Challenges in the Diagnosis and Management of Inflammatory Bowel Disease in the Elderly

Taleban, Sasha

doi:10.1007/s11938-015-0059-6

Cited by 20 publications

(15 citation statements)

References 93 publications

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“…Although previous literature suggests that the older-onset patients have more systemic corticosteroid use 14, 16, 17 , our data do not support this. It is notable that older-onset CD patients had less lifetime exposure to systemic corticosteroids compared to the young and younger-onset CD patients.…”

Section: Discussioncontrasting

confidence: 99%

Inflammatory Bowel Disease is Similar in Patients with Older Onset and Younger Onset

Kochar

Long

Galanko

et al. 2017

Inflammatory Bowel Diseases

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Background As the American population is aging, the number of older people with IBD is increasing. We used clinical data from the Sinai-Helmsley Alliance for Research Excellence (SHARE), a prospective cohort, to examine disease and treatment differences in older adults. Methods We performed a cross-sectional study assessing demographics and disease behavior by age at diagnosis with univariate, bivariate and multivariate analyses. “Older-onset” patients were diagnosed after age 60, “younger-onset” patients were diagnosed before age 60, but are older than 60 years and the remainder were “young”. Results There were 91 older-onset, 389 younger-onset and 3431 young Crohn's disease (CD) patients. Older-onset patients had more ileal (37%) and colonic (27%) disease compared to younger-onset and young patients. There were no differences in disease behavior, location or surgeries between older-onset and young CD patients within 5 years of diagnosis. Older-onset patients with inflammatory disease had a higher odds of being in remission. Young patients reported more anti-TNF and thiopurine use compared to younger-onset and older-onset patients (p <0.01). There were 98 older-onset, 218 younger-onset and 1702 young ulcerative colitis (UC) patients. There were no differences in disease extent, activity index or surgeries. Young UC patients reported more anti-TNF use (26%) compared to younger-onset patients (17%, p <0.01). Conclusions Disease behavior or location were not different between younger and older adults with IBD. Older patients were less likely to be treated with immunosuppression. If older patients have similar disease behavior, less frequent treatment with immunosuppressives may risk sub-optimally controlled disease.

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Section: Discussioncontrasting

confidence: 99%

Inflammatory Bowel Disease is Similar in Patients with Older Onset and Younger Onset

Kochar

Long

Galanko

et al. 2017

Inflammatory Bowel Diseases

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“…8, 9, 30 Biologic agents are used less frequently, in spite of literature supporting efficacy in moderate-to-severe CD and UC. Delays in starting appropriate steroid-sparing therapies may contribute to the potentially lower therapeutic efficacy seen in the few studies available, as well as the increased rates of adverse events.…”

Section: Discussionmentioning

confidence: 99%

Medication Utilization and the Impact of Continued Corticosteroid Use on Patient-reported Outcomes in Older Patients with Inflammatory Bowel Disease

Geisz

Kappelman

et al. 2016

Inflammatory Bowel Diseases

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Background Older individuals with inflammatory bowel disease (IBD) require ongoing medications. We aimed to describe 1) medication use in older and younger IBD patients and 2) medication associations with patient reported outcomes (PRO’s) in older patients. Methods We conducted cross-sectional and longitudinal analyses within CCFA Partners internet-based cohort of patients with self-reported IBD. We assessed medication use by disease sub-type and age. We used bivariate analyses to 1) compare medication use in older and younger patients and 2) determine associations between continued steroid use and PRO’s in older patients. Results We included 5382 participants with IBD; 1004 were older (≥ age 60). Older patients with Crohn’s disease (CD) had lower anti-tumor necrosis factor alpha (anti-TNF) use at baseline (29.1% vs 44.3%, p<0.001), comparable steroid use (16.0% vs. 16.5%, p=0.77), and higher aminosalicylate use (40.3% vs. 33.9%, p=0.003) versus younger patients. Older ulcerative colitis (UC) patients had similar anti-TNF use (16.0% vs. 19.2%, p=0.16), lower steroid use (9.6% vs. 15.4%, p=0.004) and higher aminosalicylate use (73.8% vs. 68.2%, p=0.04) at baseline. In longitudinal analyses, older CD patients had higher continued steroid use (11.6% vs. 7.8%, p=0.002); which was associated with worsened anxiety (p=0.02), sleep (p=0.01), and fatigue (p=0.001) versus non-use. Older CD patients on steroids, versus anti-TNF or immunomodulators, had increased depression (p=0.04) and anxiety (p=0.03). Conclusions Medication utilization differs in older patients with IBD. Older CD patients have higher continued steroid use; associated with worsened PRO’s. As in younger IBD populations; continued steroid use should be limited in older patients.

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“…3 Data which have identified clusters of infected individuals 5,6 with similar DNA signatures 7 is consistent with spread of infection between cluster members and/or an environmental exposure which is common to the cluster. If that is the case, our current "case finding" approach to H. pylori infection is unlikely to lead to a decrease in recurrence rates.…”

Section: Acknowledg Ementsmentioning

confidence: 78%

“…4 Evidence-based treatment strategies are scarce, because these patients have typically been excluded from efficacy studies. 5 Our study, which analyses risk factors for myelosuppression and infections in patients with a normal TPMT genotype, is a post-hoc analysis of the TOPIC trial. The TOPIC trial was designed to represent a real life population, including the elderly patient with IBD.…”

mentioning

confidence: 99%

Editorial: thiopurine‐induced myelosuppression and infections in inflammatory bowel disease patients with a normal TPMT genotype—the perils of ageing. Authors’ reply

Broekman

Wanten

Jong

2017

Aliment Pharmacol Ther

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Challenges in the Diagnosis and Management of Inflammatory Bowel Disease in the Elderly

Cited by 20 publications

References 93 publications

Inflammatory Bowel Disease is Similar in Patients with Older Onset and Younger Onset

Inflammatory Bowel Disease is Similar in Patients with Older Onset and Younger Onset

Medication Utilization and the Impact of Continued Corticosteroid Use on Patient-reported Outcomes in Older Patients with Inflammatory Bowel Disease

Editorial: thiopurine‐induced myelosuppression and infections in inflammatory bowel disease patients with a normal TPMT genotype—the perils of ageing. Authors’ reply

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