Systematic Review and Meta-analysis: Phenotype and Clinical Outcomes of Older-Onset Inflammatory Bowel Disease

Background: Little is known of the clinical outcome of patients with older-onset inflammatory bowel disease (IBD). We performed a systematic review to determine phenotype and outcomes of older-onset IBD compared with younger-onset subjects. Methods: A systematic search of Embase and Medline up to June 2015 identified studies investigating phenotype and outcomes of older-onset (diagnosed at age ≥50 years) Crohn’s disease (CD) and ulcerative colitis (UC) subjects. Pooled analysis of disease phenotype, medication use, and disease-related surgery were calculated. Results: We analyzed findings from 43 studies comprising 8,274 older-onset and 34,641 younger-onset IBD subjects. Compared with younger-onset patients, older-onset CD patients were more likely to have colonic disease (Odds ratio (OR) 2.56, 95% confidence interval (CI) 1.88 – 3.48) and inflammatory behavior (OR 1.19, 95% CI 1.07 – 1.33), whilst less likely to have penetrating disease or perianal involvement. More older-onset UC patients had left-sided colitis (OR 1.49, 95% CI 1.18 – 1.88). Although fewer older-onset IBD patients received immunomodulator (CD: OR 0.44; UC: OR 0.60) or biologics (CD: OR 0.34; UC: OR 0.41), older-onset CD was similar in the need for surgery (OR 0.70, 95% CI 0.40 – 1.22) whereas more older-onset UC patients underwent surgery (OR 1.36, 95% CI 1.18 – 1.57). Conclusions: Elderly IBD patients present with less complicated disease, but have similar or higher rate of surgery than non-elderly patients. Whether this reflects a non-benign disease course, physicians' reluctance to employ immunomodulators, or both, merits further study which is essential for improving the care of IBD in the elderly.