Incidence and Treatment of Patients Diagnosed With Inflammatory Bowel Diseases at 60 Years or Older in Sweden

Everhov, Åsa H; Halfvarson, Jonas; Myrelid, Pär; Sachs, Michael; Nordenvall, Caroline; Söderling, Jonas; Ekbom, Anders; Neovius, Martin; Ludvigsson, Jonas F.; Askling, Johan; Olén, Ola

doi:10.1053/j.gastro.2017.10.034

Cited by 175 publications

(210 citation statements)

References 56 publications

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“…Overall, it is estimated that up to 15% of patients have been diagnosed after the age of 60 years, while up to 20% of these patients have been diagnosed earlier and have transitioned into older age [4,6]. In the previously mentioned National cohort study in Sweden [11], more than 1 out of 5 incidents of CD (21%) and UC (24%) cases occurred in elderly individuals. Notably, new diagnoses of UC are generally more common in elderly males than in females, with reversed rates for newly diagnosed CD [8].…”

Section: Diagnosismentioning

confidence: 98%

“…A recently published National cohort study in Sweden has reported that 23% of subjects with diagnosed IBD had a first diagnosis of IBD at age ≥60 years and that in elderly patients, the IBD incident rate was 35/100,000 person/years (male: 37; female: 33) and was 10/100,000 for CD, 19/100,000 for UC, and 5/100,000 for IBD unclassified [11].…”

Section: Epidemiologymentioning

confidence: 99%

“…Elderly IBD patients have more frequent hospital admissions and may have substantially higher postoperative mortality and more complications than younger patients [11,37]. In particular, the risk of thrombotic complications of IBD during hospitalisation is increased in elderly IBD patients as a consequence of disease-related hypercoagulability, reduced mobility and dehydration [1].…”

Section: Medical Therapy: Therapeutic Approachesmentioning

confidence: 99%

“…Moreover, ageing CD patients treated with steroids are at a significantly increased risk for developing hypokalaemia and mental status changes [40,41]. Due to these reasons, it has been estimated that only 25-33% of elderly IBD patients are treated with corticosteroids [8], even though recent data from Sweden indicate these figures represent an underestimation of the cumulative exposure to steroids [11]. Although budesonide seems to be a preferable option as it interferes less with bone metabolism, repeated bone densitometry and vitamin D/calcium supplementation are still required for the prevention of bone loss.…”

Section: Corticosteroidsmentioning

confidence: 99%

“…However, it has been estimated that anti-TNF agents are used as part of maintenance therapy in less than 10% of older CD and only in 1-2% of older UC patients due to the risk of adverse effects or complications [4,11]. A recent observational retrospective study [44] has shown that elderly patients treated with anti-TNF have a significantly lower rate of short-term clinical response (68% in the elderly vs. 89% in younger patients) and a higher risk of severe adverse events than the younger patients receiving the same treatment.…”

Section: Immunomodulatorsmentioning

confidence: 99%

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The Management of Inflammatory Bowel Disease in Elderly: Current Evidence and Future Perspectives

2017

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Data on the elderly population with inflammatory bowel disease (IBD) are scarce, as this population is normally excluded from clinical trials. With an ageing population and an overall increasing prevalence of IBD; the incidence of IBD in elderly is rising. Comorbidities, wide differential diagnosis and polypharmacy make the diagnosis and management of the disease in elderly more challenging compared to that in younger adults. The knowledge of specific requirements for the management and treatment of IBD in advanced age may help in the framing of the definition of the appropriate care of this patient group. This manuscript reviews the most recent knowledge in the epidemiology, diagnosis and management of IBD in this population.

