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

Shi, Hai Yun; Chan, Francis K L; Leung, Wai Keung; Li, Michael K K; Leung, Chi Man; Sze, Shun Fung; Ching, Jessica Y L; Lo, Fu Hang; Tsang, Steve W C; Shan, Edwin H S; Mak, Lai Yee; Lam, Belsy C Y; Hui, Aric J; Wong, Sai Ho; Wong, Marc T L; Hung, Ivan F N; Hui, Yee Tak; Chan, Yiu Kay; Chan, Kam Hon; Loo, Ching Kong; Tong, Raymond W H; Chow, Wai Hung; Ng, Carmen K M; Lao, Wai Cheung; Harbord, Marcus; Wu, Justin C Y; Sung, Joseph J Y; Ng, Siew C.
J Crohns Colitis; 10(2): 176-85, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26512132

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.
Selo DaSilva