Patients With Late-Adult-Onset Ulcerative Colitis Have Better Outcomes Than Those With Early Onset Disease

Ha, Christina; Newberry, Rodney D.; Stone, Christian D.; Ciorba, Matthew A.

doi:10.1016/j.cgh.2010.03.022

Cited by 67 publications

(52 citation statements)

References 41 publications

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“…Our results also differ from those published in a recent study by Ha et al [18] which also utilized the Montreal classification system to categorize disease extent by age of diagnosis. This retrospective study did not find a difference in disease extent or severity when comparing patients diagnosed between 18 and 30 years of age to patients diagnosed at age 50 or over.…”

Section: Discussioncontrasting

confidence: 99%

Association of Age at Diagnosis and Ulcerative Colitis Phenotype

Quezada

Cross

2012

Dig Dis Sci

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Background Ulcerative colitis (UC) primarily affects young adults; however, 12% of patients are diagnosed at an advanced age. Previous studies report that older patients are less likely to have pancolitis and more likely to have distal disease location. Aims Our objective was to compare UC phenotype by age of diagnosis in a tertiary referral cohort. Methods Retrospective database analysis. Demographics, disease extent, and EIM were compared by the following age of diagnosis groups:<17 years, 17–40 years, and>40 years. Results A total of 260 patients evaluated between July 1, 2004 and April 19, 2010 were included. Race, smoking history, extraintestinal manifestations of disease, and disease duration were significantly associated with age of diagnosis. As age of diagnosis increased, the proportion of non-white patients increased (p = 0.04), former smoking history increased (p<0.001), extraintestinal manifestations of disease decreased (p<0.017), and disease duration decreased (p<0.0001). As age of diagnosis increased, there was a trend for a higher proportion of patients with proctitis and a decreased proportion of patients with pancolitis. Multivariable analysis adjusting for sex, race, smoking history, family history, and disease duration demonstrated that diagnosis at >40 years was associated with a decreased likelihood for pancolitis compared to younger cohorts (OR 0.43, 95% CI 0.24, 0.76). Conclusions Diagnosis of ulcerative colitis after age 40 years was associated with decreased disease extent compared to younger age groups, even after adjustment for sex, race, smoking history, family history, and disease duration. Our results suggest that older patients have distinct clinical phenotypes.

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Section: Discussioncontrasting

confidence: 99%

Association of Age at Diagnosis and Ulcerative Colitis Phenotype

Quezada

Cross

2012

Dig Dis Sci

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“…In addition, a younger age at diagnosis has been found to be an independent predictor of earlier relapse, with an HR increase of 0.4 per decade [20]. Patients with late onset disease also have better responses to therapy and are more likely to experience steroid-free clinical remission 1 year after diagnosis than are patients with YO disease [21]. Overall, the results of the present study are consistent with those in the previous studies.…”

Section: Discussionsupporting

confidence: 89%

Comparing the clinical outcomes of young-onset and adult-onset ulcerative colitis: a multi-center Korean Association for the Study for Intestinal Diseases study

