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Clinical manifestations, pathophysiology, treatment and outcome of inflammatory bowel diseases in older people


Butter, Matthias; Weiler, Stefan; Biedermann, Luc; Scharl, Michael; Rogler, Gerhard; Bischoff-Ferrari, Heike A; Misselwitz, Benjamin (2018). Clinical manifestations, pathophysiology, treatment and outcome of inflammatory bowel diseases in older people. Maturitas, 110:71-78.

Abstract

Approximately 10–20% of inflammatory bowel disease (IBD) cases are diagnosed after 60 years of age. Due to the high prevalence of conditions mimicking IBD at older age – including bowel disease associated with non-steroidal anti-inflammatory drugs, diverticulitis, and microscopic colitis – differential diagnosis of IBD among older adults is frequently delayed.
Late-onset IBD is characterized by a predominance of colonic disease and an overall milder disease course; disease progression and new intestinal manifestations are rare. However, older patients are less able to tolerate inflammation and their risk of mortality from severe disease is increased.
Management of late-onset IBD has been insufficiently studied since older adults are underrepresented in clinical trials and specific problems of older patients such as incontinence have not been addressed. To date, treatment generally follows the same principles as in the younger. However, older patients are at higher risk of severe adverse effects of the disease and its treatments, including bone and muscle loss, infections and lymphoma. Therefore, the safety profile of a given drug is of paramount importance in older patients with IBD. Colectomy with ileo-anal pouch anastomosis for refractory ulcerative colitis can be performed safely, although functional results may be inferior to those in middle-aged patients. To decrease mortality among older patients, a timely surgical intervention is important.
Patients with late-onset IBD frequently develop colorectal carcinoma within 8 years of diagnosis; therefore, colorectal cancer screening immediately after diagnosis should be considered. Further, the clinical care of older patients with IBD needs to extend to overall health, including nutrition, vaccination, bone, muscle and mental health.

Abstract

Approximately 10–20% of inflammatory bowel disease (IBD) cases are diagnosed after 60 years of age. Due to the high prevalence of conditions mimicking IBD at older age – including bowel disease associated with non-steroidal anti-inflammatory drugs, diverticulitis, and microscopic colitis – differential diagnosis of IBD among older adults is frequently delayed.
Late-onset IBD is characterized by a predominance of colonic disease and an overall milder disease course; disease progression and new intestinal manifestations are rare. However, older patients are less able to tolerate inflammation and their risk of mortality from severe disease is increased.
Management of late-onset IBD has been insufficiently studied since older adults are underrepresented in clinical trials and specific problems of older patients such as incontinence have not been addressed. To date, treatment generally follows the same principles as in the younger. However, older patients are at higher risk of severe adverse effects of the disease and its treatments, including bone and muscle loss, infections and lymphoma. Therefore, the safety profile of a given drug is of paramount importance in older patients with IBD. Colectomy with ileo-anal pouch anastomosis for refractory ulcerative colitis can be performed safely, although functional results may be inferior to those in middle-aged patients. To decrease mortality among older patients, a timely surgical intervention is important.
Patients with late-onset IBD frequently develop colorectal carcinoma within 8 years of diagnosis; therefore, colorectal cancer screening immediately after diagnosis should be considered. Further, the clinical care of older patients with IBD needs to extend to overall health, including nutrition, vaccination, bone, muscle and mental health.

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Additional indexing

Item Type:Journal Article, refereed, further contribution
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Clinical Pharmacology and Toxicology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2018
Deposited On:08 Mar 2018 16:58
Last Modified:14 Mar 2018 15:35
Publisher:Elsevier
ISSN:0378-5122
OA Status:Closed
Publisher DOI:https://doi.org/10.1016/j.maturitas.2018.01.015

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