A substantial and growing proportion of patients with inflammatory bowel disease (IBD) are elderly, and these patients require tailored treatment strategies. However, significant challenges exist in the management of this population due to the paucity of data. Establishing the initial diagnosis and assessing the etiology of future symptoms and flares can be challenging as several other prevalent diseases can masquerade as IBD, such as ischemic colitis, diverticular disease, and infectious colitis. Important pharmacologic considerations include reduced glomerular filtration rate and drug-drug interactions in the elderly. No drug therapy is absolutely contraindicated in this population; however, special risk and benefit assessments should be made. Older patients are more susceptible to side effects of steroids such as delirium, fractures, and cataracts. Budesonide can be an appropriate alternative for mild to moderate ulcerative colitis (UC) or Crohn's disease (CD) as it has limited systemic absorption. Pill size and quantity, nephrotoxicity, and difficulty of administration of rectal preparations should be considered with 5-aminosalicylic (5-ASA) therapy. Biologics are very effective, but modestly increase the risk of infection in a susceptible group. Based on their mechanisms, integrin receptor antagonists (e.g., vedolizumab) may reduce these risks. Use of antibiotics for anorectal or fistulizing CD or pouchitis in UC increases the risk of Clostridium difficile infection. Pre-existing comorbidities, functional status, and nutrition are important indicators of surgical outcomes. Morbidity and mortality are increased among IBD patients undergoing surgery, often due to postoperative complications or sepsis. Elderly adults with IBD, particularly UC, have very high rates of venous thromboembolism (VTE). Colonoscopy appears safe, but the optimal surveillance interval has not been well defined. Should the octogenarian, nonagenarian, and centurion undergo colonoscopy? The length of surveillance should likely account for the individual's overall life expectancy. Specific health maintenance should emphasize administering non-live vaccines to patients on thiopurines or biologics and regular skin exams for those on thiopurines. Smoking cessation is crucial to overall health and response to medical therapy, even among UC patients. This article will review management of IBD in the elderly.

Osteopetrosis is a genetic disorder of bone remodeling caused by osteoclast dysfunction. Clinical features include short stature, frequent fractures, and recurrent infections. Abnormal bone obliterates the marrow cavity, resulting pancytopenia and extramedullary hematopoiesis in the liver and spleen. The splenomegaly can lead to left-sided portal hypertension. We report the second case of osteopetrosis-induced portal hypertension and the first case of upper gastrointestinal bleeding in a 52-year-old woman with osteopetrosis.

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Abstracts S222Results: Th ree patients were managed with this technique. Th e procedure was successful in all the patients. Two patients had recurrent stenotic stoma from Crohn's disease, while the third patient had colostomy following colon cancer resection and developed recurrent stricture even aft er surgical revision and multiple balloon dilations. All patients had great response following stent placement with marked decrease abdominal girth within 24 hours. One patient had severe pain and could tolerate the stent for only 4 days. Th e other 2 patients' stents were left in situ for 6 weeks. All 3 patients had symptomatic improvement following stent placement. Th e patient who could not tolerate the stent developed recurrent stenosis in 4 weeks. Conclusion: Fully covered metal stents appear to be a safe, eff ective, and less invasive option in the management of stomal stenosis. Larger studies are needed to validate the results of our pilot study.Introduction: Basaloid squamous cell carcinoma of the ascending colon is the fi rst case of its kind by location. Other documented cases have demonstrated this aggressive high-grade tumor in the anal canal, descending colon, splenic fl exure, rectosigmoid, and sigmoid colon, respectively. It is an important diff erential diagnosis to consider given its very aggressive nature and relative obscurity. We describe a patient who presents with weakness associated with incidental A-fi b. A 74-year-old male with a past history of osteoarthritis requiring hip replacement presented with weakness of 3-months' duration followed by a syncopal episode and loose stools for 3 weeks. Blood was detected on rectal exam. His initial hemoglobin was 6.5 g, MCV 99.5, and platelet count 193. Following transfusion, the hemoglobin rose to 7.8 g. Alkaline phosphatase was 280 initially. Abdominal CT demonstrated multiple masses compatible with metastasis and focal mural thickening of the ascending colon near the hepatic fl exure with infi ltrative changes in the adjacent mesenteric fat and multiple lymph nodes measuring 1 cm. Esophagoduodenoscopy and biopsy demonstrated a gastric ulcer. Colonoscopy revealed a large ulcerated irregular mass lesion measuring 5 x 6 cm in the ascending colon. Extensive colonic diverticulosis were also noted. Immediate surgical removal of the bleeding and obstructing colonic mass was performed. Biopsy showed infi ltrating solid nests of poorly diff erentiated carcinoma without glandular formation atypical of adenocarcinoma. Pathology further demonstrated a 3.8 x 3 x 0.7 cm ulcerated mass located above the peritoneal refl ection, extending through the colonic wall, reaching the peritoneal serosal surface, with extensive angiolymphatic invasion and vascular invasion. Th e tumor forms many small nodules in the mesenteric pericolic adipose tissue with metastasis in 12 of 17 pericolic lymph nodes. Treatment is ongoing. Basaloid colorectal tumors are extremely rare, with only a handfull of documented cases worldwide. Th ey are very aggressive and have a propensity for metas...