Inflammatory bowel disease in the elderly: A focus on disease characteristics and treatment patterns

Abstract

Background: As the population ages, the number of elderly inflammatory bowel disease (IBD) patients is expected to increase. The clinical features and therapeutic options for young and old patients may differ, as elderly IBD patients are likely to have different comorbidities and disease characteristics. The goal of this study was to examine the clinical aspects and therapeutic choices for elderly Saudi IBD patients. Methods: We conducted a retrospective study aimed at describing the demographic, clinical, and management characteristics of IBD in elderly patients (≥60 years) who followed up at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia. The data was extracted from the KAUH inflammatory bowel disease information system (IBDIS) registry. The primary outcome was to describe disease characteristics in accordance with the Montréal classification and the secondary outcomes were to describe treatment patterns and identify significant clinical associations. Results: Our data were collected from 76 patients who fulfilled the study inclusion criteria. Females outnumbered males (53.9% vs 46.1%) and the mean age was 51.5 ± 9.7 years. Essential hypertension (26.3%) was the most common comorbidity followed by diabetes mellitus (23.6%), and malignant neoplasms (9.21%). More than half of the patients with Crohn’s disease (CD) had disease onset after forty years of age. The most common form of disease distribution was ileocolonic disease (64.7%). Less than 17% of patients had a penetrating disease phenotype. About 88 percent of patients with UC presented >40 years of age. Approximately, half of the cohort had left-sided ulcerative colitis (UC) (48%), followed by pancolitis (40%). The most prescribed medication class for IBD was 5-aminosalicylic acid (5-ASA) derivatives (56.58%) followed by corticosteroids and immunosuppressive drugs. Conclusions: In Saudi Arabia, age-specific concerns including comorbidities and polypharmacy remain the major challenges in the management of elderly IBD patients.

Selecting first-line advanced therapy for ulcerative colitis: A clinical application of personalized medicine

“…[ 37 ] However, some patients are diagnosed earlier or later. [ 37 ] For example, IBD is seldom diagnosed in older patients (>60 years of age) and is termed “Elderly-onset IBD.”[ 38 ] Furthermore, in improved healthcare worldwide, patients with IBD grow older with the disease and face the challenges of typical comorbidities that occur beyond 40. [ 39 ] Accordingly, age directly affects the selection of advanced treatment for UC.…”

IBD in the elderly - beware of pitfalls!

“…In this current issue of the Saudi Journal of Gastroenterology, Mosli and colleagues try to address this gap by conducting a retrospective single-center study of elderly IBD patients treated in Saudi Arabia. [ 8 ] The study’s primary objectives were to describe disease phenotype and treatment patterns among elderly IBD patients. The predominance of left-sided colitis and a lower prevalence of perianal disease and penetrating phenotype largely align with previously published literature.…”