Angyal Dorottya, Gonczi Lorant, Balogh Fruzsina, Wetwittayakhlang Panu, Golovics Petra A, Pandur Tunde, David Gyula, Erdelyi Zsuzsanna, Szita Istvan, Ilias Akos, Lakatos Laszlo, Lakatos Peter L
Department of Internal Medicine and Oncology, Semmelweis University, Budapest, 1083, Hungary.
Gastroenterology and Hepatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
J Crohns Colitis. 2025 Jan 11;19(1). doi: 10.1093/ecco-jcc/jjaf003.
Limited data are available on long-term disease outcomes in elderly-onset (EO) inflammatory bowel diseases (IBD) from well-defined population-based cohorts. Our aim was to analyze incidence, disease course, surgery rates, and therapeutic strategies of EO IBD in a prospective population-based cohort.
Elderly-onset inflammatory bowel diseases were defined if diagnosis was established at ≥60 years of age. Patient inclusion lasted between 1977 and 2018. Study endpoints were compared between elderly- and adult-onset (AO) patients and different therapeutic eras. Data from medical records were prospectively collected and regularly reviewed, as part of the well-established Veszprem IBD cohort.
Data from 946 Crohn's disease (CD) and 1370 ulcerative colitis (UC) patients were analyzed. The proportion of EO CD and UC patients was 6.1% (58/946) and 13.4% (183/1370) in the total cohort. Biological therapy exposure was significantly lower in EO CD compared to AO [pLogRank = 0.003], but similar exposure was seen amongst UC patients [pLogRank = 0.770]. Early surgery rates (≤1 year from diagnosis) were significantly higher in EO CD patients compared to AO (27.6% vs 15.6%; P < .001). However, there was no statistically significant difference in overall resective surgery rates between the EO and AO cohorts in CD [pLogRank = 0.838], nor colectomy rates differed in UC [pLogRank = 0.435]. Disease phenotype progression in CD and UC were both lower in EO disease [pLogRank = 0.015; pLogRank = 0.022].
Elderly-onset inflammatory bowel diseases represents an increasing proportion of IBD patients, with high exposure to biologicals in EO UC. Overall surgery rates were similar in EO and AO cohorts, however, early surgeries in CD were higher in EO patients.
来自明确的基于人群队列的老年起病（EO）炎症性肠病（IBD）长期疾病转归的数据有限。我们的目的是分析基于人群的前瞻性队列中EO IBD的发病率、疾病进程、手术率和治疗策略。
如果在≥60岁时确诊，则定义为老年起病的炎症性肠病。患者纳入时间为1977年至2018年。比较老年起病和成年起病（AO）患者以及不同治疗时代的研究终点。作为成熟的维斯普雷姆IBD队列的一部分，前瞻性收集并定期审查病历数据。
分析了946例克罗恩病（CD）和1370例溃疡性结肠炎（UC）患者的数据。在整个队列中，EO CD和UC患者的比例分别为6.1%（58/946）和13.4%（183/1370）。与AO相比，EO CD患者接受生物治疗的比例显著更低[p对数秩检验=0.003]，但UC患者的生物治疗暴露情况相似[p对数秩检验=0.770]。与AO相比，EO CD患者的早期手术率（诊断后≤1年）显著更高（27.6%对15.6%；P<0.001）。然而，CD的EO和AO队列之间的总体切除手术率无统计学显著差异[p对数秩检验=0.838]，UC的结肠切除术率也无差异[p对数秩检验=0.435]。EO疾病中CD和UC的疾病表型进展均较低[p对数秩检验=0.015；p对数秩检验=0.022]。
老年起病的炎症性肠病在IBD患者中所占比例日益增加，EO UC患者接受生物制剂治疗的比例较高。EO和AO队列的总体手术率相似，然而，EO患者中CD的早期手术率更高。
