title: Medical and surgical therapy of inflammatory bowel disease in the elderly - prospects and complications.
abstract: Population ageing is a global phenomenon. People aged 65 years and older comprise approximately 16% of the population of Europe. The medical management of elderly patients with inflammatory bowel disease (IBD) is challenging with respect to diagnosis, pharmaceutical and surgical treatment, and complications. IBD has a late onset in 10%-15% of patients, with the first flare occurring at 60 to 70 years of age; others suffer from the disease for several decades. Even though the natural course of the disease in geriatric populations and the diagnostic options may not differ much from those in younger patients, distinct problems exist in the choice of medical therapy. Recommended clinical practise has been rapidly evolving towards an intensified initial treatment in IBD. However, in patients older than 65 years, a gentler approach should be used, and a combination of immunosuppressive agents should be avoided because of increased risk of infectious and neoplastic complications. Furthermore, elderly patients with severe IBD show prolonged, complicated post-operative clinical courses with worse hospital outcomes, so early surgical intervention for elderly patients is recommended. This article provides an overview of elderly IBD patient care, including medical and surgical therapeutic considerations and emphasises the necessity of close collaborations between gastroenterologists and surgeons.
authors.affiliation: Division of Gastroenterology, Hepatology and Infectious Diseases, Department of Internal Medicine II, Jena University Hospital, Germany. andreas.stallmach@med.uni-jena.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Stallmach
authors.forename: Stefan
authors.initials: S
authors.lastname: Hagel
authors.forename: Akram
authors.initials: A
authors.lastname: Gharbi
authors.forename: Utz
authors.initials: U
authors.lastname: Settmacher
authors.forename: Michael
authors.initials: M
authors.lastname: Hartmann
authors.forename: Carsten
authors.initials: C
authors.lastname: Schmidt
authors.forename: Tony
authors.initials: T
authors.lastname: Bruns
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003093:Colitis, Ulcerative / Q000150:complications / Q000188:drug therapy* / Q000601:surgery*; D003424:Crohn Disease / Q000150:complications / Q000188:drug therapy* / Q000601:surgery*; D004347:Drug Interactions; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D017053:Infection Control; D007239:Infections / Q000209:etiology; D008228:Lymphoma, Non-Hodgkin / Q000453:epidemiology; D009369:Neoplasms / Q000453:epidemiology
chemical_list: D007166:Immunosuppressive Agents