Skip to main content

Inflammatory Bowel Disease in the Elderly

  • Living reference work entry
  • First Online:
Book cover Geriatric Diseases

Abstract

Inflammatory bowel disease (IBD) embraces two diseases, Crohn’s disease (CD) and ulcerative colitis (UC), which are immunologically mediated, chronic, relapsing and inflammatory conditions of unknown aetiology. In the elderly, there are two groups, elderly with onset of IBD at a later age (late onset) and, the other, elderly with a long-standing history of IBD with an initial diagnosis at a younger age. Late-onset CD has been variably defined ranging from 40 to >65 years of age. The review summarises the two diseases, Crohn’s and ulcerative colitis, with the main focus on the age of onset.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Institutional subscriptions

References

  1. Sartor RB. Mechanisms of disease: pathogenesis of Crohn’s disease and ulcerative colitis. Nature Clin Pract Gastroenterol Hepatol. 2006;(3):390–407.

    Article  CAS  Google Scholar 

  2. Zhang YZ, Li YY. Inflammatory bowel disease: pathogenesis. World J Gastroenterol. 2014;20(1):91–9.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Da Silva BC, Lyra AC, Rocha R, Santana GO. Epidemiology demographic characteristics and prognostic predictors of ulcerative colitis. World J Gastroenterol. 2014;20(28):9458–67.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Molodecky NA, Soon IS, Rabi DM, Ghali WA, Ferris M, Chernoff G, et al. Increasing incidence and prevalence of inflammatory bowel disease, with time, based on systematic review. Gastroenterol. 2012;142:46–54.

    Article  Google Scholar 

  5. Burisch J. Crohn’s disease and ulcerative colitis. Occurrence course and prognosis during the first year of disease in a European population-based inception cohort. Dan Med J. 2014;61(1):B4778.

    PubMed  Google Scholar 

  6. CCFA. Inflammatory bowel disease and older adults. http://www.ccfa.org/resources/ibd-and-older-adults.html. retrieved on 9 October 2014.

  7. Sung MK, Park MY. Nutritional modulators of ulcerative colitis: Clinical efficacies and mechanistic view. World J Gastroenterol. 2013;19(7):994–1004.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Karlinger K, Gyorke T, Mako E, Mestr A, Tarjan Z. The epidemiology and the pathogenesis of inflammatory bowel disease. Eur J Radiol. 2000;35(3):154–67

    Article  CAS  PubMed  Google Scholar 

  9. Loftus EV, Silverstein MD, Sandborn WJ, Tremaine WJ, Harmsen WS, Zinsmeister AR. Ulcerative colitis in Olmsted County, Minnesota, 1940–1993 incidence, prevalence and survival. Gut. 2000;46:336–343.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Gisbert JP, Chaparro M. Inflammatory bowel disease in the elderly. Aliment Pharmcol Ther. 2014;39(5):459–47.

    Article  CAS  Google Scholar 

  11. Sandler RS, Golden AL. Epidemiology of Crohn’s disease. J Clin Gastroenterol. 1986;8(2):160–5.

    Article  CAS  PubMed  Google Scholar 

  12. Jones HW, Hoare A. Does ulcerative colitis behave differently in the elderly? Age Aging. 1988;17:410–414.

    Article  CAS  Google Scholar 

  13. Robertson DJ, Grimm IS. Inflammatory bowel disease in the elderly. Gastroenterol Clin. 2001;30:409–426.

    Article  CAS  Google Scholar 

  14. Young-Fadok TM, Wolff BG. Inflammatory Bowel Disease in the Elderly. Principles and Pract Geriatr Surg. 2001;pp 609–619.

    Google Scholar 

  15. del Val JH. Old-age inflammatory bowel disease onset: A different problem? World J Gastroenterol. 2011;17(22):2734–2739.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Grimm IS, Friedman LS. Inflammatory bowel disease in the elderly. Gastroenterol Clin North Am. 1990;19:361–389.

    CAS  PubMed  Google Scholar 

  17. Riegler G, Tatraglione MT, Carrutu R, D’Inca R, Valpiani D, Russo MI, et al. Age-related clinical severity at diagnosis in 1,705 patients with ulcerative colitis: a study by GISC (Italian Colon Rectum Study Group) Dig Dis Sci. 2000;45:462–465.

    Article  CAS  PubMed  Google Scholar 

  18. Triantafillidis JK, Emmanouilidis A, Nicholas D, Ifantis T, Cheracakis P, Merika EG, et al. Crohn’s disease in the elderly: clinical features and long-term outcome of 19 Greek patients. Dig Liver Dis. 2000;32:498–503.