Kim

Park

Han

et al. 2017

Korean J Intern Med

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Background/AimsThe aim of this study was to compare the clinical features and outcomes of ulcerative colitis (UC) according to the age of onset in Korea.MethodsA total of 1,141 patients who were diagnosed with UC between July 1987 and November 2013 at 11 tertiary hospitals were enrolled. The baseline disease characteristic and disease state at onset, treatment during the disease course were retrospectively reviewed among patients with young-onset (YO, < 20 years) and adult-onset (AO, ≥ 20 years). Severe outcome was defined as use of intravenous (IV) steroids, infliximab, immunosuppressant, or UC-related operation.ResultsThere were 55 YO patients (mean age, 17.8 ± 2.4) and 1,086 AO patients (mean age, 43.0 ± 13.6). High Mayo scores (7.7 ± 3.0 vs. 5.6 ± 2.7, p = 0.000), extensive UC (52.7% vs. 25.8%, p = 0.000) and IV steroid (41.8% vs. 18.0%, p = 0.000), immunosuppressant (47.3% vs. 26.9%, p = 0.002), and infliximab (20.0% vs. 7.2%, p = 0.001) use were more frequent in the YO than in the AO group. According to multivariate analysis, severe outcomes were related to YO disease (hazard ratio [HR], 2.18; 95% confidence interval [CI], 1.27 to 3.71), body mass index < 23 kg/m2 (HR, 1.46; 95% CI, 1.07 to 2.00), severe (HR, 2.29; 95% CI, 1.36 to 3.38), and moderate (HR, 2.48; 95% CI, 1.67 to 3.67) disease, extensive UC (HR, 2.90; 95% CI, 1.79 to 4.69), UC-related admission (HR, 63.89; 95% CI, 20.41 to 200.02), and oral steroid use (HR, 0.51; 95% CI, 0.39 to 0.67).ConclusionsUC with YO presented with more advanced clinical features at onset and more severe outcomes than the AO. YO cases require careful management and intense treatment strategies.

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“…Older-onset IBD may be associated with a milder disease phenotype with decreased progression to more severe stages such as stricturing or penetrating disease. 5, 6 Despite a milder phenotype, older IBD patients, regardless of age of onset, have higher resource utilization with increased rates of in-hospital morbidity and mortality compared to younger IBD patients. 4 Therefore, optimizing the management of IBD in the older is increasingly important.…”

Section: Introductionmentioning

confidence: 99%

Medication Utilization and the Impact of Continued Corticosteroid Use on Patient-reported Outcomes in Older Patients with Inflammatory Bowel Disease

Geisz

Kappelman

et al. 2016

Inflammatory Bowel Diseases

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Background Older individuals with inflammatory bowel disease (IBD) require ongoing medications. We aimed to describe 1) medication use in older and younger IBD patients and 2) medication associations with patient reported outcomes (PRO’s) in older patients. Methods We conducted cross-sectional and longitudinal analyses within CCFA Partners internet-based cohort of patients with self-reported IBD. We assessed medication use by disease sub-type and age. We used bivariate analyses to 1) compare medication use in older and younger patients and 2) determine associations between continued steroid use and PRO’s in older patients. Results We included 5382 participants with IBD; 1004 were older (≥ age 60). Older patients with Crohn’s disease (CD) had lower anti-tumor necrosis factor alpha (anti-TNF) use at baseline (29.1% vs 44.3%, p<0.001), comparable steroid use (16.0% vs. 16.5%, p=0.77), and higher aminosalicylate use (40.3% vs. 33.9%, p=0.003) versus younger patients. Older ulcerative colitis (UC) patients had similar anti-TNF use (16.0% vs. 19.2%, p=0.16), lower steroid use (9.6% vs. 15.4%, p=0.004) and higher aminosalicylate use (73.8% vs. 68.2%, p=0.04) at baseline. In longitudinal analyses, older CD patients had higher continued steroid use (11.6% vs. 7.8%, p=0.002); which was associated with worsened anxiety (p=0.02), sleep (p=0.01), and fatigue (p=0.001) versus non-use. Older CD patients on steroids, versus anti-TNF or immunomodulators, had increased depression (p=0.04) and anxiety (p=0.03). Conclusions Medication utilization differs in older patients with IBD. Older CD patients have higher continued steroid use; associated with worsened PRO’s. As in younger IBD populations; continued steroid use should be limited in older patients.

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Patients With Late-Adult-Onset Ulcerative Colitis Have Better Outcomes Than Those With Early Onset Disease

Cited by 67 publications

References 41 publications

Association of Age at Diagnosis and Ulcerative Colitis Phenotype

Association of Age at Diagnosis and Ulcerative Colitis Phenotype

Comparing the clinical outcomes of young-onset and adult-onset ulcerative colitis: a multi-center Korean Association for the Study for Intestinal Diseases study

Medication Utilization and the Impact of Continued Corticosteroid Use on Patient-reported Outcomes in Older Patients with Inflammatory Bowel Disease

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