Ananthakrishnan Ashwin N, Shi Hai Yun, Tang Whitney, Law Cindy C Y, Sung Joseph J Y, Chan Francis K L, Ng Siew C
Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Department of Medicine and Therapeutics, Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong.
J Crohns Colitis. 2016 Oct;10(10):1224-36. doi: 10.1093/ecco-jcc/jjw054. Epub 2016 Feb 29.
Little is known of the clinical outcome of patients with older-onset inflammatory bowel disease [IBD]. We performed a systematic review to determine phenotype and outcomes of older-onset IBD compared with younger-onset subjects.
A systematic search of Embase and Medline up to June 2015 identified studies investigating phenotype and outcomes of older-onset [diagnosed at age ≥ 50 years] Crohn's disease [CD] and ulcerative colitis [UC] subjects. Pooled analyses of disease phenotype, medication use, and disease-related surgery were calculated.
We analysed findings from 43 studies comprising 8274 older-onset and 34641 younger-onset IBD subjects. Compared with younger-onset patients, older-onset CD patients were more likely to have colonic disease (odds ratio [OR] 2.56, 95% confidence interval [CI] 1.88 - 3.48) and inflammatory behaviour [OR 1.19, 95% CI 1.07 - 1.33], and less likely to have penetrating disease or perianal involvement. More older-onset UC patients had left-sided colitis [OR 1.49, 95% CI 1.18 - 1.88]. Although fewer older-onset IBD patients received immunomodulators [CD: OR 0.44; UC: OR 0.60] or biologicals [CD: OR 0.34; UC: OR 0.41], older-onset CD was similar in the need for surgery [OR 0.70, 95% CI 0.40 - 1.22] whereas more older-onset UC patients underwent surgery [OR 1.36, 95% CI 1.18 - 1.57].
Elderly IBD patients present with less complicated disease, but have similar or higher rates of surgery than non-elderly patients. Whether this reflects a non-benign disease course, physicians' reluctance to employ immunomodulators, or both, merits further study which is essential for improving the care of IBD in the elderly.
关于老年起病的炎症性肠病（IBD）患者的临床结局，人们了解甚少。我们进行了一项系统评价，以确定老年起病的IBD与年轻起病的患者相比的表型和结局。
对截至2015年6月的Embase和Medline进行系统检索，以确定研究老年起病（诊断年龄≥50岁）的克罗恩病（CD）和溃疡性结肠炎（UC）患者的表型和结局的研究。计算疾病表型、药物使用和疾病相关手术的汇总分析。
我们分析了43项研究的结果，这些研究包括8274例老年起病和34641例年轻起病的IBD患者。与年轻起病的患者相比，老年起病的CD患者更有可能患有结肠疾病（优势比[OR]2.56，95%置信区间[CI]1.88 - 3.48）和炎症行为[OR 1.19，95%CI 1.07 - 1.33]，而发生穿透性疾病或肛周受累的可能性较小。更多老年起病的UC患者患有左侧结肠炎[OR 1.49，95%CI 1.18 - 1.88]。尽管接受免疫调节剂治疗的老年起病IBD患者较少[CD：OR 0.44；UC：OR 0.60]或生物制剂治疗的较少[CD：OR 0.34；UC：OR 0.41]，但老年起病的CD患者的手术需求相似[OR 0.70，95%CI 0.40 - 1.22]，而更多老年起病的UC患者接受了手术[OR 1.36，95%CI 1.18 - 1.57]。
老年IBD患者的疾病复杂性较低，但手术率与非老年患者相似或更高。这是反映了疾病的非良性病程、医生不愿使用免疫调节剂，还是两者兼而有之，值得进一步研究，这对于改善老年IBD患者的护理至关重要。
