Saad Abdo M, Czul Frank, Sakuraba Atsushi, Rubin David T, Cohen Russell D
Inflammatory Bowel Disease Center, University of Chicago Medical Center, Chicago, Illinois.
Inflamm Bowel Dis. 2016 May;22(5):1027-31. doi: 10.1097/MIB.0000000000000732.
Although Crohn's disease (CD) is usually diagnosed at a younger age, a growing population of patients with inflammatory bowel disease is diagnosed above age 60 (elderly). The aim of this study was to compare disease phenotype, behavior, and therapy in elderly patients with CD to young patients diagnosed between 18 to 25 years.
This retrospective case-control study identified patients diagnosed with CD at age 60 or above (elderly) and matched them by gender and disease duration with 2 "young" controls diagnosed between 18 and 25 years. Demographic data, disease information, and medical and surgical history were collected from the University of Chicago Medicine inflammatory bowel disease database.
Thirty-two patients were identified in the "elderly" group and matched to 64 "young" patients. Crohn's colitis was more common in older patients (37.5% versus 15.6%, P = 0.02) who were also less likely to have ileocolonic, perianal, or penetrating disease with less extraintestinal manifestations. After 1998, there was no difference in the use of steroids, 5-aminosalicylates, immunomodulators, biologics, or immunomodulators + biologics. No difference was found in the rates of bowel surgery between the 2 groups. Elderly patients developed fewer therapy-related noninfectious complications and Crohn's-related abscesses. Three serious infections (staphylococcal septicemia, pneumonia, and cryptococcal meningitis) were identified in 3 elderly patients on combination immunomodulators + biologics.
Elderly CD is more likely to present with Crohn's colitis and less likely to present with ileocolonic, perianal, or penetrating disease with less extraintestinal manifestations. Elderly are more likely to develop serious therapy-related infectious complications. Larger prospective trials are needed to evaluate the risks of CD immunosuppressive therapy in elderly patients.
尽管克罗恩病（CD）通常在较年轻的时候被诊断出来，但炎症性肠病患者中60岁以上（老年人）的诊断人数在不断增加。本研究的目的是比较老年CD患者与18至25岁之间被诊断出的年轻患者的疾病表型、行为和治疗情况。
这项回顾性病例对照研究确定了60岁及以上被诊断为CD的患者（老年人），并按性别和病程将他们与两名18至25岁之间被诊断出的“年轻”对照进行匹配。从芝加哥大学医学炎症性肠病数据库收集人口统计学数据、疾病信息以及医疗和手术史。
“老年”组确定了32名患者，并与64名“年轻”患者进行了匹配。克罗恩结肠炎在老年患者中更常见（37.5%对15.6%，P = 0.02），他们患回结肠、肛周或穿透性疾病的可能性较小，肠外表现也较少。1998年以后，在使用类固醇、5-氨基水杨酸类药物、免疫调节剂、生物制剂或免疫调节剂+生物制剂方面没有差异。两组之间的肠道手术率没有差异。老年患者发生的治疗相关非感染性并发症和克罗恩病相关脓肿较少。在3名接受免疫调节剂+生物制剂联合治疗的老年患者中发现了3例严重感染（葡萄球菌败血症、肺炎和隐球菌性脑膜炎）。
老年CD更有可能表现为克罗恩结肠炎，而表现为回结肠、肛周或穿透性疾病以及肠外表现较少的可能性较小。老年人更有可能发生严重的治疗相关感染性并发症。需要更大规模的前瞻性试验来评估老年患者CD免疫抑制治疗的风险。
