P682. Elderly onset inflammatory bowel disease is a risk factor for gastric cancer development

Abstract Background Incidence of elderly-onset inflammatory bowel disease (IBD), defined as age ≥ 60 at diagnosis, is increasing rapidly worldwide. We aimed to compare the clinical characteristics and natural history of elderly onset IBD patients to non-elderly onset IBD patients. Methods Patients with a confirmed diagnosis of IBD from 1981 to 2016 were identified from a territory-wide Hong Kong IBD registry involving 13 hospitals. Demographics, comorbidities, clinical features and outcomes of elderly-onset IBD patients were compared with non-elderly onset IBD patients. Results Total 2413 patients were identified, of whom 270 (11.2%) had elderly-onset IBD during 21805 person-years follow-up. Median follow-up duration was 111 months (Interquartile range [IQR]: 68–165 months). The ratio of ulcerative colitis (UC): Crohn’s disease (CD) was higher in elderly-onset IBD than non-elderly onset IBD patients. (3.82:1 vs. 1.39:1; p < 0.001). Elderly-onset Crohn’s disease (CD) had less perianal involvement (5.4% vs. 25.4%; p < .001) but more stricturing phenotype (32.1% vs. 20.5%; p = 0.04) than non-elderly onset. There was no difference in the rate of cumulative use of biologics (p = 0.49), but significantly lower use of immunosuppressants in elderly-onset IBD patients (p = 0.001). Cumulative risk of IBD-related surgeries was similar (p = 0.89). Elderly-onset IBD was associated with higher risks of cytomegalovirus colitis (Odds ratio [OR]: 3.07; 95% Confidence Interval (CI) 1.92–4.89; p < 0.001); herpes zoster infections (OR: 2.42; 95% CI: 1.22–4.80; p = 0.12) and all cancer development (Hazard ratio: 2.97; 95% CI: 1.84–4.79; p < 0.001). Elderly-onset IBD was also associated with increased number of overall hospitalisation (OR: 1.14; 95% CI 1.09–1.20; p < 0.001), increased number of infections-related hospitalisation (OR: 1.87; 95% CI 1.47–2.38; p < 0.001) and longer hospitalisation (OR: 1.004; 95% CI: 1.001- 1.007; p = 0.007) compared with non-elderly onset IBD. Conclusion Elderly-onset IBD has less perianal CD. However, they have significantly more comorbidities and are associated with increased risk of infections, cancer development and increased and prolonged hospitalisations. Specific therapeutic strategies are needed in this special group of patients.

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Epidemiology and Natural History of Elderly-onset Inflammatory Bowel Disease: Results From a Territory-wide Hong Kong IBD Registry

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjaa181 ◽

2020 ◽

Author(s):

Joyce Wing Yan Mak ◽

Carmen Lok Tung Ho ◽

Kylie Wong ◽

Tsz Yan Cheng ◽

Terry Cheuk Fung Yip ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Hong Kong ◽

Natural History ◽

Bowel Disease ◽

Cancer Development ◽

Adult Onset ◽

Related Hospitalisation ◽

History Of ◽

Elderly Onset ◽

Inflammatory Bowel

Abstract Background Elderly-onset inflammatory bowel disease [IBD], defined as age ≥60 at diagnosis, is increasing worldwide. We aimed to compare clinical characteristics and natural history of elderly-onset IBD patients with those of adult-onset IBD patients. Methods Patients with a confirmed diagnosis of IBD from 1981 to 2016 were identified from a territory-wide Hong Kong IBD registry involving 13 hospitals. Demographics, comorbidities, clinical features, and outcomes of elderly-onset IBD patients were compared with those of adult-onset IBD patients. Results A total of 2413 patients were identified, of whom 270 [11.2%] had elderly-onset IBD. Median follow-up duration was 111 months (interquartile range [IQR]: 68–165 months). Ratio of ulcerative colitis [UC]: Crohn’s disease [CD] was higher in elderly-onset IBD than in adult-onset IBD patients [3.82:1 vs 1.39:1; p <0.001]. Elderly-onset CD had less perianal involvement [5.4% vs 25.4%; p <0.001] than adult-onset CD. Elderly-onset IBD patients had significantly lower cumulative use of immunomodulators [p = 0.001] and biologics [p = 0.04]. Elderly-onset IBD was associated with higher risks of: cytomegalovirus colitis (odds ratio [OR]: 3.07; 95% confidence interval [CI] 1.92–4.89; p <0.001); herpes zoster [OR: 2.42; 95% CI 1.22–4.80; p = 0.12]; and all cancer development [hazard ratio: 2.97; 95% CI 1.84–4.79; p <0.001]. They also had increased number of overall hospitalisations [OR: 1.14; 95% CI 1.09–1.20; p <0.001], infections-related hospitalisation [OR: 1.87; 95% CI 1.47–2.38; p <0.001], and IBD-related hospitalisation [OR: 1.09; 95% CI 1.04- 1.15; p = 0.001] compared with adult-onset IBD patients. Conclusions Elderly-onset IBD was associated with increased risk of infections and cancer development, and increased infection- and IBD-related hospitalisations. Specific therapeutic strategies to target this special population are needed.

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Diversion colitis: a trigger for ulcerative colitis in the in-stream colon?

Gut ◽

10.1136/gut.44.2.279 ◽

1999 ◽

Vol 44 (2) ◽

pp. 279-282 ◽

Cited By ~ 17

Author(s):

A G Lim ◽

F L Langmead ◽

R M Feakins ◽

D S Rampton

Keyword(s):

Ulcerative Colitis ◽

Inflammatory Bowel Disease ◽

Risk Factor ◽

Large Intestine ◽

Bowel Disease ◽

Rectosigmoid Colon ◽

Diversion Colitis ◽

End Colostomy ◽

Microscopic Features ◽

Inflammatory Bowel

The aetiology of ulcerative colitis is unknown. Two patients without pre-existing inflammatory bowel disease in whom end colostomy for faecal incontinence was complicated by diversion colitis in the defunctioned rectosigmoid colon, are described. In both instances, colitis with the clinical, colonoscopic, and microscopic features of ulcerative colitis developed about a year later in the previously normal in-stream colon proximal to the colostomy. These cases suggest that diversion colitis may be a risk factor for ulcerative colitis in predisposed individuals and that ulcerative colitis can be triggered by anatomically discontinuous inflammation elsewhere in the large intestine.

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The Changing Phenotype of Inflammatory Bowel Disease

Gastroenterology Research and Practice ◽

10.1155/2016/1619053 ◽

2016 ◽

Vol 2016 ◽

pp. 1-9 ◽

Cited By ~ 7

Author(s):

Carthage Moran ◽

Donal Sheehan ◽

Fergus Shanahan

Keyword(s):

Colorectal Cancer ◽

Inflammatory Bowel Disease ◽

Surgical Treatment ◽

Cancer Risk ◽

Bowel Disease ◽

Mortality Rates ◽

Phenotypic Changes ◽

Disease Mortality ◽

Elderly Onset ◽

Inflammatory Bowel

It is widely known that there have been improvements in patient care and an increased incidence of Inflammatory Bowel Disease (IBD) worldwide in recent decades. However, less well known are the phenotypic changes that have occurred; these are discussed in this review. Namely, we discuss the emergence of obesity in patients with IBD, elderly onset disease, mortality rates, colorectal cancer risk, the burden of medications and comorbidities, and the improvement in surgical treatment with a decrease in surgical rates in recent decades.

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