title: Geriatric inflammatory bowel disease: phenotypic presentation, treatment patterns, nutritional status, outcomes, and comorbidity.
abstract: OBJECTIVE
  The U.S. population is aging and the burden of geriatric inflammatory bowel disease (IBD) patients has increased. Systematic data describing phenotypic presentation, treatment regimens, outcomes and comorbidities in elderly IBD patients is limited. We performed a retrospective observational study of IBD patients age ≥65 followed in a 20-hospital system to determine patterns of phenotypic presentation, treatment, polypharmacy, nutritional status and comorbidity.
  
  
  METHODS
  Data were extracted from electronic medical record based on ICD-9 coding/indexed terms on Crohn's disease (CD) and ulcerative colitis (UC) patients.
  
  
  RESULTS
  A total of 393 geriatric IBD patients were identified (49.1% males; 50.9% females; 61.8% UC; 38.2% CD; 73.4 ± 6.6 years old). Younger age at diagnosis of CD (≤64) was associated with greater prevalence of small bowel surgeries (63.6%) compared with those diagnosed after age ≥65 (20.9%) (p < 0.005). Fistulizing/penetrating disease was frequent in patients diagnosed with CD at a younger age (43.6% compared to 7%) (p < 0.005). IBD maintenance treatment included: 44% 5-ASA agents; 31.6% maintenance prednisone (defined as ≥6 months treatment duration); 4.8% steroid suppositories; 5.6% 6MP/azathioprine; 1.3% methotrexate; 1.3% adalimumab; 1.3% infliximab; 9.4% loperamide/diphenoxylate/atropine; 0.5% had no IBD medications. Longer duration of CD disease correlated with vitamin B12, vitamin D and iron deficiency.
  
  
  CONCLUSIONS
  Geriatric patients diagnosed with CD earlier in life had greater small bowel involvement compared with new onset geriatric CD. There is low utilization of immunomodulator and biologic agents in geriatric IBD patients. Duration of CD correlates with nutrient deficiency. Prospective studies are warranted in this respect.
authors.affiliation: Department of Medicine, Georgetown University School of Medicine, Washington, DC, USA. Manie.Juneja@gunet.georgetown.edu
authors.forename: Manie
authors.initials: M
authors.lastname: Juneja
authors.forename: Leonard
authors.initials: L
authors.lastname: Baidoo
authors.forename: Marc B
authors.initials: MB
authors.lastname: Schwartz
authors.forename: Arthur
authors.initials: A
authors.lastname: Barrie
authors.forename: Miguel
authors.initials: M
authors.lastname: Regueiro
authors.forename: Michael
authors.initials: M
authors.lastname: Dunn
authors.forename: David G
authors.initials: DG
authors.lastname: Binion
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy* / Q000473:pathology*; D008297:Male; D019804:Mesalamine / Q000627:therapeutic use; D009752:Nutritional Status; D010276:Parasympatholytics / Q000627:therapeutic use; D011687:Purines / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D010276:Parasympatholytics; D011687:Purines; D019804:Mesalamine