title: Disease patterns in late-onset ulcerative colitis: Results from the IG-IBD "AGED study".
abstract: BACKGROUND
  Late-onset UC represents an important issue for the near future, but its outcomes and relative therapeutic strategies are yet poorly studied.
  
  
  OBJECTIVE
  To better define the natural history of late-onset ulcerative colitis.
  
  
  METHODS
  In a multicenter retrospective study, we investigated the disease presentation and course in the first 3 years in 1091 UC patients divided into 3 age-groups: diagnosis ≥65years, 40-64 years, and <40years. Disease patterns, medical and surgical therapies, and risk factors for disease outcomes were analyzed.
  
  
  RESULTS
  Chronic active or relapsing disease accounts for 44% of patients with late-onset UC. Across all age-groups, these disease patterns require 3-6 times more steroids than remitting disease, but immunomodulators and, to a lesser extent, biologics are less frequently prescribed in the elderly. Advanced age, concomitant diseases and related therapies were found to be inversely associated with the use of immunomodulators or biologics, but not with surgery.
  
  
  CONCLUSIONS
  The conclusion that late-onset UC follows a mild course may apply only to a subset of patients. an important percentage of elderly patients present with more aggressive disease. Since steroid use and surgery rates did not differ in this subgroup, lower use of immunosuppressive therapy and biologics may reflect concerns in prescribing these therapies in the elderly.
authors.affiliation: Clinical Unit for Chronic Bowel Disorders, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy. Electronic address: fwalter@unime.it.
authors.forename: Walter
authors.initials: W
authors.lastname: Fries
authors.affiliation: Clinical Unit for Chronic Bowel Disorders, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Viola
authors.affiliation: Gastroenterology Unit, University Hospital Careggi, Florence, Italy.
authors.forename: Natalia
authors.initials: N
authors.lastname: Manetti
authors.affiliation: Gastroenterology Unit, Department of Surgical, Oncological, and Gastroenterological Sciences, University of Padua, Padua, Italy.
authors.forename: Iris
authors.initials: I
authors.lastname: Frankovic
authors.affiliation: IBD Unit Complesso Integrato Columbus, Fondazione Policlinico Gemelli Università Cattolica, Rome, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Pugliese
authors.affiliation: Gastroenterology Unit, A.O. San Camillo Forlanini, Rome, Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: Monterubbianesi
authors.affiliation: Div. of Gastroenterology, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Scalisi
authors.affiliation: Gastroenterology Unit, San Filippo Neri Hospital, Rome, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Aratari
authors.affiliation: Gastroenterology Unit, Campus BioMedico, University of Rome, Rome, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Cantoro
authors.affiliation: UOC Gastroenterologia ed Epatologia, A.O.U. Policlinico, Palermo, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Cappello
authors.affiliation: Internal Medicine, Department of Medical and Pediatric Sciences, University of Catania, Catania, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Samperi
authors.affiliation: U.O. Gastroenterologia, Ospedale di Rho, ASST Rhodense, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Saibeni
authors.affiliation: Dipartimento di Medicina Ospedale Desio, Dipartimento di Medicina, Desio, MB, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Casella
authors.affiliation: SC Gastroenterologia Ospedale "Brotzu", Cagliari, Italy.
authors.forename: Giammarco
authors.initials: G
authors.lastname: Mocci
authors.affiliation: Gastroenterology, "Federico II" University, Naples, Italy.
authors.forename: Matilde
authors.initials: M
authors.lastname: Rea
authors.affiliation: Gastroenterology and IBD-Unit, Luigi Sacco University Hospital, Milan, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Furfaro
authors.affiliation: Gastroenterology Section (D.E.T.O.), University of Bari, Bari, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Contaldo
authors.affiliation: Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Magarotto
authors.affiliation: Gastroenterology, Ospedale San Giuseppe, Azienda USL11, Empoli, Firenze, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Calella
authors.affiliation: UOSC of Gastroenterology and Endoscopy, AORN "A. Cardarelli", Naples, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Manguso
authors.affiliation: Internal Medicine, Department of Medical and Pediatric Sciences, University of Catania, Catania, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Inserra
authors.affiliation: IBD Unit Azienda Ospedaliera per l'Emergenza "Cannizzaro", Catania, Italy.
authors.forename: Antonino C
authors.initials: AC
authors.lastname: Privitera
authors.affiliation: Gastroenterology Section (D.E.T.O.), University of Bari, Bari, Italy.
authors.forename: Mariabeatrice
authors.initials: M
authors.lastname: Principi
authors.affiliation: Gastroenterology, "Federico II" University, Naples, Italy.
authors.forename: Fabiana
authors.initials: F
authors.lastname: Castiglione
authors.affiliation: Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.
authors.forename: Flavio
authors.initials: F
authors.lastname: Caprioli
authors.affiliation: Gastroenterology and Digestive Endoscopy, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Ardizzone
authors.affiliation: IBD Center, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy.
authors.forename: Silvio
authors.initials: S
authors.lastname: Danese
authors.affiliation: Gastroenterology Unit, San Filippo Neri Hospital, Rome, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Papi
authors.affiliation: Div. of Gastroenterology, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Bossa
authors.affiliation: Gastroenterology Unit, A.O. San Camillo Forlanini, Rome, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Kohn
authors.affiliation: IBD Unit Complesso Integrato Columbus, Fondazione Policlinico Gemelli Università Cattolica, Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Armuzzi
authors.affiliation: Gastroenterology Unit, Department of Surgical, Oncological, and Gastroenterological Sciences, University of Padua, Padua, Italy.
authors.forename: Renata
authors.initials: R
authors.lastname: D'Incà
authors.affiliation: Gastroenterology Unit, University Hospital Careggi, Florence, Italy.
authors.forename: Vito
authors.initials: V
authors.lastname: Annese
authors.affiliation: Department of Economics, University of Messina, Messina, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Alibrandi
authors.affiliation: IBD Center, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy.
authors.forename: Stefanos
authors.initials: S
authors.lastname: Bonovas
authors.affiliation: IBD Center, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy.
authors.forename: Gionata
authors.initials: G
authors.lastname: Fiorino
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy*; D018450:Disease Progression; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D007558:Italy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013256:Steroids / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D007155:Immunologic Factors; D013256:Steroids
keywords: Outcome; Steroids; Surgery; Thiopurines; Tumors