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Medical and Surgical Complications of Inflammatory Bowel Disease in the Elderly: A Systematic Review

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Abstract

Background/Aims

The complications of therapy, hospitalization, and surgery related to inflammatory bowel disease (IBD) in the elderly are not well described. While multiple reviews have described the management and complications of elderly patients with IBD, none have been performed in a systematic fashion.

Methods

We performed a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to evaluate the association between elderly patients with IBD and complications from therapy, hospitalizations, and surgery. Eligible studies were identified via structured keyword searches in PubMed and manual literature searches.

Results

A total of 5,644 publications were identified. Of these, fourteen studies met inclusion criteria, encompassing 963 elderly IBD patients (113 Crohn’s disease and 850 ulcerative colitis patients), over 37,000 hospitalizations of elderly IBD patients and over 4,500 controls. Consistent associations were observed between increased age and higher nocturnal stool frequency post-ileal pouch anal anastomosis. Only two studies met inclusion criteria for medication-related complications, one observed an increased mortality and infection risk among elderly patients treated with tumor necrosis factor antagonists and the other observed increased hospital-related complications among elderly patients treated with steroids.

Conclusions

Elderly patients with IBD are at an increased risk of hospital- and therapy-related complications. We found a paucity of high-quality studies evaluating outcomes in elderly patients with IBD. Further studies of elderly patients with IBD are needed to further evaluate the effect of age on medical and surgical complications.

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References

  1. Loftus CG, Loftus EV Jr, Harmsen WS, et al. Update on the incidence and prevalence of Crohn’s disease and ulcerative colitis in Olmsted County, Minnesota, 1940–2000. Inflamm Bowel Dis. 2007;13:254–261.

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  3. Molodecky NA, Soon IS, Rabi DM, et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology. 2012;142:46.e42–54.e42 (quiz e30).

  4. Pardi DS, Loftus EV Jr, Camilleri M. Treatment of inflammatory bowel disease in the elderly: an update. Drugs Aging. 2002;19:355–363.

    Article  CAS  PubMed  Google Scholar 

  5. Katz S, Feldstein R. Inflammatory bowel disease of the elderly: a wake-up call. Gastroenterol Hepatol. 2008;4:337–347.

    Google Scholar 

  6. Vavricka SR, Rogler G. Treatment of severe ulcerative colitis: differences in elderly patients? Dig Dis Basel Switz. 2009;27:315–321.

    Article  Google Scholar 

  7. Stallmach A, Hagel S, Gharbi A, et al. Medical and surgical therapy of inflammatory bowel disease in the elderly—prospects and complications. J Crohns Colitis. 2011;5:177–188.

    Article  PubMed  Google Scholar 

  8. Swaroop PP. Inflammatory bowel diseases in the elderly. Clin Geriatr Med. 2007;23:809–821, vi.

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

    Article  PubMed  Google Scholar 

  10. Katz S, Pardi DS. Inflammatory bowel disease of the elderly: frequently asked questions (FAQs). Am J Gastroenterol. 2011;106:1889–1897.

    Article  PubMed  Google Scholar 

  11. Katz S, Surawicz C, Pardi DS. Management of the elderly patients with inflammatory bowel disease: practical considerations. Inflamm Bowel Dis. 2013;19:2257–2272.

    Article  PubMed  Google Scholar 

  12. Turrentine FE, Wang H, Simpson VB, et al. Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg. 2006;203:865–877.

    Article  PubMed  Google Scholar 

  13. Cross RK, Wilson KT, Binion DG. Polypharmacy and Crohn’s disease. Aliment Pharmacol Ther. 2005;21:1211–1216.

    Article  CAS  PubMed  Google Scholar 

  14. Chung ES, Packer M, Lo KH, et al. Randomized, double-blind, placebo-controlled, pilot trial of infliximab, a chimeric monoclonal antibody to tumor necrosis factor-alpha, in patients with moderate-to-severe heart failure: results of the anti-TNF Therapy Against Congestive Heart Failure (ATTACH) trial. Circulation. 2003;107:3133–3140.

