title: Age at onset of inflammatory bowel disease and the risk of surgery for non-neoplastic bowel disease.
abstract: BACKGROUND
  There is conflicting data regarding the response to medical and surgical therapy for inflammatory bowel disease with respect to age at disease onset.
  
  
  OBJECTIVE
  To determine if the age at onset of Crohn's disease and ulcerative colitis is a risk factor for surgery for non-neoplastic bowel disease.
  
  
  METHODS
  This was a case-control study of patients evaluated between 1998 and 2001. Cases had undergone an initial operation for bowel disease. Controls were matched 1:1 for gender, disease subtype, date of first visit (+/-2 years), time from diagnosis prior to first visit (+/-3 years) and duration of follow-up. Association with age, disease extent, smoking history, medication use and co-morbidities vs. case/control status was assessed using multiple variable conditional logistic regression to estimate the odds ratio (OR) and 95% confidence intervals (CI) for undergoing surgery.
  
  
  RESULTS
  Among 132 Crohn's patients, older patients had lower odds for surgery (OR per 5 years, 0.86; 95% CI: 0.75-0.98). The rate of surgery for non-neoplastic bowel disease was not significantly associated with disease distribution, co-morbidities or cigarette smoking. Among 234 ulcerative colitis patients, the rate of surgery was unrelated to age, disease extent, co-morbidities or cigarette smoking,
  
  
  CONCLUSIONS
  For Crohn's disease, but not ulcerative colitis, the risk of surgery for non-neoplastic bowel disease decreases with increasing age at diagnosis, irrespective of disease distribution and history of cigarette smoking.
authors.affiliation: Division of Gastroenterology and Hepatology, Fiterman Center, Mayo Clinic College of Medicine, Rochester, MN 55905, USA. tremaine.william@mayo.edu
authors.forename: W J
authors.initials: WJ
authors.lastname: Tremaine
authors.forename: L J
authors.initials: LJ
authors.lastname: Timmons
authors.forename: E V
authors.initials: EV
authors.lastname: Loftus
authors.forename: D S
authors.initials: DS
authors.lastname: Pardi
authors.forename: W J
authors.initials: WJ
authors.lastname: Sandborn
authors.forename: W S
authors.initials: WS
authors.lastname: Harmsen
authors.forename: P
authors.initials: P
authors.lastname: Thapa
authors.forename: A R
authors.initials: AR
authors.lastname: Zinsmeister
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002648:Child; D003093:Colitis, Ulcerative / Q000453:epidemiology / Q000601:surgery*; D003424:Crohn Disease / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors