Objective:

To summarize the differences in clinical features and prognosis between elderly-onset ulcerative colitis (EO-UC) and adult-onset ulcerative colitis (AO-UC) patients, providing empirical evidence to guide treatment decisions.

Key Findings:

• EO-UC patients had milder clinical manifestations compared to AO-UC patients (e.g., abdominal pain 58.5% vs. 75.0%, p = 0.022).
• EO-UC patients exhibited a higher comorbidity burden (p < 0.001) and different lesion location distributions (higher proctitis and left-sided colitis).
• Lower utilization rates of corticosteroids and biologics were observed in EO-UC patients compared to AO-UC patients (13.2% vs. 42.6% for corticosteroids, 0.0% vs. 13.2% for biologics, both p < 0.001).
• No significant differences in concurrent infections, clinical remission rates, relapse patterns, rehospitalization, or complications were found between the two groups.
• The male-to-female ratio in the EO-UC group was 1.8:1.

Interpretation:

EO-UC patients are predominantly male with milder symptoms and higher comorbidity, leading to challenges in clinical diagnosis and treatment. The lower use of immunosuppressants and biologics may reflect treatment considerations in elderly patients, emphasizing the need for tailored therapeutic approaches.

Limitations:

• The study is preliminary and exploratory, requiring larger prospective studies for validation.
• Data is limited to two centers, which may affect generalizability and introduce potential biases.

Conclusion:

EO-UC patients present unique clinical features and treatment challenges compared to AO-UC patients, necessitating careful therapeutic regimen selection and further research to validate these findings.