title: Natural History of Elderly-onset Ulcerative Colitis: Results from a Territory-wide Inflammatory Bowel Disease Registry.
abstract: OBJECTIVE
  Data on the natural history of elderly-onset ulcerative colitis [UC] are limited. We aimed to investigate clinical features and outcomes of patients with elderly-onset UC.
  
  
  METHODS
  Patients with a confirmed diagnosis of UC between 1981 and 2013, from 13 hospitals within a territory-wide Hong Kong Inflammatory Bowel Disease Registry, were included. Clinical features and outcomes of elderly-onset patients, defined as age ≥ 60 years at diagnosis, were compared with those of non-elderly-onset disease [< 60 years at diagnosis].
  
  
  RESULTS
  We identified 1225 patients, of whom 12.8% [157/1225; 56.1% male] had elderly-onset UC. Median duration of follow-up was 11 years [interquartile range, 6-16 years]. Age-specific incidence of elderly-onset UC increased from 0.1 per 100000 persons before 1991 to 1.3 per 100000 persons after 2010. There were more ex-smokers [32.2% vs. 12.2%, p < 0.001] and higher proportion of comorbidities [p < 0.001] in elderly-onset than non-elderly-onset patients. Disease extent, corticosteroids, immunosuppressants use, and colectomy rates were similar between the two groups. Elderly-onset disease was an independent risk factor for cytomegalovirus infection [odds ratio 2.9, 95% confidence interval 1.6-5.2, p < 0.001]. More elderly-onset patients had Clostridium difficile infection [11.0% vs. 5.4%, p = 0.007], hospitalisation for UC exacerbation [50.6% vs. 41.8%, p = 0.037], colorectal cancer [3.2% vs. 0.9%, p = 0.033], all-cause mortality [7.0% vs. 1.0%, p < 0.001], and UC-related mortality [1.9% vs. 0.2%, p = 0.017] than non-elderly-onset patients.
  
  
  CONCLUSIONS
  Elderly-onset UC patients are increasing in number. These patients have higher risk of opportunistic infections, hospitalisation, colorectal cancer, and mortality than non-elderly-onset patients. Management and therapeutic strategies in this special group need careful attention.
authors.affiliation: Department of Medicine and Therapeutics, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Hai Yun
authors.initials: HY
authors.lastname: Shi
authors.affiliation: Department of Medicine and Therapeutics, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Francis K L
authors.initials: FK
authors.lastname: Chan
authors.affiliation: Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong.
authors.forename: Wai Keung
authors.initials: WK
authors.lastname: Leung
authors.affiliation: Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong.
authors.forename: Michael K K
authors.initials: MK
authors.lastname: Li
authors.affiliation: Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong.
authors.forename: Chi Man
authors.initials: CM
authors.lastname: Leung
authors.affiliation: Department of Medicine, Queen Elizabeth Hospital, Hong Kong.
authors.forename: Shun Fung
authors.initials: SF
authors.lastname: Sze
authors.affiliation: Department of Medicine and Therapeutics, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Jessica Y L
authors.initials: JY
authors.lastname: Ching
authors.affiliation: Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong.
authors.forename: Fu Hang
authors.initials: FH
authors.lastname: Lo
authors.affiliation: Department of Medicine, Tseung Kwan O Hospital, Hong Kong.
authors.forename: Steve W C
authors.initials: SW
authors.lastname: Tsang
authors.affiliation: Department of Medicine and Geriatrics, Caritas Medical Center, Hong Kong.
authors.forename: Edwin H S
authors.initials: EH
authors.lastname: Shan
authors.affiliation: Department of Medicine, North District Hospital, Hong Kong.
authors.forename: Lai Yee
authors.initials: LY
authors.lastname: Mak
authors.affiliation: Department of Medicine and Geriatrics, Kwong Wah Hospital, Hong Kong.
authors.forename: Belsy C Y
authors.initials: BC
authors.lastname: Lam
authors.affiliation: Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong.
authors.forename: Aric J
authors.initials: AJ
authors.lastname: Hui
authors.affiliation: Department of Medicine, Yan Chai Hospital, Hong Kong.
authors.forename: Sai Ho
authors.initials: SH
authors.lastname: Wong
authors.affiliation: Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong.
authors.forename: Marc T L
authors.initials: MT
authors.lastname: Wong
authors.affiliation: Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong.
authors.forename: Ivan F N
authors.initials: IF
authors.lastname: Hung
authors.affiliation: Department of Medicine, Queen Elizabeth Hospital, Hong Kong.
authors.forename: Yee Tak
authors.initials: YT
authors.lastname: Hui
authors.affiliation: Department of Medicine and Geriatrics, Caritas Medical Center, Hong Kong.
authors.forename: Yiu Kay
authors.initials: YK
authors.lastname: Chan
authors.affiliation: Department of Medicine, North District Hospital, Hong Kong.
authors.forename: Kam Hon
authors.initials: KH
authors.lastname: Chan
authors.affiliation: Department of Medicine and Geriatrics, Kwong Wah Hospital, Hong Kong.
authors.forename: Ching Kong
authors.initials: CK
authors.lastname: Loo
authors.affiliation: Department of Medicine and Geriatrics, Kwong Wah Hospital, Hong Kong.
authors.forename: Raymond W H
authors.initials: RW
authors.lastname: Tong
authors.affiliation: Department of Medicine, Yan Chai Hospital, Hong Kong.
authors.forename: Wai Hung
authors.initials: WH
authors.lastname: Chow
authors.affiliation: Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong.
authors.forename: Carmen K M
authors.initials: CK
authors.lastname: Ng
authors.affiliation: Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong.
authors.forename: Wai Cheung
authors.initials: WC
authors.lastname: Lao
authors.affiliation: Department of Gastroenterology, Chelsea and Westminster Hospital, London, UK.
authors.forename: Marcus
authors.initials: M
authors.lastname: Harbord
authors.affiliation: Department of Medicine and Therapeutics, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Justin C Y
authors.initials: JC
authors.lastname: Wu
authors.affiliation: Department of Medicine and Therapeutics, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Joseph J Y
authors.initials: JJ
authors.lastname: Sung
authors.affiliation: Department of Medicine and Therapeutics, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong siewchienng@cuhk.edu.hk.
authors.forename: Siew C
authors.initials: SC
authors.lastname: Ng
mesh_terms: D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D017668:Age of Onset; D000368:Aged; D003093:Colitis, Ulcerative / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D013997:Time Factors
keywords: Natural history; elderly-onset; ulcerative colitis