The elderly IBD patient in the modern era: changing paradigms in risk stratification and therapeutic management

Hong, Simon; Katz, Seymour

doi:10.1177/17562848211023399

Cited by 17 publications

(14 citation statements)

References 119 publications

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“…There was no difference for symptoms that lead to a diagnosis of IBD, except for abdominal pain, which was more common amongst adults, both for UC and CD, respectively. This unreported abdominal pain in the elderly might be due to decreased intestinal motility or better ability to tolerate pain 21,17 .…”

Section: Discussionmentioning

confidence: 99%

Elderly and adult-onset Inflammatory Bowel Disease: 20 years report

Pirali

Zammarchi

Lotti

et al. 2023

Preprint

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Background Cases of IBD diagnosed after the age of 65 are increasing, due to either an ageing population or a greater awareness of this condition in older patients. This study aims to compare natural history, therapeutical approach, disease and therapy-related complications in elderly and adult patients. Methods Patients referring to the IBD-outpatient clinic of the Gastroenterology Unit (Spedali Civili Brescia) that received a diagnosis of IBD after the age of 65 between January 2000 and August 2021 were enrolled and matched 1:1 by disease, sex and year of diagnosis with a patient who received diagnosis between 40 and 64 years of age. Results A total of 154 elderly patients (45 Crohn’s disease and 109 Ulcerative colitis) were matched with 154 adults. In Crohn’s disease, abdominal pain and diarrhea were more frequent amongst adults; while symptoms at UC presentation were similar. Extraintestinal manifestations were more frequently reported amongst adults (p 0.03). Despite a similar number of relapses in both cohorts, the elderly were more frequently hospitalized. In CD, the number of patients who faced a surgical approach was similar for both cohorts, but mean time to surgery was significantly lower in the elderly (4.7 vs 28.9 months, p0.03). On the contrary, UC elderly patients faced surgery more frequently (17% vs 8%, p0.07), but mean time from diagnosis was similar. Biological therapy was more common for adults (p<0.05), with a larger use of anti-integrin, despite anti-TNFalfa in elderly-UC patients (70% vs 7%). Intestinal complications and systemic infections were higher amongst the elderly. Conclusions Elderly and adult-onset IBD seem to have similar presentation and clinical behavior. However, the elderly present more IBD-related hospitalizations and complications.

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Section: Discussionmentioning

confidence: 99%

Elderly and adult-onset Inflammatory Bowel Disease: 20 years report

Pirali

Zammarchi

Lotti

et al. 2023

Preprint

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“…IBD diagnosed or occurring at an older age differs from adult-onset IBD, with a distinct phenotype and disease manifestation. 59 UC was found to be more common than CD in elderly IBD patients. For example, a French study showed that left-sided UC was more common in elderly patients, 60 whereas a South Korean study found that rectitis was more common.…”

Section: Previous Researchmentioning

confidence: 92%

A Mendelian Randomization Study on IBD and Aging

Wang

Tang

et al. 2023

Preprint

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Background and Aims: Although observational studies have reported correlations between inflammatory bowel disease (IBD) and aging, there is no evidence supporting causal relationships between the two. Methods: Summary data from the Genome-Wide Association Study (GWAS) were subjected to two-sample and bidirectional Mendelian randomization (MR) to assess the causal relationships between biomarkers of IBD and aging. Following IEU GWAS database screening and single nucleotide polymorphism filtering, various MR methods, including the inverse-variance weighted method, were applied to qualified instrumental variables. The heterogeneity and pleiotropy of the instrumental variables were verified by sensitivity analyses. Results: Ulcerative colitis (UC) was associated with a 0.10 standard deviation (SD) unit increase in DNA methylation PhenoAge acceleration (adjusted P-value=0.010). SD unit increases in intrinsic epigenetic age acceleration were associated with increases in the probability of Crohn’s disease (CD) and IBD of 0.05 (adjusted P-value=0.032) and 0.04 (adjusted P-value=0.039), respectively. SD unit increases in physical activity and DNA methylation PhenoAge acceleration increased the probabilities of IBD by 0.03 and 0.04 (adjusted P-value=0.039), respectively. CD was associated with shorter telomere length; UC was associated with increased DNA methylation PhenoAge acceleration; and IBD was associated with decreased appendicular lean mass. Four factors associated with aging showed causal relationships: telomere length, DNA methylation GrimAge acceleration, DNA methylation Hannum age acceleration, and usual walking pace, with IBD ruled out. Conclusion: These findings provide new evidence for the causal relationship between IBD and aging in European populations, as well as providing suggestions for the prevention and treatment of IBD.

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“…1 Furthermore, diagnosis can be difficult due to atypical symptoms that can resemble other agerelated conditions. 2 The European Crohn's and Colitis Organisation has defined elderly onset IBD as that diagnosed at 60 years or older. 3 However, the definition is not consensual, with studies using cutoffs up to 75 years old.…”

Section: N V I T E D E D I T O R I a L Editorial: Elderly Onset Infla...mentioning

confidence: 99%

“…Given the current evidence, 2,7,8 it seems pertinent to include an A4 category, for patients with disease onset after 60, in the Montreal classification, and to enrol these individuals in observational studies and randomised controlled trials. The evaluation of the efficacy and safety of biologics in this population is particularly important, considering immunosenescence and pharmacokinetic peculiarities.…”

Section: N V I T E D E D I T O R I a L Editorial: Elderly Onset Infla...mentioning

confidence: 99%