Systematic Review and Meta-analysis: Phenotype and Clinical Outcomes of Older-onset Inflammatory Bowel Disease

Abstract

Background: 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.

Methods: 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.

Results: 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].

Conclusions: 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.

Keywords: Older-onset IBD; natural history; outcomes; phenotype.

Figure 1.

Flowchart depicting search strategy for the systematic review.

Figure 2.

Comparison of disease location in older-onset and younger-onset Crohn’s disease. [a] Ileal disease [L1]. [b] Colonic disease [L2]. [c] Ileocolonic disease [L3].

Figure 2.

Comparison of disease location in older-onset and younger-onset Crohn’s disease. [a] Ileal disease [L1]. [b] Colonic disease [L2]. [c] Ileocolonic disease [L3].

Figure 2.

Comparison of disease location in older-onset and younger-onset Crohn’s disease. [a] Ileal disease [L1]. [b] Colonic disease [L2]. [c] Ileocolonic disease [L3].

Figure 3.

Comparison of outcomes in older-onset and younger-onset Crohn’s disease. [a] Surgery. [b] Immunomodulator use. [c] Biological [anti-tumour necrosis factor α] agents.

Figure 3.

Comparison of outcomes in older-onset and younger-onset Crohn’s disease. [a] Surgery. [b] Immunomodulator use. [c] Biological [anti-tumour necrosis factor α] agents.

Figure 3.

Comparison of outcomes in older-onset and younger-onset Crohn’s disease. [a] Surgery. [b] Immunomodulator use. [c] Biological [anti-tumour necrosis factor α] agents.

Figure 4.

Comparison of frequency of left-sided involvement in older-onset and younger-onset ulcerative colitis.

Figure 5.

Comparison of outcomes in older-onset and younger-onset ulcerative colitis. [a] Surgery. [b] Immunomodulator use. [c] Biological [anti-tumour necrosis factor α] agents.