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J Crohns Colitis. 2016 Feb;10(2):176-85. doi: 10.1093/ecco-jcc/jjv194. Epub 2015 Oct 28.

Natural History of Elderly-onset Ulcerative Colitis: Results from a Territory-wide Inflammatory Bowel Disease Registry.

Author information

1
Department of Medicine and Therapeutics, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong.
2
Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong.
3
Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong.
4
Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong.
5
Department of Medicine, Queen Elizabeth Hospital, Hong Kong.
6
Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong.
7
Department of Medicine, Tseung Kwan O Hospital, Hong Kong.
8
Department of Medicine and Geriatrics, Caritas Medical Center, Hong Kong.
9
Department of Medicine, North District Hospital, Hong Kong.
10
Department of Medicine and Geriatrics, Kwong Wah Hospital, Hong Kong.
11
Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong.
12
Department of Medicine, Yan Chai Hospital, Hong Kong.
13
Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong.
14
Department of Gastroenterology, Chelsea and Westminster Hospital, London, UK.
15
Department of Medicine and Therapeutics, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong siewchienng@cuhk.edu.hk.

Abstract

BACKGROUND AND AIMS:

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.

KEYWORDS:

Natural history; elderly-onset; ulcerative colitis

PMID:
26512132
DOI:
10.1093/ecco-jcc/jjv194
[Indexed for MEDLINE]

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