INFLAMMATORY BOWEL DISEASE IN THE ELDERLY: CLINICAL ASPECTS AND EPIDEMIOLOGY

Introduction Inflammatory bowel disease (IBD) is generally associated with young adults. However, a significant proportion of new IBD cases are diagnosed in older individuals as the incidence of IBD increases and our population ages. Older patients with IBD comprise two groups: those with a new diagnosis (late-onset IBD > 60 years) and patients with juvenile or adult-onset IBD who have reached advanced age. Older patients with IBD present a significant challenge due to the limited specific studies and characteristics inherent to this population, such as polypharmacy, comorbidities, and frailty.

Objectives To evaluate the clinical and epidemiological aspects of patients with late-onset IBD in comparison to patients diagnosed at younger ages (<60 years).

Methods A retrospective analysis of data from patients with late-onset IBD and younger-onset IBD, randomized in a 1:2 ratio based on sex, disease location, and phenotype of Crohn's disease (CD) and ulcerative colitis (UC), and year of diagnosis, followed from January 2001 to December 2021. Disease severity, therapies, clinical and endoscopic remission, surgeries, comorbidities, and deaths were assessed.

Results A total of 63 patients with late-onset IBD (57.1% female, mean age: 72.00±6.4 years, 52.4% UC) were included. Lower use of immunomodulators [CD (36.7% vs. 70.0%; p=0.0020), UC (15.2% vs. 45.6%; p=0.003)] and biological agents [CD (50.0% vs. 75.0%; p=0.020), UC (12.1% vs. 33.8%; p=0.003)] was significantly observed in patients with late-onset IBD compared to those with younger-onset IBD. Greater disease severity was observed in patients with CD diagnosed at younger ages (66.7%; p=0.006). Higher frequency of comorbidities (92.06% vs 31.25%; p<0.0001) and deaths (7.9% vs 0.7%; p=0.0015) were observed in patients with late-onset IBD compared to those with younger-onset IBD. No significant differences were observed regarding clinical and endoscopic remission, use of corticosteroids and aminosalicylates, and surgery (p>0.05).

Conclusion Older patients with IBD have substantial comorbidities, higher mortality, and lower use of immunomodulators and biological agents compared to younger patients with IBD. Further studies in this specific population are needed.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025