Late-onset Crohn's disease: a comparison of disease behaviour and therapy with younger adult patients: the Italian Group for the Study of Inflammatory Bowel Disease 'AGED' study

Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD)

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Disease phenotype and outcome of late-onset Crohn's disease are still poorly defined. METHODS: In this Italian nationwide multicentre retrospective study, patients diagnosed ≥65 years (late-onset) were compared with young adult-onset with 16-39 years and adult-onset Crohn's disease 40-64 years. Data were collected for 3 years following diagnosis. RESULTS: A total of 631 patients (late-onset 153, adult-onset 161, young adult-onset 317) were included. Colonic disease was more frequent in late-onset (P < 0005), stenosing behaviour was more frequent than in adult-onset (P < 0003), but fistulising disease was uncommon. Surgery rates were not different between the three age groups. Systemic steroids were prescribed more frequently in young adult-onset in the first year, but low bioavailability steroids were used more frequently in late-onset in the first 2 years after diagnosis (P < 0.036, P < 0.041, respectively). The use of immunomodulators and anti-TNF's even in patients with more complicated disease, that is, B2 or B3 behaviour (Montreal classification), remained significantly inferior (P < 0.0001) in late-onset compared to young adult-onset. Age at diagnosis, Charlson comorbidity index, and steroid used in the first year were negatively associated with the use of immunomodulators and biologics. Comorbidities, related medications and hospitalizations were more frequent in late-onset. Polypharmacy was present in 56% of elderly Crohn's disease patients. CONCLUSION: Thirty-two percent of late-onset Crohn's disease presented with complicated disease behaviour. Despite a comparable use of steroids and surgery, immunomodulators and biologics were used in a small number of patients.

Original languageEnglish
Pages (from-to)1361-1369
Number of pages9
JournalEuropean journal of gastroenterology & hepatology
Volume31
Issue number11
DOIs
Publication statusPublished - Nov 1 2019

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Behavior Therapy
Inflammatory Bowel Diseases
Crohn Disease
Young Adult
Immunologic Factors
Steroids
Biological Products
Comorbidity
Colonic Diseases
Polypharmacy
Biological Availability
Multicenter Studies
Hospitalization
Retrospective Studies
Age Groups
Late Onset Disorders
Phenotype

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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Late-onset Crohn's disease : a comparison of disease behaviour and therapy with younger adult patients: the Italian Group for the Study of Inflammatory Bowel Disease 'AGED' study. / Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD).

In: European journal of gastroenterology & hepatology, Vol. 31, No. 11, 01.11.2019, p. 1361-1369.

Research output: Contribution to journalArticle

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title = "Late-onset Crohn's disease: a comparison of disease behaviour and therapy with younger adult patients: the Italian Group for the Study of Inflammatory Bowel Disease 'AGED' study",
abstract = "BACKGROUND: Disease phenotype and outcome of late-onset Crohn's disease are still poorly defined. METHODS: In this Italian nationwide multicentre retrospective study, patients diagnosed ≥65 years (late-onset) were compared with young adult-onset with 16-39 years and adult-onset Crohn's disease 40-64 years. Data were collected for 3 years following diagnosis. RESULTS: A total of 631 patients (late-onset 153, adult-onset 161, young adult-onset 317) were included. Colonic disease was more frequent in late-onset (P < 0005), stenosing behaviour was more frequent than in adult-onset (P < 0003), but fistulising disease was uncommon. Surgery rates were not different between the three age groups. Systemic steroids were prescribed more frequently in young adult-onset in the first year, but low bioavailability steroids were used more frequently in late-onset in the first 2 years after diagnosis (P < 0.036, P < 0.041, respectively). The use of immunomodulators and anti-TNF's even in patients with more complicated disease, that is, B2 or B3 behaviour (Montreal classification), remained significantly inferior (P < 0.0001) in late-onset compared to young adult-onset. Age at diagnosis, Charlson comorbidity index, and steroid used in the first year were negatively associated with the use of immunomodulators and biologics. Comorbidities, related medications and hospitalizations were more frequent in late-onset. Polypharmacy was present in 56{\%} of elderly Crohn's disease patients. CONCLUSION: Thirty-two percent of late-onset Crohn's disease presented with complicated disease behaviour. Despite a comparable use of steroids and surgery, immunomodulators and biologics were used in a small number of patients.",
author = "{Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD)} and Anna Viola and Rita Monterubbianesi and Giuseppe Scalisi and Federica Furfaro and Matilde Rea and Simone Saibeni and Annalisa Aratari and Roberto Bringiotti and Giovanni Casella and Laura Cantoro and Iris Frankovic and Francesca Calella and Daniela Pugliese and Stefania Orlando and Leonardo Samperi and Maria Cappello and Giammarco Mocci and Natalia Manetti and Vito Annese and Privitera, {Antonino C.} and Gaetano Inserra and Flavio Caprioli and Renata D'Inc{\`a} and Mariabeatrice Principi and Claudio Papi and Fabiana Castiglione and Silvio Danese and Sandro Ardizzone and Fabrizio Bossa and Anna Kohn and Francesco Manguso and Angela Alibrandi and Gionata Fiorino and Alessandro Armuzzi and Walter Fries",
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T1 - Late-onset Crohn's disease