    Article  CAS  PubMed  Google Scholar 

  19. Roberts PL, Schoetz DJ, Pricolo R, Veidenheimer MC. Clinical course of Crohn’s disease in older patients. A retrospective study. Dis Colon Rectum. 1990;33(6):458–462.

    Article  CAS  PubMed  Google Scholar 

  20. Eisen GM, Schutz SM, Washington MK, Burton CS, Sidhu-Malk N, Wilson AP. Atypical presentation of inflammatory bowel disease in the elderly. Am J Gastrenterol. 1993;88:2098–2101.

    CAS  Google Scholar 

  21. Walmsley RS, Gillen CD, Allan RN. Prognosis and management of Crohn’s disease in the over 55 age group. Postgrad Med J 1997;73(858):225–229.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Levin A, Shibolet O. Infliximab in ulcerative colitis. Biologics. 2008;2(3):379–388.

    CAS  PubMed  PubMed Central  Google Scholar 

  23. Satsangi J, Silverberg MS, Vermeirre S, Colombel JF. The Montreal classification of inflammatory bowel disease controversies, consensus and implications. Gut 2006;55:749–753.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Angelcucci E, Cocco A, Latella G, Caprilli R. Clinical course of late-onset Crohn’s disease. Inflamm Bowel Dis 2009;15:1290–1292.

    Article  Google Scholar 

  25. Walker MA, Pennington CR, Pringle R. Crohn’s disease in the elderly. Br Med J Clin Res Edu. 1985:291:1725–1726.

    Article  CAS  Google Scholar 

  26. Lockhart-Mummery HE. Crohn’s disease of the large bowel. Br J Surg 1972;59;823.

    Article  CAS  PubMed  Google Scholar 

  27. Hadithi M, Cazemier M, Meijer GA, Bioenema E, Felt Bersma RJ, Mulder C, et al. Retrospective analysis of old-age colitis in the Dutch inflammatory bowel disease population. World J Gastrroenterol. 2008;14(20):3183–3167.

    Article  Google Scholar 

  28. Danese S, Semeraro S, Papa A, Roberto I, Scaldaferri F, Fedeli G, et al. Extraintestinal manifestations of inflammatory bowel disease. World J Gasteroenterol. 2005;11:7227.

    Article  Google Scholar 

  29. Softley A, Mren J, Clamp SE, Bouchier IA, Watkinson G, de Dombal FT, et al. Inflammatory bowel disease in the elderly patients. Scand J Gastroenterol. Suppl 1988;144:27–30.

    CAS  PubMed  Google Scholar 

  30. Greth J, Torok HP, Koenig A, Folwaczny C. Comparison of inflammatory bowel disease at younger and older age. Eur J Med Res. 2004;9:552–554.

    CAS  PubMed  Google Scholar 

  31. Picco MF, Cangemi JR. Inflammatory bowel disease in the elderly. Gastroenterol Clin North Am. 2009;38:447–462.

    Article  PubMed  Google Scholar 

  32. Shepherd NA. Pathological mimics of chronic inflammatory bowel disease. J Clin Pathol 1991;44:726–733.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Berner Y, Vigder C, Stern M, Feldman J. Inflammatory bowel diseases in the elderly. Harefuah. 2003;142(3):188–92

    PubMed  Google Scholar 

  34. Greenwald DA, Brandt LJ. Inflammatory Bowel Disease After Age 60. Curr Treat Options Gastroenterol. 2003;6(3):2130225.

    Article  Google Scholar 

  35. Van Rosendaal GM, Andersen MA. Segmental Colitis complicating diverticular disease. Can J Gastroenterol. 1996;10:361–364.

    Article  PubMed  Google Scholar 

  36. Makapugay LM, Dean PJ. Diverticular disease – associated chronic colitis. Am J Surg Pathol. 1996;20:94–102.

    Article  CAS  PubMed  Google Scholar 

  37. Harper PC, McAuliffe T, Beeken WL. Crohn’s disease in the elderly. A statistical comparison with younger patients matched for sex and duration of disease. Arch Intern Med. 1986;146:753–755).

    Article  CAS  PubMed  Google Scholar 

  38. Komblath A, Sachar DB. Ulcerative colitis practice guidelines in adults. American College of Gastroenterology, Practical Parameters Committee. Am J Gastroenterol. 1997;92:204–211.

    Google Scholar 

  39. Van Assche G, Dignass A, Reinisch W, Jannekevan Wonde C, Sturm A, DeVos M, et al, The second European evidence-based Consensus on the diagnosis and management of Crohn’s disease. Special situations. J Crohns Colitis. 2010;4:63–101.

    Article  PubMed  Google Scholar 

  40. Katz S, Surawicz C, Pardi DS. Management of the elderly patients with inflammatory disease: practical considerations. Inflamm Bowel Dis. 2013;19(10):2257–72.

    Article  PubMed  Google Scholar 

  41. Katz S, Feldstein R. Inflammatory Bowel Disease of the Elderly. A wake up call. Gastroenerol Hepatol 2008;4(5):337–347.

    Google Scholar 

  42. Dignass A, Van Assche G, Lindsay JO, Lemann M, Soderholm J, Colombel JF, et al. The second European evidenced-based Consensus on the diagnosis and management of Crohn’s disease. Special situations. J Crohns Colitis. 2010;4:28–62.

    Article  CAS  PubMed  Google Scholar 

  43. Manguso F, Balzano A. Meta-analysis: the efficacy of rectal beclomethasone dipropionate vs 5-aminosalicyclic acid in mild and moderate distal ulcerative colitis. Aliment Pharmacol Ther. 2007;26:21–29.

    Article  CAS  PubMed  Google Scholar 

  44. Feagon BG, Rutgeerts P, Sands B E, Hanauer S, Colombel J-F, Sandborn WJ, et al. Vedolizumab as induction and maintenance therapy in ulcerative colitis. NEJM. 2013;369:699–710.

    Article  Google Scholar 

  45. Sandborn WJ, Ghosh S, Panes J, Vranic I, Su C, Rousell S, et al. Tofacitinib an oral Janus-kinas inhibitor in active ulcerative colitis. NEJM. 2012;367:616–624.

    Article  CAS  PubMed  Google Scholar 

  46. Lobaton T, Ferrante M, Rutgeerts P, Ballet V, Van Assche G, Vermeire S. Efficacy and safety of anti-TNF therapy in elderly patients with inflammatory bowel disease. Aliment Pharacol Ther. 2015;42(4):441–51.

    Article  CAS  Google Scholar 

  47. Park SC, Jeen YT. Current emerging biologics for ulcerative colitis. Gut Liver. 2015;9(1):18–27).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Arova Z, Shen B. Biological therapy for ulcerative colitis. Gastroenterol Rep. (2014) https://doi.org/10.1093/gastro/gou070.

  49. Moteno-Rincon E Serrano Ruiz FJ, Benitez Cantero JM, Vazquez Moron JM, Pilares Manrique H, Herrera Justiniano JM, Leo Camero E, et al. Prognosis of patients with ulcerative colitis in sustained remission after thiopurines withdrawal. Inflamm Bowel Dis. 2015;21(7):1564–71

    Article  Google Scholar 

  50. Smith LA, Gaye DR. Utility of faecal calprotectin analysis in adult inflammatory bowel disease. World J Gastroenterol. 2012;18(46):6782–6789.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Lehman FS, Burri E, Beglinger C. The role and utility of faecal markers in inflammatory bowel disease. Therap Adv Gastroenterol. 2015;8:23–36.

    Article  Google Scholar 

  52. Schoepfer AM, Beglniger C, Stranma A, Safroneeva E, Romero Y, Armstrong D, Schmidt C, et al. Faecal calprotectin more accurately reflects endoscopic activity of ulcerative colitis than Lichtiger Index, C reactive protein, platelets, haemoglobin and blood leucocytes. Inflamm Bowel Dis. 2013;19(2):333–4.

    Article  Google Scholar 

  53. Xiang J-Y, Ouyang Q, Li G-D, Xiao N-P. Clinical value of faecal calprotectin in determining disease activity of ulcerative colitis. World J Gastroenterol. 2008;14(1(:53–57.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Guardiola J, Lobaton T, Rodriquoz-Alonso L, Riuz-Cerulla X, Avajo C, Lozyza C, et al. Fecal level of calprotectin identifies histologic inflammation in patients with ulcerative colitis in clinical and endoscopic recurrences. Clin Gastroenerol Hepatol. 2014;12(11):1865–70.

    Article  CAS  Google Scholar 

  55. Guy TS, Williams NN, Rosato EF. Crohn’s disease of the colon. Surg Clin North Am. 2001;81:159–168.

    Article  CAS  PubMed  Google Scholar 

  56. Michelassi F, Block GE. Surgical management of Crohn’s disease. Adv Surg 1993;26:307–322.

    CAS  PubMed  Google Scholar 

  57. Fabricius PJ, Gyde SN, Shouler P, Keighley MR, Alexander-Williams J, Allan RN. Crohn’s disease in the elderly. Gut. 1985;26(5):461–465.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  58. Limsal D, Pardi DS. Quality of Life in ulcerative colitis. From Medscape Gastroenterology. Advamvesin Ulcerative Colitis-Vol 4.

    Google Scholar 

  59. Sajadinejad MS, Asgari IK, Molavi H, Kalautari M, Adibi P. Psychological issues in Inflammatory Bowel Diseases: Am Overview. Gastroenterol Res Pract. 2012;.http://dx.doi.org/10.155/2012/106502.

  60. Tabatabaelan N, Afshar H, Rooh afza HR, Daghaghadeh H, Falzi A, Sharbafchi MR, et al. Psychological stress in Iranian patients with ulcerative colitis and its relation to disease activity and quality of life. J Res Med Sci. 2015;20(6):577–84.

    Article  Google Scholar 

  61. Bernklev T, Jahnsen J, Henriksen M, Lygren I, Aadland E, Sauar J, et al. Relationship between sick leave, unemployment, disability and health-related quality of life in patients with inflammatory bowel disease. Infamm Bowel Dis 2006;12:402–412.

    Article  Google Scholar 

  62. Feagan GB, Renisch W, Rutgeerts P, Sandborn WJ, Yans S, Eisenberg D, et al. The effects of infliximab therapy on health related quality of life in ulcerative colitis patients. Am J Gastroenterol. 2007;102:798–802.

    Google Scholar 

  63. Rutgeerts P. Sandborn WJ, Feagan BG, Reinisch W, Olson A, Johanns J, et al. Infliximab for induction and maintenance therapy for ulcerative colitis. NEJM. 2005;353:2402–2476.

    Article  Google Scholar 

  64. Stierman H, Tusk C, Almer S, Strom M, Hiortswane H. Unfortunately outcome for women in study of health-related QoL, social factors and work disability in Crohn’s disease. Eur J Gastroenterol Hepatol. 2011;23:671–679.

    Article  Google Scholar 

  65. Stiemer H, Granno C, Bodemar G, Jarmerot G, Ockander L, Tusk C, et al. Evaluation of the Inflammatory Bowel Disorders. Question in Swedish patients with Crohn’s Disease. Scand J Gastrenterol. 2006;41:934–943.

    Article  Google Scholar 

  66. Han SW, McCall E, Barton JR, James P, Stein IN, Welfan MR. Predictors of quality of life: the importance of symptoms and clinical representations. Inflam Bowel Dis. 2005;11:24–34.

    Article  Google Scholar 

  67. Horde O, Huppertz-Hausi G, Hoivil ML, Moum B. Aust J Gastrenterol. 2014;1(4):1017-.

    Google Scholar 

  68. Seagrove A, Rupport F, Williams J. PTU-061 Infliximab or ciclosporin: Patients’ treatment preferences and the impact of ulcerative colitis (UC) on their lives. Gut. 2014 63. A65 https://doi.org/10.1136/gutjnl-20114 307263.135

    Article  Google Scholar 

  69. Soetikno RM, Lin OS, Heidenreich PA, Young HS, Blackstone MOl. Increased risk of colorectal neoplasia in patients with primary sclerosing cholangitis and ulcerative colitis: a meta-analysis. Gastrointest Endosc. 2002;56:48.

    Article  PubMed  Google Scholar 

  70. Broome U, Lofberg R, Veress B, Erikssson LS. Primary sclerosing cholangitis and ulcerative colitis: evidence for increased neoplastic potential. Hepatology. 1995;22:1404.

    CAS  PubMed  Google Scholar 

  71. Oldenburg B, Koningsberger JC, Van Nerge Henegouwen GP, Van Asbeck BS, Marx JJ. Aliment Pharmacol Ther 2001;15(4):429–38.

    Article  CAS  PubMed  Google Scholar 

  72. Narita T, Akiyama M, Ohnuma H, Matsuda K. Crohn’s disease in a92-year old male. J Gastroenterol 1996;31(1):114–118.

    Article  CAS  PubMed  Google Scholar 

  73. Greenberg GR, Feagon BG, Martin F, Sutherlsnd LR, Thomson B, Willisms N, et al. Oral budesonide for active Crohn’s disease. NEJM. 1994;337:836–84

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Nages Nagaratnam .

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this entry

Cite this entry

Nagaratnam, N., Nagaratnam, K., Cheuk, G. (2017). Inflammatory Bowel Disease in the Elderly. In: Geriatric Diseases. Springer, Cham. https://doi.org/10.1007/978-3-319-32700-6_16-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-32700-6_16-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-32700-6

  • Online ISBN: 978-3-319-32700-6

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics