The Management of Inflammatory Bowel Disease in Elderly: Current Evidence and Future Perspectives

Abstract

Data on the elderly population with inflammatory bowel disease (IBD) are scarce, as this population is normally excluded from clinical trials. With an ageing population and an overall increasing prevalence of IBD; the incidence of IBD in elderly is rising. Comorbidities, wide differential diagnosis and polypharmacy make the diagnosis and management of the disease in elderly more challenging compared to that in younger adults. The knowledge of specific requirements for the management and treatment of IBD in advanced age may help in the framing of the definition of the appropriate care of this patient group. This manuscript reviews the most recent knowledge in the epidemiology, diagnosis and management of IBD in this population.

Management of the Elderly Inflammatory Bowel Disease Patient

“…This is highly relevant as in a recent Swiss IBD Cohort study addressing safety issues a positive correlation between the number of concomitantly administered IBD drugs and the occurrence of side effects requiring drug cessation was observed [30]. Also in the elderly population, additional factors have to be considered as cardiovascular diseases, hypertension, diabetes mellitus, malignancies, functional and cognitive impairments, smoking history, and renal dysfunction are more prevalent [31]. Physicians should be at greater awareness that these patients may be treated already with different medications as polypharmacy increases the risk of drug-drug interactions and may trigger or worsen concomitant diseases [31].…”

“…Also in the elderly population, additional factors have to be considered as cardiovascular diseases, hypertension, diabetes mellitus, malignancies, functional and cognitive impairments, smoking history, and renal dysfunction are more prevalent [31]. Physicians should be at greater awareness that these patients may be treated already with different medications as polypharmacy increases the risk of drug-drug interactions and may trigger or worsen concomitant diseases [31]. Age-dependent changes in liver and renal function and age-related body composition (increase of body fat, decrease of lean muscle mass, hypoproteinemia) may impair the pharmacokinetics of medications and have to be considered while prescribing additional therapies in these patients.…”

“…Therefore, metabolic (i.e., diabetes mellitus, dyslipidemia, weight gain, lipodystrophy) and cardiovascular (i.e., hypertension, cardiovascular events) adverse events have to be considered specifically in this patient group and repetitive or prolonged courses of corticosteroids should be avoided [45]. Prolonged use of steroid-based therapies may worsen different clinical conditions such as preexisting diabetes mellitus, hypertension, infections (e.g., pneumonia), eye lens cataract, or may cause mental state alterations [31,46]. Attention has to be given also to corticosteroid-induced osteoporosis and the risk of bone fractures.…”

(Patho-)Physiology of Na+/H+ Exchangers (NHEs) in the Digestive System

“…Inflammatory bowel disease is a chronic inflammatory disorder which is classified into UC and CD (Arnott et al, 2018). One of the common symptoms in IBD patients is diarrhea, possibly caused by NHEs' dysfunction (Magalhaes et al, 2016).…”

Oxidative Stress Markers in Inflammatory Bowel Diseases: Systematic Review

“…Amon the elderly, the time to diagnosis is even longer than in younger adults, and any delay in the proper diagnosis may negatively affect the disease outcome. Elderly patients, usually suffering from multiple comorbidities, could particularly benefit from non-invasive testing [8]. Non-invasive diagnostic tools are of even more importance for pediatric IBD patients, and yet, the limited discovery of biomarker in pediatrics prompted Shores and Everett [9] to claim children to be "biomarker orphans".…”