Joyce Wing Yan Mak1, Carmen Lok Tung Ho2, Kylie Wong1, Tsz Yan Cheng1, Terry Cheuk Fung Yip1, Wai Keung Leung3, Michael Li4, Fu Hang Lo5, Ka Man Ng6, Shun Fung Sze7, Chi Man Leung8, Steven Woon Choy Tsang9, Edwin Hok Shing Shan10, Kam Hon Chan11, Belsy C Y Lam12, Aric Josun Hui13, Wai Hung Chow14, Siew Chien Ng1. 1. Department of Medicine and Therapeutics, Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong. 2. Imperial College School of Medicine, London, UK. 3. Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong. 4. Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong. 5. Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong. 6. Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong. 7. Department of Medicine, Queen Elizabeth Hospital, Hong Kong. 8. Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong. 9. Department of Medicine, Tseung Kwan O Hospital, Hong Kong. 10. Department of Medicine and Geriatrics, Caritas Medical Centre, Hong Kong. 11. Department of Medicine, North District Hospital, Hong Kong. 12. Department of Medicine and Geriatrics, Kwong Wah Hospital, Hong Kong. 13. Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong. 14. Department of Medicine, Yan Chai Hospital, Hong Kong.
Abstract
BACKGROUND: Elderly-onset inflammatory bowel disease [IBD], defined as age ≥60 at diagnosis, is increasing worldwide. We aimed to compare clinical characteristics and natural history of elderly-onset IBD patients with those of adult-onset IBD patients. METHODS: Patients with a confirmed diagnosis of IBD from 1981 to 2016 were identified from a territory-wide Hong Kong IBD registry involving 13 hospitals. Demographics, comorbidities, clinical features, and outcomes of elderly-onset IBD patients were compared with those of adult-onset IBD patients. RESULTS: A total of 2413 patients were identified, of whom 270 [11.2%] had elderly-onset IBD. Median follow-up duration was 111 months (interquartile range [IQR]: 68-165 months). Ratio of ulcerative colitis [UC]: Crohn's disease [CD] was higher in elderly-onset IBD than in adult-onset IBD patients [3.82:1 vs 1.39:1; p <0.001]. Elderly-onset CD had less perianal involvement [5.4% vs 25.4%; p <0.001] than adult-onset CD. Elderly-onset IBD patients had significantly lower cumulative use of immunomodulators [p = 0.001] and biologics [p = 0.04]. Elderly-onset IBD was associated with higher risks of: cytomegalovirus colitis (odds ratio [OR]: 3.07; 95% confidence interval [CI] 1.92-4.89; p <0.001); herpes zoster [OR: 2.42; 95% CI 1.22-4.80; p = 0.12]; and all cancer development [hazard ratio: 2.97; 95% CI 1.84-4.79; p <0.001]. They also had increased number of overall hospitalisations [OR: 1.14; 95% CI 1.09-1.20; p <0.001], infections-related hospitalisation [OR: 1.87; 95% CI 1.47-2.38; p <0.001], and IBD-related hospitalisation [OR: 1.09; 95% CI 1.04- 1.15; p = 0.001] compared with adult-onset IBD patients. CONCLUSIONS: Elderly-onset IBD was associated with increased risk of infections and cancer development, and increased infection- and IBD-related hospitalisations. Specific therapeutic strategies to target this special population are needed.
BACKGROUND: Elderly-onset inflammatory bowel disease [IBD], defined as age ≥60 at diagnosis, is increasing worldwide. We aimed to compare clinical characteristics and natural history of elderly-onset IBDpatients with those of adult-onset IBDpatients. METHODS:Patients with a confirmed diagnosis of IBD from 1981 to 2016 were identified from a territory-wide Hong Kong IBD registry involving 13 hospitals. Demographics, comorbidities, clinical features, and outcomes of elderly-onset IBDpatients were compared with those of adult-onset IBDpatients. RESULTS: A total of 2413 patients were identified, of whom 270 [11.2%] had elderly-onset IBD. Median follow-up duration was 111 months (interquartile range [IQR]: 68-165 months). Ratio of ulcerative colitis [UC]: Crohn's disease [CD] was higher in elderly-onset IBD than in adult-onset IBDpatients [3.82:1 vs 1.39:1; p <0.001]. Elderly-onset CD had less perianal involvement [5.4% vs 25.4%; p <0.001] than adult-onset CD. Elderly-onset IBDpatients had significantly lower cumulative use of immunomodulators [p = 0.001] and biologics [p = 0.04]. Elderly-onset IBD was associated with higher risks of: cytomegalovirus colitis (odds ratio [OR]: 3.07; 95% confidence interval [CI] 1.92-4.89; p <0.001); herpes zoster [OR: 2.42; 95% CI 1.22-4.80; p = 0.12]; and all cancer development [hazard ratio: 2.97; 95% CI 1.84-4.79; p <0.001]. They also had increased number of overall hospitalisations [OR: 1.14; 95% CI 1.09-1.20; p <0.001], infections-related hospitalisation [OR: 1.87; 95% CI 1.47-2.38; p <0.001], and IBD-related hospitalisation [OR: 1.09; 95% CI 1.04- 1.15; p = 0.001] compared with adult-onset IBDpatients. CONCLUSIONS: Elderly-onset IBD was associated with increased risk of infections and cancer development, and increased infection- and IBD-related hospitalisations. Specific therapeutic strategies to target this special population are needed.
Authors: Gustavo Drügg Hahn; Jean-Frédéric LeBlanc; Petra Anna Golovics; Panu Wetwittayakhlang; Abdulrahman Qatomah; Anna Wang; Levon Boodaghians; Jeremy Liu Chen Kiow; Maryam Al Ali; Gary Wild; Waqqas Afif; Alain Bitton; Peter Laszlo Lakatos; Talat Bessissow Journal: World J Gastroenterol Date: 2022-09-07 Impact factor: 5.374