Elderly-onset UC patients are increasing in number. These patients have higher risk of opportunistic infections, hospitalisation, colorectal cancer, and mortality than non-elderly-onset patients. Management and therapeutic strategies in this special group need careful attention.

Introduction Endoscopic transmural drainage (ED) or percutaneous drainage (PD) has mostly replaced surgery for the initial management of patients with symptomatic pancreatic fluid collections (PFCs). This study aimed to compare outcomes for patients undergoing ED or PD of symptomatic PFCs.MethodsBetween January 2000 and December 2013, all patients who required PD or ED of a PFC were included. Rates of treatment success, length of hospital stay, adverse events, re-interventions and length of follow-up were recorded retrospectively in all cases.ResultsIn total, 164 patients were included in the study; 109 patients underwent ED; and 55 had PD alone. During the 14-year study period, the incidence of ED increased and PD fell. In the 109 patients who were managed by ED, treatment success was considerably higher than in those managed by PD (70 vs. 31 %). Rates of procedural adverse events were higher in the ED cohort compared to the PD group (10 vs. 1 %), but patients managed by ED required fewer interventions (median of 1.8 vs. 3.3) had lower rates of residual collections (21 vs. 67 %) and need for surgical intervention (4 vs. 11 %). In the ED group, treatment success was similar for walled-off pancreatic necrosis (WOPN) and pseudocysts (67 vs. 72 %, P = 0.77). There were no procedure-related deaths.ConclusionCompared with PD, ED of symptomatic PFCs was associated with higher rates of treatment success, lower rates of re-intervention, including surgery and shorter lengths of hospital stay. Outcomes in WOPN were comparable to those in patients with pseudocysts.

Background Elderly-onset inflammatory bowel disease (IBD), defined as age ≥60 at diagnosis, is increasing worldwide. We aimed to compare clinical characteristics and natural history of elderly-onset IBD patients to adult-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 to adult-onset IBD patients. Results A total of 2413 patients were identified, of whom 270 (11.2%) had elderly-onset IBD. Median follow-up duration was 111 months (Interquartile range [IQR]: 68-165 months). Ratio of ulcerative colitis (UC): Crohn’s disease (CD) was higher in elderly-onset IBD than adult-onset IBD patients (3.82:1 vs. 1.39:1; p&0.001). Elderly-onset CD had less perianal involvement (5.4% vs. 25.4%; p&.001) than adult-onset. Elderly-onset IBD patients had significantly lower cumulative use of immunomodulators (p=0.001) and biologics (p=0.04). 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 (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). They also had increased number of overall hospitalization (OR: 1.14; 95% CI 1.09-1.20; p&0.001), infections-related hospitalization (OR: 1.87; 95% CI 1.47-2.38; p&0.001) and IBD-related hospitalization (OR: 1.09; 95% CI: 1.04- 1.15; p=0.001) compared to adult-onset IBD. Conclusion Elderly-onset IBD patients were associated with increased risk of infections, cancer development and increased infections- and IBD-related hospitalizations. Specific therapeutic strategies to target this special population is needed.

In a population-based study in Hong Kong, prevalence of IBD is lower than in the west although comparable to that of other East Asian countries. Complicated CD is common. Overall mortality remains low in Asians with IBD.

In the Chinese population, low-dose AZA is effective for maintaining remission in steroid-dependent UC patients. Standard-dose AZA was associated with more than threefold increased risk of leukopenia.

Hospitalization and 5-aminosalicylic acid usage accounted for 56% of total direct medical costs in the first 2 years of our newly diagnosed IBD patients. Direct health-care costs were higher in the first year compared with the second year of diagnosis. Surgery and low hemoglobin on presentation were associated with high cost outliers.

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