Crohn's disease in the elderly

Area of Science:

• Gastroenterology
• Internal Medicine
• Geriatric Medicine

Background:

• Crohn's disease (CD) diagnosis in elderly patients presents unique challenges.
• Understanding CD features in older adults is crucial for effective management.

Purpose of the Study:

• To delineate the clinical, radiographic, and histologic characteristics of Crohn's disease in patients aged 60 and above.
• To compare CD presentation in elderly versus younger populations.

Main Methods:

• Retrospective chart, roentgenogram, and pathology review of elderly Crohn's disease patients (onset >60 years) diagnosed between 1966-1979.
• Analysis of disease location (ileitis, colitis, ileocolitis), surgical requirements, and recurrence rates.

Main Results:

• Thirty-three elderly patients (5.2% of total CD cases) were identified.
• Clinical, radiographic, and histologic features were largely similar to younger patients.
• Differentiation from ischemic bowel disease and diverticulitis was challenging, often requiring histology.
• Surgery was required in 58% of elderly patients, with higher rates in colitis (91%) and ileocolitis (50%).
• Cumulative clinical recurrence rate for ileal disease was 21% at 9 years and 37% at 15 years.

Conclusions:

• Crohn's disease in the elderly shares many features with younger patients but poses diagnostic difficulties.
• Elderly patients, particularly those with colitis, have a high rate of surgical intervention.
• Long-term recurrence rates in elderly patients with ileal Crohn's disease are significant.