title: Epidemiology and Long-term Outcome of Inflammatory Bowel Disease Diagnosed at Elderly Age-An Increasing Distinct Entity?
abstract: Elderly onset (EO) inflammatory bowel disease (IBD) may become a more common entity as a result of population aging and the rising IBD incidence. Its management is challenging, because of multimorbidity, polypharmacy, and frailty. Insight into the long-term outcome is essential for optimal patient counseling and treatment. We studied the incidence and disease outcome of elderly-onset IBD in direct comparison to adult-onset (AO) IBD.
  
  
  
  All 2823 cases with IBD from the Dutch population-based IBD South Limburg cohort, diagnosed between 1991 and 2011, were included. Long-term outcome (hospitalization, surgery, and disease phenotype) was compared between AO (<60 years at diagnosis) and EO (≥60 years at diagnosis) disease, for Crohn's disease (CD) and ulcerative colitis (UC) separately.
  
  
  
  In total, 1162 patients with CD (136 EO/1026 AO) and 1661 patients with UC (373 EO/1288 AO) were included. The EO IBD incidence increased from 11.71 per 100,000 persons in 1991 to 23.66 per 100,000 persons in 2010, P < 0.01. Immunomodulators were less often used in EO CD (61.8% versus 77.1%, P = 0.03) and EO UC (22.8% versus 35.4%, P < 0.01), even as biologicals (25.1% versus 55.1%, P = 0.03 and 7.8% versus 18.0%, P < 0.01, respectively). No differences were observed in surgery risk (CD: hazard ratio [HR] 1.19; 95% confidence interval [CI], 0.85-1.67 and UC: HR, 0.88; 95% CI, 0.53-1.46), or in CD phenotype progression (HR, 0.81; 95% CI, 0.52-1.25), but more patients with EO UC required hospitalization (HR, 1.29; 95% CI, 1.01-1.63).
  
  
  
  EO IBD is rising, warranting physicians' alertness for IBD in elderly patients. The long-term outcome was not different from AO disease, despite a less frequent use of immunomodulators and biologicals.
authors.affiliation: *Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, the Netherlands; †NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands; ‡Department of Complex Genetics, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands; §CAPHRI School for Public Health and Primary Care, Maastricht University Medical Center, Maastricht, the Netherlands; ‖Department of Internal Medicine and Gastroenterology, Zuyderland Medical Center, Sittard-Geleen, the Netherlands; and ¶Department of Internal Medicine and Gastroenterology, Zuyderland Medical Center, Heerlen, the Netherlands.
authors.forename: Steven F G
authors.initials: SF
authors.lastname: Jeuring
authors.forename: Tim R A
authors.initials: TR
authors.lastname: van den Heuvel
authors.forename: Maurice P
authors.initials: MP
authors.lastname: Zeegers
authors.forename: Wim H
authors.initials: WH
authors.lastname: Hameeteman
authors.forename: Mariëlle J L
authors.initials: MJ
authors.lastname: Romberg-Camps
authors.forename: Liekele E
authors.initials: LE
authors.lastname: Oostenbrug
authors.forename: Ad A M
authors.initials: AA
authors.lastname: Masclee
authors.forename: Daisy M A E
authors.initials: DM
authors.lastname: Jonkers
authors.forename: Marieke J
authors.initials: MJ
authors.lastname: Pierik
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001685:Biological Factors / Q000627:therapeutic use; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000453:epidemiology* / Q000601:surgery; D003424:Crohn Disease / Q000188:drug therapy* / Q000453:epidemiology* / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000706:statistics & numerical data; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D055815:Young Adult
chemical_list: D001685:Biological Factors; D007155:Immunologic Factors