This ECCO topical review of the European Crohn's and Colitis Organisation [ECCO] focuses on the epidemiology, pathophysiology, diagnosis, management and outcome of the two most common forms of inflammatory bowel disease, Crohn's disease and ulcerative colitis, in elderly patients. The objective was to reach expert consensus to provide evidence-based guidance for clinical practice.

EO IBD is rising, warranting physicians' alertness for IBD in elderly patients. The long-term outcome was not different from AO disease, despite a less frequent use of immunomodulators and biologicals.

Over the past two decades, a reduction in early colectomy rate was observed, with no further reduction in the most recent era. Late colectomy rate and hospitalisation rate remained unchanged over time.

No abstract

Over the past two decades, the risk of developing a perianal fistula was stable, as well as its recurrence rate, underlining the lasting need for improving treatment strategies for this invalidating condition.

The management of inflammatory bowel disease (IBD) has changed since the mid-1990s (e.g., use of thiopurines/anti-TNFα agents, improved surveillance programs), possibly affecting cancer risk. To establish current cancer risk in IBD, updates are warranted from cohorts covering this time span, and detailed enough to study associations with phenotype and medication. We studied intestinal-, extra-intestinal- and overall cancer risk in the Dutch population-based IBDSL cohort. In total, 1,157 Crohn's disease (CD) and 1,644 ulcerative colitis (UC) patients were diagnosed between 1991 and 2011, and followed until 2013. Standardized incidence ratios (SIRs) were calculated for CD and UC separately, as well as for gender-, phenotype-, disease duration-, diagnosis era- and medication groups. We found an increased risk for colorectal cancer in CD patients with colon involvement (SIR 2.97; 95% CI 1.08-6.46), but not in the total CD or UC population. In addition, CD patients were at increased risk for hematologic- (2.41; 1.04-4.76), overall skin- (1.55; 1.06-2.19), skin squamous cell- (SCC; 3.83; 1.83-7.04) and overall cancer (1.28; 1.01-1.60), whereas UC patients had no increased risk for extra-intestinal- and overall cancer. Finally, in a medication analysis on CD and UC together, long-term immunosuppression exposure (>12 months) was associated with an increased risk for hematologic cancer, non-Hodgkin lymphoma, SCC and overall cancer, and this increase was mainly attributed to thiopurines. IBD patients with long-term immunosuppression exposure can be considered as having a higher cancer risk, and our data support the advice in recent IBD guidelines to consider skin cancer screening in these patients.

Background and aims Real-life data on long-term disease activity in Crohn’s disease (CD) are scarce. Most studies describe disease course by using proxies, such as drug exposure, need for surgery or hospitalisations, and disease progression. We aimed to describe disease course by long-term disease activity and identify distinctive disease activity patterns in the population-based IBD South Limburg cohort (IBDSL). Methods All CD patients in IBDSL with ≥10 years follow-up (n=432) were included. Disease activity was defined for each yearly quarter by mucosal inflammation on endoscopy or imaging, hospitalisation, surgery or treatment adjustment for increased symptoms. Six distinct disease activity clusters were defined. Subsequently, the association between clinical characteristics and the patterns were assessed using multivariable logistic regression models. Results On average, patients experienced 5.44 (SD 3.96) quarters of disease activity during the first 10 years after diagnosis. Notably, 28.2% of the patients was classified to a quiescent pattern (≤2 active quarters in 10 years), and 89.8% of those never received immunomodulators nor biologicals. Surgery at diagnosis (OR 2.99; 95%-CI 1.07-8.34) and higher age (OR 1.03; 95%CI 1.01-1.06) were positively associated with the quiescent pattern, whereas inverse associations were observed for ileocolonic location (OR 0.44; 95%CI 0.19-1.00), smoking (OR 0.43; 95%CI 0.24-0.76) and need for steroids <6 months (OR 0.24; 95%CI 0.11-0.52). Conclusions Considering long-term disease activity, 28.2% of CD patients was classified to a quiescent cluster. Given the complex risk-benefit balance of immunosuppressive drugs, our findings underline the importance to identify better predictive markers to prevent both overtreatment and undertreatment.