Inflammatory bowel diseases in the elderly population: epidemiology, long-term disease course, surgery rates, and biological use—data from the Veszprem county cohort between 1977 and 2020 - Scorecard - MDSpire
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Inflammatory bowel diseases in the elderly population: epidemiology, long-term disease course, surgery rates, and biological use—data from the Veszprem county cohort between 1977 and 2020
Clinical Scorecard: Elderly-Onset Inflammatory Bowel Diseases: Analyzing Epidemiology, Long-Term Outcomes, Surgical Interventions, and Biologic Treatments in a Veszprem County Cohort from 1977 to 2020
At a Glance
Category
Detail
Condition
Elderly-onset inflammatory bowel diseases (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC)
Key Mechanisms
Idiopathic, progressive inflammatory disorders of the gastrointestinal tract with differing disease course and treatment response in elderly-onset cases
Target Population
Patients diagnosed with IBD at age ≥60 years (elderly-onset)
Care Setting
Population-based cohort from Veszprem County, Hungary; outpatient and inpatient clinical management including medical therapy and surgery
Key Highlights
Elderly-onset IBD represents an increasing proportion of IBD patients, with 6.1% of CD and 13.4% of UC cases diagnosed at age ≥60 years in the cohort.
Biological therapy exposure is significantly lower in elderly-onset CD compared to adult-onset CD, but similar in elderly-onset and adult-onset UC.
Early surgery rates (within 1 year of diagnosis) are higher in elderly-onset CD compared to adult-onset, though overall surgery and colectomy rates do not differ significantly.
Guideline-Based Recommendations
Diagnosis
Define elderly-onset IBD as diagnosis at age 60 years or older per ECCO consensus.
Use prospective population-based cohort data to assess incidence and disease characteristics.
Management
Consider lower biological therapy exposure in elderly-onset CD patients compared to younger adults.
Maintain similar biological therapy use in elderly-onset UC as in adult-onset UC.
Recognize higher early surgery rates in elderly-onset CD, indicating need for close monitoring and timely surgical intervention.
Monitoring & Follow-up
Monitor disease phenotype progression, which is lower in elderly-onset CD and UC compared to adult-onset.
Regularly review therapeutic response and adjust treatment strategies across different therapeutic eras.
Risks
Higher risk of early surgery in elderly-onset CD patients within the first year after diagnosis.
Potential underuse of biological therapies in elderly-onset CD may impact disease control.
Patient & Prescribing Data
Elderly-onset IBD patients diagnosed at age ≥60 years in a population-based cohort
Biological therapy is less frequently used in elderly-onset CD compared to adult-onset, while usage in elderly-onset UC is comparable; early surgical intervention is more common in elderly-onset CD.
Clinical Best Practices
Adopt age-specific definitions and classifications for elderly-onset IBD to guide diagnosis and research.
Tailor therapeutic strategies recognizing differences in biological therapy exposure and surgery rates between elderly- and adult-onset patients.
Implement vigilant early monitoring for elderly-onset CD patients to identify those requiring prompt surgical intervention.
Use long-term prospective data to inform treatment decisions and anticipate disease progression in elderly-onset IBD.
by Dorottya Angyal, Lorant Gonczi, Fruzsina Balogh, Panu Wetwittayakhlang, Petra A Golovics, Tunde Pandur, Gyula David, Zsuzsanna Erdelyi, Istvan Szita, Akos Ilias, Laszlo Lakatos, Peter L Lakatos
