Crohn's disease in the older patient.

The progress of 141 consecutive patients with Crohn's disease, operated upon by the same surgeons, was examined. Patients were compared by age of onset of the disease. Few patients with Crohn's disease were older than 50 years of age and even less had a diagnosis after this age. Nevertheless, there are certain features that appear to single out these patients. It appears that Crohn's disease in patients older than 50 years in whom the disease was diagnosed before the age of 50 years, mimics that of the younger patients. An operative recurrence is not common and the mortality minimal. Patients in whom the disease is diagnosed after the age of 50 years have a relatively short duration of symptoms, no fistulas and no hydronephorosis; hemorrhage was a more common indication for operation than was intractability. These patients have just as severe a course, if not more so, than the younger patients with a marked operative recurrence and complications requiring reoperation and a significant mortality. Subsequent to all operations, all these older patients still require medical treatment and, yet, are symptomatic.