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. 2016 Feb;10(2):176-85.
doi: 10.1093/ecco-jcc/jjv194. Epub 2015 Oct 28.

Natural History of Elderly-onset Ulcerative Colitis: Results from a Territory-wide Inflammatory Bowel Disease Registry

Hai Yun Shi  1 , Francis K L Chan  1 , Wai Keung Leung  2 , Michael K K Li  3 , Chi Man Leung  4 , Shun Fung Sze  5 , Jessica Y L Ching  1 , Fu Hang Lo  6 , Steve W C Tsang  7 , Edwin H S Shan  8 , Lai Yee Mak  9 , Belsy C Y Lam  10 , Aric J Hui  11 , Sai Ho Wong  12 , Marc T L Wong  13 , Ivan F N Hung  2 , Yee Tak Hui  5 , Yiu Kay Chan  8 , Kam Hon Chan  9 , Ching Kong Loo  10 , Raymond W H Tong  10 , Wai Hung Chow  12 , Carmen K M Ng  13 , Wai Cheung Lao  4 , Marcus Harbord  14 , Justin C Y Wu  1 , Joseph J Y Sung  1 , Siew C Ng  15
Affiliations

Natural History of Elderly-onset Ulcerative Colitis: Results from a Territory-wide Inflammatory Bowel Disease Registry

Hai Yun Shi et al. J Crohns Colitis. 2016 Feb.

Abstract

Background and aims: Data on the natural history of elderly-onset ulcerative colitis [UC] are limited. We aimed to investigate clinical features and outcomes of patients with elderly-onset UC.

Methods: Patients with a confirmed diagnosis of UC between 1981 and 2013, from 13 hospitals within a territory-wide Hong Kong Inflammatory Bowel Disease Registry, were included. Clinical features and outcomes of elderly-onset patients, defined as age ≥ 60 years at diagnosis, were compared with those of non-elderly-onset disease [< 60 years at diagnosis].

Results: We identified 1225 patients, of whom 12.8% [157/1225; 56.1% male] had elderly-onset UC. Median duration of follow-up was 11 years [interquartile range, 6-16 years]. Age-specific incidence of elderly-onset UC increased from 0.1 per 100000 persons before 1991 to 1.3 per 100000 persons after 2010. There were more ex-smokers [32.2% vs. 12.2%, p < 0.001] and higher proportion of comorbidities [p < 0.001] in elderly-onset than non-elderly-onset patients. Disease extent, corticosteroids, immunosuppressants use, and colectomy rates were similar between the two groups. Elderly-onset disease was an independent risk factor for cytomegalovirus infection [odds ratio 2.9, 95% confidence interval 1.6-5.2, p < 0.001]. More elderly-onset patients had Clostridium difficile infection [11.0% vs. 5.4%, p = 0.007], hospitalisation for UC exacerbation [50.6% vs. 41.8%, p = 0.037], colorectal cancer [3.2% vs. 0.9%, p = 0.033], all-cause mortality [7.0% vs. 1.0%, p < 0.001], and UC-related mortality [1.9% vs. 0.2%, p = 0.017] than non-elderly-onset patients.

Conclusions: Elderly-onset UC patients are increasing in number. These patients have higher risk of opportunistic infections, hospitalisation, colorectal cancer, and mortality than non-elderly-onset patients. Management and therapeutic strategies in this special group need careful attention.

Keywords: Natural history; elderly-onset; ulcerative colitis.

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