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Poster presentations: Clinical: Diagnosis and Outcome 2020

P239 Elderly-onset inflammatory bowel disease is associated with higher risks of infections, cancers and hospitalisation: Results from a territory-wide Hong Kong IBD registry

J.W.Y. Mak1, L.T.C. Ho2, K. Wong1, T.Y. Cheng1, T.C.F. Yip1, W.K. Leung3, M. Li4, F.H. Lo5, K.M. Ng6, S.F. Sze7, C.M. Leung8, S.W.C. Tsang9, E.H.S. Shan10, K.H. Chan11, B.C.Y. Lam12, A.J. Hui13, W.H. Chow14, S.C. Ng1, Hong Kong IBD Registry

1Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Hong Kong, China, 2Department of Medicine, Imperial College London, London, UK, 3Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong, China, 4Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong, Hong Kong, China, 5Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong, Hong Kong, China, 6Department of Medicine and Geriatrics, Prince Margaret Hospital, Hong Kong, Hong Kong, China, 7Queen Elizabeth Hospital, Department of Medicine, Hong Kong, Hong Kong, China, 8Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong, Hong Kong, China, 9Department of Medicine, Tseung Kwan O Hospital, Hong Kong, Hong Kong, China, 10Department of Acute and Rehabilitative Medicine and Geriatrics, Caritas Medical Centre, Hong Kong, Hong Kong, China, 11Department of Medicine, North District Hospital, Hong Kong, Hong Kong, China, 12Department of Medicine and Geriatrics, Kwong Wah Hospital, Hong Kong, Hong Kong, China, 13Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, Hong Kong, China, 14Department of Medicine, Yan Chai Hospital, Hong Kong, Hong Kong, China

Background

Incidence of elderly-onset inflammatory bowel disease (IBD), defined as age ≥ 60 at diagnosis, is increasing rapidly worldwide. We aimed to compare the clinical characteristics and natural history of elderly onset IBD patients to non-elderly onset IBD patients.

Methods

Patients with a confirmed diagnosis of IBD from 1981 to 2016 were identified from a territory-wide Hong Kong IBD registry involving 13 hospitals. Demographics, comorbidities, clinical features and outcomes of elderly-onset IBD patients were compared with non-elderly onset IBD patients.

Results

Total 2413 patients were identified, of whom 270 (11.2%) had elderly-onset IBD during 21805 person-years follow-up. Median follow-up duration was 111 months (Interquartile range [IQR]: 68–165 months). The ratio of ulcerative colitis (UC): Crohn’s disease (CD) was higher in elderly-onset IBD than non-elderly onset IBD patients. (3.82:1 vs. 1.39:1; p < 0.001). Elderly-onset Crohn’s disease (CD) had less perianal involvement (5.4% vs. 25.4%; p < .001) but more stricturing phenotype (32.1% vs. 20.5%; p = 0.04) than non-elderly onset. There was no difference in the rate of cumulative use of biologics (p = 0.49), but significantly lower use of immunosuppressants in elderly-onset IBD patients (p = 0.001). Cumulative risk of IBD-related surgeries was similar (p = 0.89). Elderly-onset IBD was associated with higher risks of cytomegalovirus colitis (Odds ratio [OR]: 3.07; 95% Confidence Interval (CI) 1.92–4.89; p < 0.001); herpes zoster infections (OR: 2.42; 95% CI: 1.22–4.80; p = 0.12) and all cancer development (Hazard ratio: 2.97; 95% CI: 1.84–4.79; p < 0.001). Elderly-onset IBD was also associated with increased number of overall hospitalisation (OR: 1.14; 95% CI 1.09–1.20; p < 0.001), increased number of infections-related hospitalisation (OR: 1.87; 95% CI 1.47–2.38; p < 0.001) and longer hospitalisation (OR: 1.004; 95% CI: 1.001- 1.007; p = 0.007) compared with non-elderly onset IBD.

Conclusion

Elderly-onset IBD has less perianal CD. However, they have significantly more comorbidities and are associated with increased risk of infections, cancer development and increased and prolonged hospitalisations. Specific therapeutic strategies are needed in this special group of patients.