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Review
. 2015 Aug-Sep;29(6):327-33.
doi: 10.1155/2015/136960. Epub 2015 Jun 12.

Characterization of inflammatory bowel disease in elderly patients: A review of epidemiology, current practices and outcomes of current management strategies

Peter Stepaniuk, Charles N Bernstein, Laura E Targownik, Harminder Singh
Review

Characterization of inflammatory bowel disease in elderly patients: A review of epidemiology, current practices and outcomes of current management strategies

Peter Stepaniuk et al. Can J Gastroenterol Hepatol. 2015 Aug-Sep.

Abstract
in English, French

The authors review and summarize the current literature regarding the epidemiology, clinical presentation and management of inflammatory bowel disease (IBD) in elderly patients. Among elderly patients, the incidence of ulcerative colitis (UC) is higher than that of Crohn disease (CD). Elderly patients with a new diagnosis of UC are more likely to be male and have left-sided colitis. Elderly patients with a new diagnosis of CD are more likely to be female and have colonic disease. Conversely, increasing age at diagnosis has been associated with a lower likelihood of having any of a family history of IBD, perianal disease in CD and extraintestinal manifestations. Although response to drug therapies appears to be similar in elderly patients and younger individuals, the elderly are more likely to receive 5-aminosalicylic acid agents, and less likely to receive immunomodulators and biologics. Corticosteroid use in the elderly is comparable with use in younger individuals. The rates of surgical intervention appear to be lower for elderly CD patients but not elderly UC patients. Elderly individuals with UC are more likely to need urgent colectomy, which is associated with an increased mortality rate. Elective surgery is associated with similar outcomes among the elderly and young patients with IBD. Therefore, the use of immunomodulators and biologics, and earlier consideration of elective surgery for medically refractory disease in elderly patients with IBD, should be emphasized and further evaluated to prevent complications of chronic corticosteroid(s) use and to prevent emergency surgery.

Les auteurs ont analysé et résumé les publications récentes sur l’épidémiologie, la présentation clinique et la prise en charge des maladies inflammatoires de l’intestin (MII) chez les patients âgés.

Ainsi, chez les patients âgés, l’incidence de colite ulcéreuse (CU) est plus élevée que celle de la maladie de Crohn (MC). Un diagnostic de CU touche davantage les hommes et est davantage lié à une colite gauche, tandis qu’un diagnostic de MC touche davantage les femmes et est davantage lié à une maladie colique. En revanche, un âge plus avancé au diagnostic s’associe à une plus faible probabilité d’antécédents familiaux de MII, de MC périanale et de manifestations extra-intestinales. Même si la réponse à la pharmacothérapie semble similaire chez les personnes âgées et plus jeunes, les personnes âgées sont plus susceptibles de recevoir de l’acide 5-aminosalicylique et moins susceptibles de recevoir des immunomodulateurs et des produits biologiques. Leur utilisation de corticoïdes est toutefois comparable à celle des personnes plus jeunes. Le taux d’interventions chirurgicales semble plus faible chez les patients âgés atteints d’une MC, mais non chez ceux atteints d’une CU, qui risquent davantage de subir une colectomie urgente, associée à un taux de mortalité plus élevé. La chirurgie non urgente des MII donne des résultats similaires chez les personnes âgées et les patients plus jeunes. Par conséquent, il faut insister sur la possibilité d’utiliser des immunomodulateurs et des produits biologiques et d’envisager plus rapidement une chirurgie non urgente pour soigner une maladie réfractaire aux médicaments chez les personnes âgées atteintes d’une MII et l’envisager davantage pour prévenir les complications des corticoïdes chroniques et les chirurgies d’urgence.

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