Elderly-onset vs adult-onset ulcerative colitis: a different natural history?

Abstract

Background: Incidence of ulcerative colitis (UC) in elderly population is increasing because of ageing and because of its minimal impact on life span. Data on natural history, outcomes and therapeutic strategies are limited. Our aim is to characterize UC in elderly-onset patients followed at our Inflammatory Bowel Disease outpatient clinic and compare with adult-onset UC. Methods: From January 2000 to June 2019, 94 patients with UC diagnosed after the age of 65 years (elderly group, E-O) were identified and matched 1-1 according to gender and calendar year of diagnosis with patients diagnosed with UC at age between 40 and 64 years (adult age, A-O). Results: Comorbidity Index (3.8 vs 1.6, p < 0.0005) was higher for elderly UC patients. Symptoms at presentation were similar between the two groups, although abdominal pain was more common in adults, and weight loss was more common in the elderly. At diagnosis, left colitis (61% vs 39%) and proctitis (14% vs 26%) (p = 0.011) were more frequent in the elderly. Therapy and clinical behaviour were similar. Surgery was more frequently performed in the elderly (20% vs 9%, p = 0.02), while biological therapy was less used (2.1% vs 22%, p < 0.0005). Complications were more frequent in the elderly. Extraintestinal manifestations were lower in elderly patients (9.6% vs 19.2%, p = 0.061). Time to first relapse was similar between the two groups. Mortality (p < 0.0005) was higher in elderly patients. Conclusions: Ulcerative Colitis has similar presentation and behaviour in elderly and adults patients. However, the elderly are more fragile because of comorbidities, increased risk of infections and disease-related complications.

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

“…Second, we did not collect data on the comorbidities including malignancies and infections that may affect UC outcomes in this study. However, unlike the previous studies that reported a worse prognosis of EOUC than of N-EOUC, 12 - 14 the results of the present study may suggest that EOUC does not have an aggressive disease course compared to that of N-EOUC despite the possibility of a higher burden of comorbidities in patients with EOUC than in those with N-EOUC. Third, whether the findings of this study can be generalized to other Asian populations remains unclear, considering that there are genotypic and phenotypical variations in IBD among Asian countries.…”

“… 7 , 17 , 19 , 25 Meanwhile, referral center-based studies from both Western and Eastern countries showed higher cumulative rates of colectomy in the EOUC group than in the N-EOUC group. 12 - 14 Also, recent multicenter studies from Hong Kong showed that EO-IBD patients had a higher risk of infection, cancer, and hospitalization. 15 , 16 Although the cause of this discrepancies among results is unclear, differences in the study design (referral center-based vs population-based) may play a critical role.…”

“…Previous studies have suggested that patients with EOUC may have an aggressive disease course, such as higher probabilities of colectomy, compared to those with N-EOUC. 12 - 14 Also, recent multicenter studies from Hong Kong reported the poor outcomes of EO-IBD. 15 , 16 However, these studies used a referral center-based design, resulting in an inherent risk of referral bias.…”

Clinical characteristics of ulcerative colitis in elderly patients

“…Studies showed that elderly UC patients were more likely to be male and less likely to have a family history of inflammatory bowel disease (IBD) or extraintestinal manifestations 10,11 . Similar to the symptoms in younger patients, older UC patients typically present abdominal pain, fecal urgency, and bloody diarrhea, and there are no significant changes in symptomatic severities between the two groups 12 .…”

Innate Priming of Neutrophils Potentiates Systemic Multiorgan Injury

“…Using a well-controlled model of experimental systemic inflammation and multiorgan injury triggered by controlled administration of gut-damaging chemical dextran sulfate sodium (DSS), we, in this study, examined the effect of preconditioning with subclinical endotoxemia on the priming of neutrophils in vivo as well as the development of systemic inflammation and multiorgan damage. Previous studies suggest that pre-existing conditions such as obesity and aging increase the risk for more severe ulcerative colitis as well as subsequent comorbidity risks, including sepsis ( 10 – 12 ). Subclinical endotoxemia manifests in humans with obesity and ageing ( 13 – 15 ), which may precondition innate immune system for aggravated systemic inflammation and organ damage following subsequent ulcerative colitic injury.…”