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Published on: September 22, 2019
A prospective study of inflammatory bowel disease phenotypes in extremes of age and comparison with adults
Nikhil Bhangale1, Devendra Desai2, Philip Abraham1
1Division of Gastroenterology, P D Hinduja Hospital, Veer Savarkar Marg, Mahim, Mumbai, 400 016, India.
Insights
Pediatric and elderly inflammatory bowel disease (IBD) present distinct characteristics. Pediatric IBD shows more aggressive phenotypes, while elderly IBD is often less severe, influencing treatment approaches.
Area of Science:
- Gastroenterology
- Clinical Medicine
- Inflammatory Bowel Disease Research
Background:
- Inflammatory bowel disease (IBD) in pediatric and elderly populations is understudied, with limited retrospective data.
- Pediatric IBD often exhibits a more aggressive phenotype requiring intensive treatment.
- Elderly IBD may present with less aggressive disease patterns.
Purpose of the Study:
- To prospectively compare the disease characteristics of pediatric, adult, and elderly IBD patients.
- To identify age-specific differences in disease phenotype, behavior, and treatment requirements.
Main Methods:
- A prospective, single-center cohort study of 266 IBD patients.
- Patients were categorized into pediatric (≤16 years), adult (17-59 years), and elderly (≥60 years) groups.
- Data collected included disease characteristics, behavior, extraintestinal manifestations, and treatment over at least six months of follow-up.
Main Results:
- Pediatric ulcerative colitis (UC) patients more frequently had pancolitis (p=0.018).
- Elderly UC patients showed more indolent behavior and fewer extraintestinal manifestations (p=0.005).
- Pediatric Crohn's disease (CD) patients had more colonic involvement (p=0.02), while elderly CD patients had more ileal disease (p=0.04).
- Pediatric CD patients required biologics more often (p=0.005), whereas elderly CD patients needed fewer steroids, biologics, immunosuppressants, and surgeries (p<0.05).
Conclusions:
- Significant age-related differences exist in IBD presentation and management.
- Pediatric CD shows a tendency for colonic disease, and elderly CD for ileal disease, contrasting with some Western literature.
- Elderly CD patients had less frequent perianal disease and required less intensive medical and surgical treatment.
Background And Aims:
Pediatric and elderly inflammatory bowel disease (IBD) are less explored, often in retrospective studies. The pediatric group has a more extensive and aggressive disease phenotype requiring aggressive treatments, whereas the elderly group may have less aggressive diseases.
Methods:
We prospectively compared disease characteristics of a single center cohort of IBD patients (pediatric age ≤ 16 years; adults 17 to 59 years; and elderly ≥ 60 years) seen between September 2018 and November 2019 with at least six months of follow-up.
Results:
Total 266 IBD patients (137 males) included 47 pediatric, 175 adults and 44 elderly patients. Among ulcerative colitis (UC) patients, pancolitis was more common in the pediatric group (p = 0.018), while the elderly group had more indolent behaviors and infrequent extraintestinal manifestations (p = 0.005). Among patients with Crohn's disease (CD), the pediatric group had more often colonic diseases (p = 0.02) and the elderly, ileal diseases (p = 0.04). The disease behavior was similar in the three age groups. Perianal disease was least common in elderly CD patients (p = 0.03). There was no treatment difference among different age groups in UC. In CD, pediatric patients needed biologics more frequently (p = 0.005), while elderly CD patients less frequently required steroids, biologics, immunosuppressants and surgery (p < 0.05).
Conclusions:
We noted differences compared to western literature such as colonic location in pediatric CD and ileal location in elderly CD. Perianal disease was less frequent in the elderly CD group. There was no difference in treatment in the three age groups in UC, while there were no inter-age-group disease behavioral differences for UC and CD.
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