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Clinical characteristics and prognostic differences between elderly-onset and adult-onset ulcerative colitis: a
Hailong Li1, Shigang Ding1,2, Jun Li1
1Department of Gastroenterology, Peking University Third Hospital, Beijing, China.
Background:
The incidence of elderly-onset ulcerative colitis (EO-UC) has been gradually increasing. The unique characteristics of clinical manifestations, therapeutic strategies, and prognosis in EO-UC patients compared with adult-onset ulcerative colitis (AO-UC) patients remain unclear.
Methods:
We retrospectively analyzed hospitalized ulcerative colitis (UC) patients from March 2010 to June 2024 at Peking University Third Hospital and Peking University International Hospital. We recruited 68 EO-UC patients (age at diagnosis≥60 years) and 136 AO-UC patients (age at diagnosis <60 years, matched ratio = 1:2). Follow-up lasted from the date of UC diagnosis to the earlier of two endpoints: January 31, 2025, or the date of the last clinical visit at our center. Subsequently, we analyzed the differences in clinical manifestations, therapeutic strategies, and prognosis between the two groups.
Results:
The male-to-female ratio in the EO-UC group was 1.8:1, and this group had milder clinical manifestations (abdominal pain 58.5% vs. 75.0%, p = 0.022; mucous bloody stool 50.0% vs. 74.3%, p < 0.001) and a higher comorbidity burden (p < 0.001) than the AO-UC group. The distribution of lesion locations differed significantly between the two groups (p = 0.001), with higher proportions of proctitis and left-sided colitis in the EO-UC group (14.7% vs. 2.2% and 22.1% vs. 18.4%). The use of corticosteroids and biologics before hospitalization was significantly lower in the EO-UC group than in the AO-UC group (13.2% vs. 42.6%, p < 0.001; 0.0% vs. 13.2%, p = 0.002). No significant differences were observed between the two groups in terms of concurrent infections, clinical remission rates, relapse patterns, rehospitalization, or complication occurrence. During follow-up, six surgical cases occurred in the adult-onset group, and two in-hospital all-cause mortality cases occurred in the elderly-onset group.
Conclusion:
The EO-UC group was predominantly male, and it exhibited higher comorbidity and concomitant medication rates and milder clinical manifestations than the AO-UC group, presenting challenges for clinical diagnosis. 5-Aminosalicylic acid (5-ASA) remains the first-line therapeutic regimen, and the EO-UC group demonstrated lower utilization rates of immunosuppressants and biologics than the AO-UC group, which may be related to distinct treatment considerations in elderly patients, although this did not translate into observable differences in clinical outcomes between the two groups. This study is preliminary and exploratory, and larger prospective studies with adequate sample sizes are needed to validate these findings in the future.
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