Abstract

Progression of Elderly-Onset Inflammatory Bowel Diseases: A Systematic Review and Meta-Analysis of Population-based Cohort Studies

Rozich JJ1, Dulai PS2, Fumery M3, Sandborn WJ2, Singh S4. Clin Gastroenterol Hepatol. 2020 Mar 3. pii: S1542-3565(20)30267-6. doi: 10.1016/j.cgh.2020.02.048. [Epub ahead of print]

 
     

Author information

Department of Internal Medicine, University of California San Diego, La Jolla, California.

Division of Gastroenterology, University of California San Diego, La Jolla, California.

Gastroenterology Unit, Amiens University and Hospital, Université de Picardie Jules Verne, Amiens, France.

Division of Gastroenterology, University of California San Diego, La Jolla, California; Division of Biomedical Informatics, University of California San Diego, La Jolla, California. Electronic address: sis040@ucsd.edu.

Abstract

BACKGROUND & AIMS: The incidence of inflammatory bowel diseases (IBD) in older adults is increasing. We performed a systematic review and meta-analysis to evaluate progression of elderly-onset (EO)-IBD in population-based cohorts and compared it with adult-onset (AO)-IBD.

METHODS: In a systematic review through June 1, 2019, we identified population-based cohort studies of EO-IBD reporting cumulative risk of hospitalization, surgery, mortality, treatment patterns, and escalation and/or malignancy. Data were synthesized using random-effects meta-analysis as cumulative risk of events at 1 y, 5 y, and 10 y, and compared with data from patients with AO-IBD in the same cohorts.

RESULTS: We identified 9 studies, comprising 14,765 patients with EO-IBD. In patients with EO-Crohn's disease (CD), the cumulative 5-year risk of surgery was 22.6% (95% CI, 18.7-27.2) and was similar to that of patients with AO-CD (relative risk [RR], 1.04; 95% CI, 0.80-1.34). Overall exposure to corticosteroids was comparable between patients with EO-CD vs AO-CD (5 y risk: 55.4%; 95% CI, 53.4-57.4; RR, 0.88; 95% CI, 0.78-1.00), but exposure to immunomodulators (31.5%; 95% CI, 29.7-33.4; RR, 0.62; 95% CI, 0.51-0.77) or biologic agents (6.5%; 95% CI, 5.6-7.6; RR, 0.36; 95% CI, 0.25-0.52) was significantly lower for patients with EO-CD than for patients with AO-CD. Similarly, in patients with EO-ulcerative colitis (UC), the cumulative 5 y risk of surgery was 7.8% (95% CI, 5.0-12.0), similar to the risk for patients with AO-UC (RR, 1.29; 95% CI, 0.79-2.11). Overall exposure to corticosteroids was comparable between patients with EO-UC vs AO-UC (5 y risk: 57.2%; 95% CI, 55.6-58.7; RR, 0.98; 95% CI, 0.91-1.06), but exposure to immunomodulators (16.1%; 95% CI, 15.0-17.2; RR, 0.58; 95% CI, 0.54-0.62) or biologic agents (2.0%; 95% CI, 1.6-2.5; RR, 0.36; 95% CI, 0.24-0.52) was significantly lower for patients with EO-UC than for patients with AO-UC. Patients with EO-IBD appeared to have increased mortality, but not malignancy, compared with the general population. There were few data on comorbidities or adverse effects of medications.

CONCLUSIONS: In a systematic review and meta-analysis, we found that patients with EO-IBD have a similar risk of surgery as patients with AO-IBD. However, patients with EO-IBD are less likely to receive treatment with immunomodulators or biologic agents.

© Copyright 2013-2020 GI Health Foundation. All rights reserved.
This site is maintained as an educational resource for US healthcare providers only. Use of this website is governed by the GIHF terms of use and privacy statement.