Inflammatory Bowel Diseases in the Elderly

Swaroop, Prabhakar

doi:10.1016/j.cger.2007.06.007

Cited by 11 publications

(8 citation statements)

References 85 publications

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“…In relative terms (with respect to total IBD cases), in the largest population‐based study of elderly onset IBD reported to date, 1/20 incident cases of CD and 1/8 incident cases of UC occurred in people aged >60 years . In summary, studies have shown that 10–15% of cases of IBD are diagnosed in patients aged ≥60 years …”

Section: Frequency Of Ibd In the Elderlymentioning

confidence: 93%

“…However, this proposal remains open to debate and has not been confirmed in population studies using strict radiological and endoscopic diagnostic criteria . Thus, the traditional bimodal distribution of IBD was not uniformly seen in recent epidemiological studies . Misdiagnosis leads to confusion with acute self‐limiting infectious colitis, ischaemia or bowel changes associated with nonsteroidal anti‐inflammatory drugs (NSAIDs) and can therefore confound studies on the epidemiology of IBD in the elderly …”

Section: Frequency Of Ibd In the Elderlymentioning

confidence: 99%

“…Concomitant malabsorption and nutritional deprivation of vitamin D and calcium frequently affects the elderly . Therefore, elderly patients receiving long‐term corticosteroid therapy should undergo baseline assessment of bone density, and use of bisphosphonates should be considered along with vitamin D and calcium supplementation …”

Section: Medical Treatmentmentioning

confidence: 99%

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Systematic review with meta‐analysis: inflammatory bowel disease in the elderly

Gisbert

Chaparro

2014

Aliment Pharmacol Ther

140

102

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Section: Frequency Of Ibd In the Elderlymentioning

confidence: 93%

Section: Frequency Of Ibd In the Elderlymentioning

confidence: 99%

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Systematic review with meta‐analysis: inflammatory bowel disease in the elderly

Gisbert

Chaparro

2014

Aliment Pharmacol Ther

140

102

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“…(37) The prevalence of malabsorption and calcium and vitamin D deficiency in the elderly emphasizes the importance of early and regular bone densitometry assessments, and use of bisphosphonates should be considered along with vitamin D and calcium supplementation. (39) Other concerns with chronic steroid use are increased risks of hyperglycemia and diabetes, both already common conditions in the elderly. (40, 41) In a case control study of CD patients aged >50 years, the relative risk (RR) for developing hyperglycemia after steroid therapy demonstrated a numerical but not statistically significant increase relative to younger patients (RR: 1.53; 95% CI: 0.54–4.32).…”

Section: Medical Management In Elderly Ibd Patientsmentioning

confidence: 99%

Management of Inflammatory Bowel Disease in the Elderly Patient

Ananthakrishnan

Donaldson

Lasch

et al. 2017

Inflammatory Bowel Diseases

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The population of older patients with inflammatory bowel disease (IBD) continues to grow, partly reflecting the aging global population in general. The debilitating effects of IBD compound age-related decrements in health and functional capacity, and make the medical management of older patients with Crohn’s disease and ulcerative colitis distinctly challenging to clinicians. Here, we review the recent literature describing the pharmacologic management of IBD in this population, with focus on the safety, tolerability, and efficacy of common treatment options, such as steroids, immunomodulators, tumor necrosis factor-α antagonists, and integrin antagonists; surgical interventions in older patients are also discussed. Few studies have systematically and prospectively evaluated the clinical challenges in the medical management of IBD in this patient population, leaving a limited evidence base to which clinicians can turn to for guidance. Treatment patterns may thus be suboptimal. For example, prolonged steroid use in the elderly was found to be common, causing significant morbidity from side effects in a particularly vulnerable population. Finally, within the context of a limited evidence base, we discuss common treatment scenarios to define the parameters within which physicians can individualize care for older patients with IBD. Overall, older IBD patients are at higher risk of adverse events and less treatment responsiveness compared with younger patients, underscoring the need for future studies to fully characterize appropriate treatment courses for this population.

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“…In addition to differences in populations studied, regional variations, case definitions of IBD, and the potential for misdiagnoses of ischemic colitis and nonsteroidal anti-inflammatory drug (NSAID)-induced colitis, there has been no standard definition of what age constitutes 'elderly'. [3][4][5] In several publications, the term was arbitrarily assigned to patient groups aged between 40-75. 6 Most developed world countries have accepted the chronological age of 65 years as a definition of 'elderly' or older person; however, the United Nations generally uses 60 years or greater to refer to the elderly population.…”

Section: Introductionmentioning

confidence: 99%

Treatment of Ulcerative Colitis in the Elderly: A Systematic Review

Baggenstos

Hanson²,

Shaukat

2013

Clinical Medicine Insights: Geriatrics

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Ulcerative colitis (UC) is increasingly recognized as a disease affecting the elderly. Approximately 10%-30% of the UC population is over the age of 60 years. Additionally, younger patients with UC are aging and thus comprise a second group of elderly IBD patients. To date, there have been no clinical trials that have evaluated treatment efficacy of UC in the elderly population. The aim of our study was to conduct a systematic review of all randomized controlled trials (RCTs) addressing treatment outcome in UC; we also sought to identify the elderly population, defined as age 60 years or older, represented in these studies, to see if pooled data would lead to meaningful conclusions regarding treatment efficacy and safety profile in the elderly. A search of the MEDLINE database via PubMed and the EMBASE database via Scopus was performed to identify all RCTs evaluating medical therapy for UC in humans, published within the English language through September 2012. Studies were grouped into three categories: biological agent (BA) therapy; immunosuppressant (IS) therapy; and 5-aminosalicylic acid (5-ASA) therapy. To estimate the number of elderly patients in each study, mean age plus 1 and 2 standard deviations (SD) was calculated to find the closest approximation to age 60. Of 876 studies, 112 RCTs were included in the final analysis-20 studies for BA, 20 for IS, and 72 for 5-ASA agents. While nearly all studies reported either a mean or median age, only 38% additionally reported the SD and age range. The mean composite age was 39.2 years for the BA studies, 38.5 years for the IS studies, and 42.8 years for the 5-ASA studies, consistent with a young middle-aged patient. We estimated that no more than 16% of patients per study would have qualified as elderly, and in most cases a much smaller percentage (,8%). Additionally, there were no BA or IS RCTs that reported results by age subgroup analysis. Four studies in the 5-ASA group report age-specific analyses and showed no difference in treatment efficacy by age. None of the 112 RCTs reported age sub-analyses of safety, tolerability, adverse events, or withdrawal rates. There is insufficient evidence to evaluate efficacy of treatment and adverse events from treatment for UC in the elderly. With the rising number of elderly patients with UC, there is a need for more clinical trials that specifically address UC treatment in this unique population.

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Inflammatory Bowel Diseases in the Elderly

Cited by 11 publications

References 85 publications

Systematic review with meta‐analysis: inflammatory bowel disease in the elderly

Systematic review with meta‐analysis: inflammatory bowel disease in the elderly

Management of Inflammatory Bowel Disease in the Elderly Patient

Treatment of Ulcerative Colitis in the Elderly: A Systematic Review

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