Geriatric Inflammatory Bowel Disease: Phenotypic Presentation, Treatment Patterns, Nutritional Status, Outcomes, and Comorbidity

Abstract

Geriatric patients diagnosed with CD earlier in life had greater small bowel involvement compared with new onset geriatric CD. There is low utilization of immunomodulator and biologic agents in geriatric IBD patients. Duration of CD correlates with nutrient deficiency. Prospective studies are warranted in this respect.

The microbiota in inflammatory bowel disease

“…2, Table 3). The largest study to date in a treatment-naïve cohort of paediatric patients with CD [61], in whom analysis of mucusol and lumen-associated microbiota was performed, confirms that inflammation 17 % of patients with CD in an Irish cohort were obese compared with 12 % of controls [47] Increased weight of patients with CD enrolling in clinical trials (1991-2008) [48] 23 % of paediatric patients with IBD in the USA were found to be overweight or obese [49] Decreased rate of surgery Cumulative probability of first major surgery at 9 years decreased from 50 % (1979-1986) to 23 % (2003-2011) in patients with CD, and from 14 to 9 % in patients with UC [50] Decreased risk of surgery in patients in whom CD was diagnosed after 1996, associated with increased specialist care [51] Increasing prevalence of elderly-onset IBD Increased proportion of colonic disease and inflammatory behaviour in elderly patients with CD [52,53] Progression of disease behaviour less than in younger patients. Milder disease course [52] BMI body mass index, CD Crohn's disease, UC ulcerative colitis J Gastroenterol (2015) 50:495-507 499 is strongly associated with an overall drop in species diversity and alterations in the abundance of several taxa.…”

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

“…A retrospective study conducted in the US has shown that ≥40 and 35% of elderly pa- tients use IBD maintenance treatment with 5-ASA and corticosteroids, respectively, compared to a low utilisation of immunomodulator and biologic agents. On average, elderly patients with IBD used a mean number of 7 concomitant drugs [38]. Although the use of each drug class is associated with its own specific risks, advanced age and the presence of comorbidities are risk factors for infections in IBD patients, irrespective of the type of treatment.…”

“…The half-life of 5-ASA derivatives can be increased in the elderly due to a reduction in glomerular filtration and renal clearance. Due to this, the monitoring of renal function during 5-ASA therapy is required, especially in patients with pre-existing renal impairment, or in the case of concomitant use of other potentially nephrotoxic drugs [38]. Other important interactions of mesalazine with drugs commonly used in the elderly include digoxin (reduced serum concentration and efficacy), hydralazine and the second generation of anti-tuberculosis drugs (increased serum concentration and risk of adverse effects) [9].…”

“…6-mercaptopurine or azathioprine is used in approximately 6% DOI: 10.1159/000490053 of cases, with only 1% of patients receiving methotrexate [38]. This low use of immune-modifying agents is likely to be due to the risk of severe adverse effects and the requirements for blood test monitoring, especially in elderly patients.…”

Enfermedad inflamatoria intestinal en pacientes mayores de 60 años: ¿es una enfermedad diferente?

“…En nuestro estudio, el compromiso colónico en EC fue la localización más frecuente, tanto en pacientes > 60 años como en aquellos diagnosticados antes de esa edad. Estos resultados son similares a los publicados en la literatura 2,3,17-19 , con excepción Juneja et al, quienes determinaron un mayor porcentaje de compromiso de intestino delgado 20 . Además, el fenotipo no penetrante/no estenosante (inflamatorio) fue más frecuente en pacientes > 60 años (73,7%) y también en pacientes que son diagnosticados sobre esa edad (77,8%), entendiendo que el fenotipo inflamatorio es el menos agresivo 3,9,11 .…”