Afzali Anita, Katz Seymour
The Ohio State University Inflammatory Bowel Disease Center, Columbus, OH, USA.
Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, 395 West 12th Avenue Room 280, Columbus, OH, 43210, USA.
Curr Treat Options Gastroenterol. 2018 Sep;16(3):289-305. doi: 10.1007/s11938-018-0188-9.
Early- and late-onset of inflammatory bowel disease (IBD) may perhaps be etiologically distinct and potentially attributed to genetics, environmental or microbial factors. We review disease factors and clinical characteristics, as well as unique management and treatment strategies to consider when caring for the "baby" or "baby boomer" with IBD.
Around 25% of cases of initial diagnosis of IBD is made before the age of 18 years old, and another 15-20% made after the age of 60. Crohn's disease (CD) typically presents as ileocolonic and stricturing or penetrating phenotype among early-onset, whereas among late-onset, it is mainly colonic and inflammatory. Pediatric ulcerative colitis (UC) is mostly pan-colonic versus primarily left-sided among the elderly. Treatment goal for both age groups is primarily symptom control, with growth and development also considered among pediatric patients. Due to alterations in pharmacokinetics, careful monitoring and reduced dose should be considered. A multidisciplinary care team is necessary to ensure better clinical outcomes. Onset of disease at either spectrum of age requires careful management and treatment, with both unique disease- and age-appropriate factors carefully considered.
炎症性肠病（IBD）的早发和晚发可能在病因上有所不同，可能归因于遗传、环境或微生物因素。我们回顾了疾病因素和临床特征，以及在照顾患有IBD的“婴儿”或“婴儿潮一代”时需要考虑的独特管理和治疗策略。
约25%的IBD初诊病例发生在18岁之前，另有15%-20%发生在60岁之后。克罗恩病（CD）在早发时通常表现为回结肠型以及狭窄或穿透型，而在晚发时主要表现为结肠型和炎症型。小儿溃疡性结肠炎（UC）多为全结肠型，而老年患者主要为左侧结肠型。两个年龄组的治疗目标主要是症状控制，小儿患者还需考虑生长发育。由于药代动力学的改变，应考虑仔细监测并减少剂量。多学科护理团队对于确保更好的临床结果是必要的。在任何一个年龄范围发病都需要仔细的管理和治疗，要同时仔细考虑独特的疾病因素和适合年龄的因素。
