Age at Diagnosis Is Determinant for the Outcome of Inflammatory Bowel Disease: Is It a Myth?

Abstract

INTRODUCTION: Patients with elderly-onset inflammatory bowel disease were previously associated with a less aggressive course of the disease. However, there are conflicting data that need further validation. We aimed to determine the association between age at diagnosis and the development of progressive disease in patients with Crohn's disease (CD) and ulcerative colitis (UC). METHODS: This cohort study included patients with CD and UC followed in 6 secondary and tertiary care centers in mainland Portugal. Patients were divided into a derivation (80%) cohort and a validation (20%) cohort. The primary outcome was progressive disease. Logistic regression analysis, receiver operating characteristic curves, and the areas under the curve (AUC) were performed. Odds ratios with 95% confidence intervals (CIs) were estimated. RESULTS: The derivation cohorts included 1245 patients with CD (68% with progressive disease) and 1210 patients with UC (37% with progressive disease), whereas the validation cohorts included 302 patients with CD and 271 patients with UC, respectively, with similar outcome proportions. In our final model, age at diagnosis older than 60 years was significantly associated with a lower risk of developing progressive disease (odds ratio 0.390, 95% CI 0.164–0.923, P = 0.032), with a high discriminative power (AUC 0.724, 95% CI 0.693–754) in patients with CD. However, according to this model, no significant associations were found between age at diagnosis and the risk of developing progressive disease in patients with UC. No differences were observed in the AUC values between the validation and the derivation cohorts. DISCUSSION: Patients with elderly-onset CD, but not patients with UC, were associated with a less progressive course of the disease.

Impact of age at diagnosis on long‐term prognosis in patients with intestinal Behçet's disease

“…27 Similarly, younger patients diagnosed with CD have an increased risk for surgery and poor outcomes. 7,16 In addition, although the difference was not statistically significant, the number of patients who underwent ≥ 2 surgeries was higher in the early-onset group (9.5%) than in the adult-onset (5.8%) and late-onset (1.1%) groups. Because the early-onset intestinal BD group had a higher risk for intestinal surgery than the adult-onset or late-onset groups, clinicians should strictly control inflammation in the early-onset intestinal BD group.…”

“…Thiopurines are relatively effective in maintaining clinical remission and preventing postoperative recurrence. 35,36 Similarly, patients with CD, who were diagnosed at a younger age, have a higher risk for complicated diseases, 15,16 such as strictures, relapse, surgery, and even mortality, suggesting that young age is an independent predictive factor for poor prognosis. Lower drug compliance in younger patients, 37 diminished CD-4-mediated and CD-8-mediated immune response, 38,39 and decreased new lymphocyte production in patients with advanced age 15 have often been considered the causes of poor disease prognosis in young patients.…”

“…Many studies have consistently reported that age at disease onset is associated with the prognosis for CD 7,15 ; however, the results are inconsistent for ulcerative colitis. 7,16,17 CD diagnosed in pediatric patients has an aggressive disease course and often exhibits poor response to conventional treatments, thus requiring immunosuppressants or biologics immediately after diagnosis. [18][19][20] However, little is known about its effect on the long-term prognosis of intestinal BD.…”

“…steroid dependency or refractoriness 7,9 of ulcerative colitis, perianal involvement, 11,12 stricturing or fistulating disease behavior, 13,14 and young age at diagnosis 12,14 in Crohn's disease (CD) have been identified as predictors of prognosis. Many studies have consistently reported that age at disease onset is associated with the prognosis for CD 7,15 ; however, the results are inconsistent for ulcerative colitis 7,16,17 . CD diagnosed in pediatric patients has an aggressive disease course and often exhibits poor response to conventional treatments, thus requiring immunosuppressants or biologics immediately after diagnosis 18–20 .…”

Clinical Features of Crohn’s Disease Stratified by Age at Diagnosis According to Montreal Classification

“…A study had indicated that age at diagnosis could affect the outcome of elderly-onset CD patients. 6 It had been found that early-onset CD was different from late-onset CD in clinical outcomes and nutritional status. 7 In addition, the lifetime costs of CD patients were associated with their age at diagnosis.…”