T2 - a comparison of disease behaviour and therapy with younger adult patients: the Italian Group for the Study of Inflammatory Bowel Disease 'AGED' study

AU - Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD)

AU - Viola, Anna

AU - Monterubbianesi, Rita

AU - Scalisi, Giuseppe

AU - Furfaro, Federica

AU - Rea, Matilde

AU - Saibeni, Simone

AU - Aratari, Annalisa

AU - Bringiotti, Roberto

AU - Casella, Giovanni

AU - Cantoro, Laura

AU - Frankovic, Iris

AU - Calella, Francesca

AU - Pugliese, Daniela

AU - Orlando, Stefania

AU - Samperi, Leonardo

AU - Cappello, Maria

AU - Mocci, Giammarco

AU - Manetti, Natalia

AU - Annese, Vito

AU - Privitera, Antonino C.

AU - Inserra, Gaetano

AU - Caprioli, Flavio

AU - D'Incà, Renata

AU - Principi, Mariabeatrice

AU - Papi, Claudio

AU - Castiglione, Fabiana

AU - Danese, Silvio

AU - Ardizzone, Sandro

AU - Bossa, Fabrizio

AU - Kohn, Anna

AU - Manguso, Francesco

AU - Alibrandi, Angela

AU - Fiorino, Gionata

AU - Armuzzi, Alessandro

AU - Fries, Walter

PY - 2019/11/1

Y1 - 2019/11/1

N2 - BACKGROUND: Disease phenotype and outcome of late-onset Crohn's disease are still poorly defined. METHODS: In this Italian nationwide multicentre retrospective study, patients diagnosed ≥65 years (late-onset) were compared with young adult-onset with 16-39 years and adult-onset Crohn's disease 40-64 years. Data were collected for 3 years following diagnosis. RESULTS: A total of 631 patients (late-onset 153, adult-onset 161, young adult-onset 317) were included. Colonic disease was more frequent in late-onset (P < 0005), stenosing behaviour was more frequent than in adult-onset (P < 0003), but fistulising disease was uncommon. Surgery rates were not different between the three age groups. Systemic steroids were prescribed more frequently in young adult-onset in the first year, but low bioavailability steroids were used more frequently in late-onset in the first 2 years after diagnosis (P < 0.036, P < 0.041, respectively). The use of immunomodulators and anti-TNF's even in patients with more complicated disease, that is, B2 or B3 behaviour (Montreal classification), remained significantly inferior (P < 0.0001) in late-onset compared to young adult-onset. Age at diagnosis, Charlson comorbidity index, and steroid used in the first year were negatively associated with the use of immunomodulators and biologics. Comorbidities, related medications and hospitalizations were more frequent in late-onset. Polypharmacy was present in 56% of elderly Crohn's disease patients. CONCLUSION: Thirty-two percent of late-onset Crohn's disease presented with complicated disease behaviour. Despite a comparable use of steroids and surgery, immunomodulators and biologics were used in a small number of patients.

AB - BACKGROUND: Disease phenotype and outcome of late-onset Crohn's disease are still poorly defined. METHODS: In this Italian nationwide multicentre retrospective study, patients diagnosed ≥65 years (late-onset) were compared with young adult-onset with 16-39 years and adult-onset Crohn's disease 40-64 years. Data were collected for 3 years following diagnosis. RESULTS: A total of 631 patients (late-onset 153, adult-onset 161, young adult-onset 317) were included. Colonic disease was more frequent in late-onset (P < 0005), stenosing behaviour was more frequent than in adult-onset (P < 0003), but fistulising disease was uncommon. Surgery rates were not different between the three age groups. Systemic steroids were prescribed more frequently in young adult-onset in the first year, but low bioavailability steroids were used more frequently in late-onset in the first 2 years after diagnosis (P < 0.036, P < 0.041, respectively). The use of immunomodulators and anti-TNF's even in patients with more complicated disease, that is, B2 or B3 behaviour (Montreal classification), remained significantly inferior (P < 0.0001) in late-onset compared to young adult-onset. Age at diagnosis, Charlson comorbidity index, and steroid used in the first year were negatively associated with the use of immunomodulators and biologics. Comorbidities, related medications and hospitalizations were more frequent in late-onset. Polypharmacy was present in 56% of elderly Crohn's disease patients. CONCLUSION: Thirty-two percent of late-onset Crohn's disease presented with complicated disease behaviour. Despite a comparable use of steroids and surgery, immunomodulators and biologics were used in a small number of patients.

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U2 - 10.1097/MEG.0000000000001546

DO - 10.1097/MEG.0000000000001546

M3 - Article

C2 - 31567640

AN - SCOPUS:85072767843

VL - 31

SP - 1361

EP - 1369

JO - European Journal of Gastroenterology and Hepatology

JF - European Journal of Gastroenterology and Hepatology

SN - 0954-691X

IS - 11

ER -