Copenhagen, Denmark, 3University Hospital Ioannina, 1st Division of Internal Medicine and Hepato-Gastroenterology Unit, Ioannina, Greece, 4State University of Medicine and Pharmacy of the Republic of Moldova, Gastroenterology, Chisinau, Moldova, Republic of, 5Morgagni Hospital, Gastroenterology and Digestive Endoscopy, Forli, Italy, 6Semmelweis University, 1st Department of Medicine, Budapest, Hungary, 7University of Medicine ‘Victor Babes’, Clinic of Gastroenterology, Timisoara, Romania, 8Moscow Regional Research Clinical Institute, Gastroenterology, Moscow, Russian Federation, 9Dronning Ingrids Hospital, Medical Department, Nuuk, Greenland, 10Lithuanian University of Health Sciences, Institute for Digestive Research, Kaunas, Lithuania, 11Adelaide and Meath Hospital, Gastroenterology, Dublin, Ireland, 12Hospital Ceské Budejovice, Gastroenterology, Ceské Budejovice, Czech Republic, 13University Hospital Center Zagreb, Gastroenterology, Zagreb, Croatia, 14Hospital de São João, Porto; Institute of Pharmacology and Therapeutics, Oporto Medical School and Institute for molecular and cell biology, Gastroenterology, Porto, Portugal, 1521Landspitali - The National University Hospital of Iceland, Gastroenterology, Reykjavik, Iceland, 16Karolinska Institutet, GastroCentrum, Stockholm, Sweden, 17Amiens University and Hospital, Epimad Registry, Gastroenterology Unit, Amiens, France, 18Charles University, IBD Center ISCARE, Prague, Czech Republic, 19Herning Central Hospital, Medicine, Herning, Denmark, 20Private Practice, Nicosia, Cyprus, 21Mater Dei Hospital, Gastroenterology, Msida, Malta, 22St Vincent's Hospital, Gastroenterology, Melbourne, Australia, 23AOU Careggi Regional Referral Center for Inflammatory Bowel Disease, Gastroenterology, Florence, Italy, 24Soroka Medical Center and Ben Gurion University of the Negev, Gastroenterology and Hepatology, Beer Sheva, Israel, 25Slagelse Hospital, Gastroenterology, Slagelse, Denmark, 26Arhus University Hospital, Medicine V (Hepatology and Gastroenterology), Arhus, Denmark, 27Tartu University Hospital, Endocrinology and Gastroenterology, Tartu, Estonia, 28Azienda Ospedaliera di Padova, Surgery, Oncology and Gastroenterology, Padova, Italy, 29Faculty of Medicine and Health, Gastroenterology, Orebro, Sweden, 30Tampere University Hospital, Gastroenterology and Alimentary Tract Surgery, Tampere, Finland, 31St. Mark's Hospital, Imperial College London, Gastroenterology, London, UK, 32The National Hospital of the Faroe Islands, Medical Department, Torshavn, Faroe Islands, 33Regional Hospital of Viborg, Medical Department, Viborg, Denmark, 34Hull and East Yorkshire NHS Trust, IBD Unit, Hull, UK, 35North Zealand University Hospital, Gastroenterology, Frederikssund, Denmark

Background

Previous reports have indicated that the treatment of patients with elderly-onset inflammatory bowel disease (IBD), defined as patients diagnosed ≥60 years, differs from that of younger patients. We aimed to assess the treatment of elderly-onset IBD during the first 3 years of follow-up, compared with IBD diagnosed in patients aged 15–39 and 40–59, in a European population-based inception cohort.

Methods

The EPI-IBD cohort is a prospective, population-based inception cohort of patients diagnosed 2010 and 2011 in 36 European and 1 Australian centres. For this study, data regarding disease characteristics and medical or surgical treatment during the first 3 years from diagnosis were analysed. All data were entered in a secure web-based database, www.epicom-ecco.eu. Patients were classified according to age at diagnosis into 15–39y, 40–59y and ≥60y. Medical treatment was assessed in each group and the time to biological and surgical treatment was analysed by Kaplan-Meyer curves. A Cox regression model was built to assess the influence of age at diagnosis in the need of biological treatment or surgery.

Results

In total, 2000 IBD patients (53.6% males) were included in the cohort, 747 (37.4%) CD, 1106 (55.3%) UC and 147 (7.4%) IBDU. Elderly-onset patients were more frequently diagnosed with UC compared with patients diagnosed at age 40–59y or 15–39y (62.9% vs. 56.3% vs. 52.6%, respectively, p = 0.006). In UC, the frequency of proctitis at diagnosis was lower, although non-statistically significant (16.2% vs. 24% vs. 23.2%, respectively, p = 0.087). In CD, elderly-onset patients more often had colonic location (38.1% vs. 29.0% vs. 22.6%, respectively, p = 0.022), while no differences were observed in disease behaviour. Elderly-onset patients were less frequently treated than the other age groups with immunomodulators (19.6% vs. 31.4% vs. 40.5%, respectively, p < 0.001) and biologicals (3.6% vs. 10.6% vs. 15.5%, respectively, p < 0.01). Biologicals were less prescribed in elderly-onset patients in both CD (7% vs. 20.9% vs. 25%, respectively, p < 0.001) and UC (2.4% vs. 5.1% vs. 9.5%, respectively, p = 0.001). No difference was found in the need of surgery among the age groups (7.7% vs. 9.7% vs. 9.1%, respectively, p = 0.617).

Conclusion

In this large population-based inception cohort, elderly-onset IBD patients were less aggressively treated than younger patients. This finding may reflect a less severe disease course in elderly-onset IBD.