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P640 Characteristics of elderly onset Inflammatory Bowel Disease in a cohort of Hispanics

Ramos, L.(1);Anca, M.(1);Feliciano, K.(1);Amaya, C.(2);Perez, A.(3);Torres, E.A.(1);

(1)University of Puerto Rico School of Medicine, Medicine, San Juan, Puerto Rico;(2)University of Puerto Rico Graduate School of Public health, Epidemiology and Biostatitics, San Juan, Puerto Rico;(3)AbbVie, Medical Affairs, San Juan, Puerto Rico

Background

The incidence and prevalence of elderly-onset Inflammatory Bowel Disease (EO-IBD), defined as diagnosed >60 y/o, is increasing. The natural history of this cohort is unclear. Disease behavior in elderly patients may differ between adult onset IBD (AO-IBD) and EO-IBD. Comorbidities, age-related frailty and side effects of medications are challenges. We compare a cohort of Hispanic EO-IBD and elderly AO-IBD patients in the IBD Registry, a database collecting demographic and medical data of patients since 1995.

Methods

Of 1345 subjects,122 were ≥60 y/o at recruitment, including AO and EO subjects. Variables included age at diagnosis, gender, IBD type, family history of ulcerative colitis (UC) and Crohn’s disease (CD), disease extent, extraintestinal manifestations (EIM), surgery, and medications. Descriptive statistics were calculated for interval and ratio variables. Frequencies and percentages were calculated for nominal variables cross-tabulated by age of diagnosis. The study is approved by the IRB.

Results

Of the 122 subjects, 59 (48.4%) had AO-IBD and 63 (51.6%) EO-IBD. Mean age of diagnosis was 49.6 y/o for the AO group and 66.4 y/o for the EO group, disease duration was 15.37 yr for AO and 3.73 yr for EO (P<.001). Female gender was more frequent (52.5%: AO, 55.6%: EO-IBD). Most were non-smokers (AO: 57.6%, EO:54%). UC was more common (AO: 62.7%, EO: 60.3%). Family history of CD was low (AO: 6.8%, EO: 6.4%), while family history of UC was more frequent in AO-IBD (18.6% vs 12.7 % in EO-IBD). Small bowel CD was the most frequent (48%) in both groups. UC extension was most commonly pancolitis (AO:58%, EO: 41%. Corticosteroid and biologic use were higher in AO-IBD (see table). EIMs were reported by 41% of AO and 27% of EO, the most frequent was joint involvement (17% AO and 16% EO). Cancer was reported in 3.4% of AO-IBD and 1.6% of EO-IBD. Osteoporosis was reported on 14% of AO-IBD and only 2% in EO-IBD. Surgery was more frequent in the AO group, 41% (n = 24) vs 24% (n = 15) in EO.

Table 1. Medication use by IBD onset (AO vs EO)

Medication Adult-Onset N (%) Elderly-Onset N (%) P value
Corticosteroids 44 (74.6%) 41 (65.1%) .25
Immunomodulators 7 (11.9%) 9 (14.3%) .69
Biologics 24 (40.7%) 18 (28.6%) .15

Conclusion

Baseline characteristics, disease location and behavior were similar in AO and EO IBD groups. Use of corticosteroids, biologics and surgery were less frequent in the EO-IBD group (not significant). Whether these findings are related to a shorter disease duration, less severe disease or a more conservative management dictated by age and co-morbidities needs to be explored. Selecting the appropriate treatment option for elderly individuals is an important clinical issue.  

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