Ulcerative Colitis in Adulthood and in Older Patients: Same Disease, Same Outcome, Same Risks?

Abstract

The number of patients with inflammatory bowel disease (IBD) approaching an older age, together with the number of over-60-year-old patients newly diagnosed with IBD, is steadily increasing, reaching 25% of all patients. The present review focuses on late-onset ulcerative colitis (UC) and its initial disease course in comparison with that observed in younger adults in terms of extension at onset and the risk of proximal disease progression, medical treatment, surgery and hospitalization in the first years after diagnosis. We summarize the clues pointing to a milder disease course in a population which frequently presents major frailty due to comorbidities. With increasing age and thus increasing comorbidities, medical and surgical therapies frequently represent a challenge for treating physicians. The response, persistence, and risks of adverse events of conventional therapies indicated for late onset/older UC patients are examined, emphasizing the risks in this particular population, who are still being treated with prolonged corticosteroid therapy. Finally, we concentrate on data on biotechnological agents for which older patients were mostly excluded from pivotal trials. Real-life data from newer agents such as vedolizumab and ustekinumab show encouraging efficacy and safety profiles in the population of older UC patients.

The Prognostic Nutritional Index is a Predictive Marker for Postoperative Complications in Patients with Late‐Onset Ulcerative Colitis

“…The number of patients with ulcerative colitis (UC) has gradually increased in recent years. While UC can develop at any age, it has been reported that patients with UC are being diagnosed at an older age, and approximately 25% of all newly diagnosed UC patients are over the age of 60 [1].…”

“…It has been reported that the number of patients who are refractory to medical treatment has decreased, and the number of patients requiring surgery has also decreased in recent years due to the introduction of various biological agents [5]. However, the percentage of elderly UC patients requiring surgery has increased, and the number of late‐onset cases has also increased in recent years [1, 6].…”

“…The number of patients with ulcerative colitis (UC) has gradually increased in recent years. While UC can develop at any age, it has been reported that patients with UC are being diagnosed at an older age, and approximately 25% of all newly diagnosed UC patients are over the age of 60 [1]. Such patients, who are diagnosed at an older age, are defined as having late‐onset UC, and the number of such patients has been increasing rapidly in recent years [2, 3].…”

Role of epigenetic modifications and aging in inflammatory bowel disease

“…Aging is a natural phenomenon characterized by a gradual decline in physiological and psychological adaptations to the environment, ultimately leading to mortality. Notably, there has been a notable rise in the incidence of IBD among individuals aged 60 and above, accounting for 25% of all cases 7 . Extensive research has indicated that this increased prevalence in older adults can be attributed to epigenetic modifications, some of which may disrupt dietary metabolism, particularly in a Western diet 8,9 .…”

“…Notably, there has been a notable rise in the incidence of IBD among individuals aged 60 and above, accounting for 25% of all cases. 7 Extensive research has indicated that this increased prevalence in older adults can be attributed to epigenetic modifications, some of which may disrupt dietary metabolism, particularly in a Western diet. 8,9 Moreover, the aging process affects the immune system, resulting in progressive immune system disorders that can lead to mild or even moderate chronic inflammation of the intestines.…”