Inflammatory Bowel Disease in the Elderly

Abstract

Introduction: The age of onset of chronic inflammatory bowel disease (IBD) is a major prognostic factor. Although these diseases can appear at any age, they generally tend to start early in life. However, according to several studies, a second peak in incidence may occur after the age of sixty. Our study aims to analyze the clinical characteristics of patients over 60 years of age at the time of diagnosis of their IBD, to follow the evolution of their state of health, and to evaluate the efficacy of the treatments administered. Methods: This is a retrospective, descriptive, cross-sectional study conducted over an 11-year period (2013-2024) at the Hassan II University Hospital in Fez, Morocco. All adult IBD patients diagnosed at 60 years of age were included. Data collected included demographic characteristics, disease phenotype and location, comorbidities, extra-intestinal manifestations, complications, treatments administered and clinical course. The Montreal Classification was used to classify CD and UC. Statistical analysis was performed using Microsoft Excel software, with statistical significance set at p < 0.05. Results: Of the 403 patients included, 14 (3.5%) were aged 60 or older at the time of diagnosis, with a mean age of 70.71 years. The population was predominantly male (64.4%). Among these patients, 8 were diagnosed with ulcerative colitis (UC) and 6 with Crohn’s disease (CD). Comorbidities were common, affecting 71.4% of patients, primarily hypertension and diabetes. The mean time to diagnosis was 23 months for CD and 1.7 months for UC. The most frequent forms of UC were left-sided colitis and pancolitis, whereas CD predominantly affected the colon and ileocolon. Four patients received 5-ASA monotherapy, four patients were treated with anti-TNF alpha therapy (infliximab or adalimumab) alone, and four patients received azathioprine monotherapy. Corticosteroids were required in 3 patients. Notably, some patients received combination or sequential therapies based on disease severity and response. Three patients underwent surgical intervention, generally due to severe acute colitis refractory to medical therapy. The hospitalization rate was 71%, with a mean hospital stay of 23.14 days. The mortality rate was 14%. Conclusion: IBD in the elderly presents specific diagnostic and therapeutic challenges due to co-morbidities and drug interactions. Management needs to be tailored to a multidisciplinary approach involving gastroenterologists, geriatricians and other specialists. A better understanding of the clinical and evolutionary characteristics of these patients could help optimize therapeutic and prognostic strategies.