Clinical Characteristics and Long-term Prognosis of Elderly-Onset Ulcerative Colitis in a Population-Based Cohort in the Songpa-Kangdong District of Seoul, Korea

Abstract

Background/Aims We aimed to evaluate the clinical characteristics and long-term prognosis of elderly-onset ulcerative colitis (EOUC) in Korean patients over a 30-year period using a well-established population-based cohort in the Songpa-Kangdong district of Seoul, Korea. Methods Clinical characteristics and prognosis were compared between two groups EOUC, defined as UC diagnosed in individuals aged ≥60 years and non-EOUC (N-EOUC), defined as UC diagnosed in individuals aged 18 to 59 years. Results We identified 99 patients with EOUC (10.3%) and 866 patients with N-EOUC (89.7%) between 1986 and 2015. During the median follow-up of 104.5 months, the overall exposure to medications was comparable between patients with EOUC and N-EOUC (p=0.091 for corticosteroids, p=0.794 for thiopurines, and p=0.095 for anti-tumor necrosis factor agents). The cumulative risks of disease outcomes were also comparable between patients with EOUC and N-EOUC (22.4% vs 30.4% for proximal disease extension [p=0.351], 11.9% vs 18.1% for hospitalization [p=0.240], and 2.3% vs 1.8% for colectomy [p=0.977]) at 10 years after diagnosis. Multivariate Cox regression analysis revealed that corticosteroid use at diagnosis was an independent predictor of proximal disease extension (hazard ratio [HR], 6.216; 95% confidence interval [CI], 1.314 to 28.826) and hospitalization (HR, 11.241; 95% CI, 3.027 to 41.742) in patients with EOUC. Conclusions In this population-based study from Korea, the pattern of medication use seemed comparable between the EOUC and N-EOUC groups. Moreover, patients with EOUC and those with N-EOUC have a similar disease course in terms of proximal disease extension, hospitalization, and colectomy. (Gut Liver 2021;15-751)

Ulcerative Colitis in Adulthood and in Older Patients: Same Disease, Same Outcome, Same Risks?

“…Concerning disease extension at diagnosis (Table 1 ), in a meta-analysis from 2016, left-sided colitis prevails in older-onset disease [ 14 ]. This finding was confirmed by subsequent studies [ 4 , 15 – 17 ], whereas in other studies, extensive colitis [ 18 ] or proctitis [ 19 , 20 ] were more frequent in late-onset UC. Some studies found significant differences for disease extension at diagnosis between adult- versus late-onset UC [ 3 , 4 , 6 , 8 , 9 , 16 , 17 , 21 , 22 ], whereas others did not find such differences [ 15 , 18 – 20 ].…”

“…Severity of disease at onset seems to be similar between adult- and late-onset UC [ 20 , 22 ] with similar steroid needs at onset [ 3 , 14 – 16 ]; in a former report, a more protracted first episode was found together with a shorter duration of remission compared with young adult-onset disease [ 23 ].…”

Clinical characteristics of ulcerative colitis in elderly patients

“…There are many reports that the hospitalization rate of elderly UC patients is significantly higher than that of non‐elderly UC patients 12,19,20 . In an accompanying article by Moroi et al (a Nationwide Study from Japan), the rate of in‐hospital death of elderly patients is higher 21 .…”

“…There are many reports that the hospitalization rate of elderly UC patients is significantly higher than that of non‐elderly UC patients. 12 , 19 , 20 In an accompanying article by Moroi et al (a Nationwide Study from Japan), the rate of in‐hospital death of elderly patients is higher. 21 One of the reasons of worse outcomes is that older‐onset UC patients have less chances of receiving strong immunosuppressive therapies considering the comorbidities and adverse events such as infections.…”

Is the Long-term Disease Course of Elderly-Onset Ulcerative Colitis Different from That of Non-Elderly-Onset Ulcerative Colitis?

“…In the current issue, Park et al 9 reported data comparing clinical characteristics and long-term disease course of EOUC with those of non-EOUC in a well-established population-based cohort in Korea. This cohort study included 99 patients with EOUC and 866 patients with non-EOUC between 1986 and 2015.…”