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Section: Diagnosismentioning

confidence: 98%

Section: Epidemiologymentioning

confidence: 99%

Section: Medical Therapy: Therapeutic Approachesmentioning

confidence: 99%

Section: Corticosteroidsmentioning

confidence: 99%

Section: Immunomodulatorsmentioning

confidence: 99%

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The Management of Inflammatory Bowel Disease in Elderly: Current Evidence and Future Perspectives

2017

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Association of Anti–Tumor Necrosis Factor Therapy With Mortality Among Veterans With Inflammatory Bowel Disease

et al. 2021

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Association of Childhood-Onset Inflammatory Bowel Disease With Risk of Psychiatric Disorders and Suicide Attempt

et al. 2019

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disease (IBD) has been associated with psychiatric morbidity in adults, although previous studies have not accounted for familial confounding. In children, IBD has an even more severe course, but the association between childhood-onset IBD and psychiatric morbidity remains unclear.OBJECTIVE To examine the risk of psychiatric morbidity in individuals with childhood-onset IBD, controlling for potential confounding shared between siblings. DESIGN, SETTING, AND PARTICIPANTSA population-based cohort study was conducted using data from the Swedish national health care and population registers of all children younger than 18 years born from 1973 to 2013. The study included 6464 individuals with a diagnosis of childhood-onset IBD (3228 with ulcerative colitis, 2536 with Crohn disease, and 700 with IBD unclassified) who were compared with 323 200 matched reference individuals from the general population and 6999 siblings of patients with IBD. Cox proportional hazards regression was used to estimate hazard ratios (HRs) with 95% CIs. Statistical analysis was performed from January 1, 1973, to December 1, 2013. MAIN OUTCOMES AND MEASURESThe primary outcome was any psychiatric disorder and suicide attempt. Secondary outcomes were the following specific psychiatric disorders: psychotic, mood, anxiety, eating, personality, and behavioral disorders; substance misuse; attention-deficit/hyperactivity disorder; autism spectrum disorders; and intellectual disability. RESULTSThe study included 6464 individuals with a diagnosis of childhood-onset IBD (2831 girls and 3633 boys; mean [SD] age at diagnosis of IBD, 13 [4] years). During a median follow-up time of 9 years, 1117 individuals with IBD (17.3%) received a diagnosis of any psychiatric disorder (incidence rate, 17.1 per 1000 person-years), compared with 38 044 of 323 200 individuals (11.8%) in the general population (incidence rate, 11.2 per 1000 person-years), corresponding to an HR of 1.6 (95% CI, 1.5-1.7), equaling 1 extra case of any psychiatric disorder per 170 person-years. Inflammatory bowel disease was significantly associated with suicide attempt (HR, 1.4; 95% CI, 1.2-1.7) as well as mood disorders (HR, 1.6; 95% CI, 1.4-1.7), anxiety disorders (HR, 1.9; 95% CI, 1.7-2.0) eating disorders (HR, 1.6; 95% CI, 1.3-2.0), personality disorders (HR, 1.4; 95% CI, 1.1-1.8), attention-deficit/hyperactivity disorder (HR, 1.2; 95% CI, 1.1-1.4), and autism spectrum disorders (HR, 1.4; 95% CI, 1.1-1.7) Results were similar for boys and girls. Hazard ratios for any psychiatric disorder were highest in the first year of follow-up but remained statistically significant after more than 5 years. Psychiatric disorders were particularly common for patients with very early-onset IBD (<6 years) and for patients with a parental psychiatric history. Results were largely confirmed by sibling comparison, with similar estimates noted for any psychiatric disorder (HR, 1.6; 95% CI, 1.5-1.8) and suicide attempt (HR, 1.7; 95% CI, 1.2-2.3). CONCLUSIONS AND RELEVANCEOverall, childhood-onset IBD was associa...

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Incidence and Treatment of Patients Diagnosed With Inflammatory Bowel Diseases at 60 Years or Older in Sweden

Cited by 175 publications

References 56 publications

The Management of Inflammatory Bowel Disease in Elderly: Current Evidence and Future Perspectives

The Management of Inflammatory Bowel Disease in Elderly: Current Evidence and Future Perspectives

Association of Anti–Tumor Necrosis Factor Therapy With Mortality Among Veterans With Inflammatory Bowel Disease

Association of Childhood-Onset Inflammatory Bowel Disease With Risk of Psychiatric Disorders and Suicide Attempt

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