    Article  CAS  PubMed  Google Scholar 

  15. Morgacheva O, Furst DE. Use of MTX in the elderly and in patients with compromised renal function. Clin Exp Rheumatol. 2010;28:S85–S94.

    CAS  PubMed  Google Scholar 

  16. Sergi G, De Rui M, Sarti S, et al. Polypharmacy in the elderly: can comprehensive geriatric assessment reduce inappropriate medication use? Drugs Aging. 2011;28:509–518.

    Article  PubMed  Google Scholar 

  17. Cherubini A, Del Signore S, Ouslander J, et al. Fighting against age discrimination in clinical trials. J Am Geriatr Soc. 2010;58:1791–1796.

    Article  PubMed  Google Scholar 

  18. Delaney CP, Fazio VW, Remzi FH, et al. Prospective, age-related analysis of surgical results, functional outcome, and quality of life after ileal pouch-anal anastomosis. Ann Surg. 2003;238:221–228.

    PubMed Central  PubMed  Google Scholar 

  19. Harper PC, McAuliffe TL, 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 

  20. Feagins LA, Spechler SJ. Biologic agent use varies inversely with age at diagnosis in Crohn’s disease. Dig Dis Sci. 2010;55:3164–3170.

    Article  PubMed  Google Scholar 

  21. Moher D, Liberati A, Tetzlaff J, et al. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement. Ann Intern Med. 2009;151:264–269.

    Article  PubMed  Google Scholar 

  22. Cottone M, Kohn A, Daperno M, et al. Advanced age is an independent risk factor for severe infections and mortality in patients given anti-tumor necrosis factor therapy for inflammatory bowel disease. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. 2011;9:30–35.

    CAS  Google Scholar 

  23. Akerkar GA, Peppercorn MA, Hamel MB, et al. Corticosteroid-associated complications in elderly Crohn’s disease patients. Am J Gastroenterol. 1997;92:461–464.

    CAS  PubMed  Google Scholar 

  24. Ananthakrishnan AN, Guzman-Perez R, Gainer V, et al. Predictors of severe outcomes associated with Clostridium difficile infection in patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2012;35:789–795.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  25. Ananthakrishnan AN, McGinley EL, Binion DG. Inflammatory bowel disease in the elderly is associated with worse outcomes: a national study of hospitalizations. Inflamm Bowel Dis. 2009;15:182–189.

    Article  PubMed  Google Scholar 

  26. Ananthakrishnan AN, McGinley EL, Binion DG, et al. Fracture-associated hospitalizations in patients with inflammatory bowel disease. Dig Dis Sci. 2011;56:176–182.

    Article  PubMed  Google Scholar 

  27. Navaneethan U, Parasa S, Venkatesh PGK, et al. Prevalence and risk factors for colonic perforation during colonoscopy in hospitalized inflammatory bowel disease patients. J Crohns Colitis. 2011;5:189–195.

    Article  PubMed  Google Scholar 

  28. Longo WE, Virgo KS, Bahadursingh AN, et al. Patterns of disease and surgical treatment among United States veterans more than 50 years of age with ulcerative colitis. Am J Surg. 2003;186:514–518.

    Article  PubMed  Google Scholar 

  29. Triantafillidis JK, Emmanouilidis A, Pomonis E, et al. Ulcerative colitis in the elderly: clinical patterns and outcome in 51 Greek patients. J Gastroenterol. 2001;36:312–316.

    Article  CAS  PubMed  Google Scholar 

  30. Ha CY, Newberry RD, Stone CD, et al. Patients with late-adult-onset ulcerative colitis have better outcomes than those with early onset disease. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. 2010;8:682-e1–687.e1.

    Google Scholar 

  31. Almogy G, Sachar DB, Bodian CA, et al. Surgery for ulcerative colitis in elderly persons: changes in indications for surgery and outcome over time. Arch Surg Chic Ill. 1960;2001:1396–1400.

    Google Scholar 

  32. Chapman JR, Larson DW, Wolff BG, et al. Ileal pouch-anal anastomosis: does age at the time of surgery affect outcome? Arch Surg Chic Ill. 1960. 2005;140:534–539 (discussion 539–540).

  33. Ho KS, Chang CC, Baig MK, et al. Ileal pouch anal anastomosis for ulcerative colitis is feasible for septuagenarians. Colorectal Dis Off J Assoc Coloproctol G B Irel. 2006;8:235–238.

  34. Bauer JJ, Gorfine SR, Gelernt IM, et al. Restorative proctocolectomy in patients older than fifty years. Dis Colon Rectum. 1997;40:562–565.

    Article  CAS  PubMed  Google Scholar 

  35. Tremaine WJ, Timmons LJ, Loftus EV Jr, et al. Age at onset of inflammatory bowel disease and the risk of surgery for non-neoplastic bowel disease. Aliment Pharmacol Ther. 2007;25:1435–1441.

    Article  CAS  PubMed  Google Scholar 

  36. Juneja M, Baidoo L, Schwartz MB, et al. Geriatric inflammatory bowel disease: phenotypic presentation, treatment patterns, nutritional status, outcomes, and comorbidity. Dig Dis Sci. 2012;57:2408–2415.

    Article  PubMed  Google Scholar 

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

    Article  PubMed Central  CAS  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  39. Routledge PA, O’Mahony MS, Woodhouse KW. Adverse drug reactions in elderly patients. Br J Clin Pharmacol. 2004;57:121–126.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  40. Kongkaew C, Noyce PR, Ashcroft DM. Hospital admissions associated with adverse drug reactions: a systematic review of prospective observational studies. Ann Pharmacother. 2008;42:1017–1025.

    Article  PubMed  Google Scholar 

  41. Olivier P, Bertrand L, Tubery M, et al. Hospitalizations because of adverse drug reactions in elderly patients admitted through the emergency department: a prospective survey. Drugs Aging. 2009;26:475–482.

    Article  PubMed  Google Scholar 

  42. Cooper JW. Probable adverse drug reactions in a rural geriatric nursing home population: a four-year study. J Am Geriatr Soc. 1996;44:194–197.

    Article  CAS  PubMed  Google Scholar 

  43. Nguyen JK, Fouts MM, Kotabe SE, et al. Polypharmacy as a risk factor for adverse drug reactions in geriatric nursing home residents. Am J Geriatr Pharmacother. 2006;4:36–41.

    Article  PubMed  Google Scholar 

  44. Pergolizzi J, Böger RH, Budd K, et al. Opioids and the management of chronic severe pain in the elderly: consensus statement of an International Expert Panel with focus on the six clinically most often used World Health Organization Step III opioids (buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone). Pain Pract Off J World Inst Pain. 2008;8:287–313.

    Article  Google Scholar 

  45. Lichtenstein GR, Feagan BG, Cohen RD, et al. Drug therapies and the risk of malignancy in Crohn’s disease: results from the TREAT™ Registry. Am J Gastroenterol. 2014;109:212–223.

    Article  CAS  PubMed  Google Scholar 

  46. Lichtenstein GR, Feagan BG, Cohen RD, et al. Serious infection and mortality in patients with Crohn’s disease: more than 5 years of follow-up in the TREAT™ registry. Am J Gastroenterol. 2012;107:1409–1422.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

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Acknowledgments

The research reported here was supported in part by the VA HSR&D Center for Innovations in Quality, Effectiveness and Safety (#CIN 13-413), at the Michael E. DeBakey VA Medical Center, Houston, TX.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Baylor College of Medicine, One Baylor Plaza BCM:901, Houston, TX, 77030, USA

    Dennis L. Shung, Joseph Sellin & Jason K. Hou

  2. The Houston Methodist Hospital, Houston, TX, USA

    Bincy Abraham

  3. Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA

    Jason K. Hou

  4. VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA

    Jason K. Hou

Authors
  1. Dennis L. Shung
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  2. Bincy Abraham
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Correspondence to Jason K. Hou.

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Shung, D.L., Abraham, B., Sellin, J. et al. Medical and Surgical Complications of Inflammatory Bowel Disease in the Elderly: A Systematic Review. Dig Dis Sci 60, 1132–1140 (2015). https://doi.org/10.1007/s10620-014-3462-2

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  • DOI: https://doi.org/10.1007/s10620-014-3462-2

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