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Ulcerative Colitis in Adulthood and in Older Patients: Same Disease, Same Outcome, Same Risks?

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Abstract

The number of patients with inflammatory bowel disease (IBD) approaching an older age, together with the number of over-60-year-old patients newly diagnosed with IBD, is steadily increasing, reaching 25% of all patients. The present review focuses on late-onset ulcerative colitis (UC) and its initial disease course in comparison with that observed in younger adults in terms of extension at onset and the risk of proximal disease progression, medical treatment, surgery and hospitalization in the first years after diagnosis. We summarize the clues pointing to a milder disease course in a population which frequently presents major frailty due to comorbidities. With increasing age and thus increasing comorbidities, medical and surgical therapies frequently represent a challenge for treating physicians. The response, persistence, and risks of adverse events of conventional therapies indicated for late onset/older UC patients are examined, emphasizing the risks in this particular population, who are still being treated with prolonged corticosteroid therapy. Finally, we concentrate on data on biotechnological agents for which older patients were mostly excluded from pivotal trials. Real-life data from newer agents such as vedolizumab and ustekinumab show encouraging efficacy and safety profiles in the population of older UC patients.

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Authors and Affiliations

  1. Gastroenterology and Chronic Bowel Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy

    Walter Fries, Maria Giulia Demarzo & Anna Viola

  2. Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy

    Maria Giulia Demarzo

  3. Oncologic Surgery, Department of Human Pathology of Adult and Evolutive Age, University of Messina, Messina, Italy

    Giuseppe Navarra

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  1. Walter Fries
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W.F., M.G.D, G.N., G. B., and A.V. have no conflict of interest to declare.

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Fries, W., Demarzo, M.G., Navarra, G. et al. Ulcerative Colitis in Adulthood and in Older Patients: Same Disease, Same Outcome, Same Risks?. Drugs Aging 39, 441–452 (2022). https://doi.org/10.1007/s40266-022-00943-0

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