Abstract
Background and Aims
Pediatric and elderly inflammatory bowel disease (IBD) are less explored, often in retrospective studies. The pediatric group has a more extensive and aggressive disease phenotype requiring aggressive treatments, whereas the elderly group may have less aggressive diseases.
Methods
We prospectively compared disease characteristics of a single center cohort of IBD patients (pediatric age ≤ 16 years; adults 17 to 59 years; and elderly ≥ 60 years) seen between September 2018 and November 2019 with at least six months of follow-up.
Results
Total 266 IBD patients (137 males) included 47 pediatric, 175 adults and 44 elderly patients. Among ulcerative colitis (UC) patients, pancolitis was more common in the pediatric group (p = 0.018), while the elderly group had more indolent behaviors and infrequent extraintestinal manifestations (p = 0.005). Among patients with Crohn’s disease (CD), the pediatric group had more often colonic diseases (p = 0.02) and the elderly, ileal diseases (p = 0.04). The disease behavior was similar in the three age groups. Perianal disease was least common in elderly CD patients (p = 0.03). There was no treatment difference among different age groups in UC. In CD, pediatric patients needed biologics more frequently (p = 0.005), while elderly CD patients less frequently required steroids, biologics, immunosuppressants and surgery (p < 0.05).
Conclusions
We noted differences compared to western literature such as colonic location in pediatric CD and ileal location in elderly CD. Perianal disease was less frequent in the elderly CD group. There was no difference in treatment in the three age groups in UC, while there were no inter-age-group disease behavioral differences for UC and CD.
Similar content being viewed by others
Data availability
The data underlying this article will be shared on reasonable request from the corresponding author.
References
Cosnes J, Gower-Rousseau C, Seksik P, Cortot A. Epidemiology and natural history of inflammatory bowel diseases. Gastroenterology. 2011;140:1785–94.
Makharia GK, Ramakrishna BS, Abraham P, et al. Survey of inflammatory bowel diseases in India. Indian J Gastroenterol. 2012;31:299–306.
Satsangi J, Silverberg MS, Vermeire S, Colombel JF. The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut. 2006;55:749–53.
Sturm A, Maaser C, Mendall M, et al. European Crohn’s and Colitis organisation topical review on IBD in the elderly. J Crohns Colitis. 2017;11:263–73.
Bequet E, Sarter H, Fumery M, et al. Incidence and phenotype at diagnosis of very-early-onset compared with later-onset paediatric inflammatory bowel disease: a population-based study [1988-2011]. J Crohns Colitis. 2017;11:519–26.
Uhlig HH, Schwerd T, Koletzko S, et al. The diagnostic approach to monogenic very early onset inflammatory bowel disease. Gastroenterology. 2014;147:990–1007.e3.
Afzali A, Katz S. Inflammatory bowel disease in the baby to baby boomer: pediatric and elderly onset of IBD. Curr Treat Options Gastroenterol. 2018;16:289–305.
Nimmons D, Limdi JK. Elderly patients and inflammatory bowel disease. World J Gastrointest Pharmacol Ther. 2016;7:51–65.
Booth IW, Harries JT. Inflammatory bowel disease in childhood. Gut. 1984;25:188–202.
Komoto S, Higashiyama M, Watanabe C, et al. Clinical differences between elderly-onset ulcerative colitis and non-elderly-onset ulcerative colitis: a nationwide survey data in Japan. J Gastroenterol Hepatol. 2018;33:1839–43.
Huang JG, Aw MM. Pediatric inflammatory bowel disease in Asia: epidemiology and natural history. Pediatr Neonatol. 2020;61:263–71.
Langholz E, Munkholm P, Nielsen OH, Kreiner S, Binder V. Incidence and prevalence of ulcerative colitis in Copenhagen county from 1962 to 1987. Scand J Gastroenterol. 1991;26:1247–56.
Munkholm P, Langholz E, Nielsen OH, Kreiner S, Binder V. Incidence and prevalence of Crohn’s disease in the county of Copenhagen, 1962–87: a six-fold increase in incidence. Scand J Gastroenterol. 1992;27:609–14.
Levine A, Griffiths A, Markowitz J, et al. Pediatric modification of the Montreal classification for inflammatory bowel disease: the Paris classification. Inflamm Bowel Dis. 2011;17:1314–21.
Magro F, Gionchetti P, Eliakim R, et al. Third European evidence-based consensus on diagnosis and management of ulcerative colitis. Part 1: Definitions diagnosis extra-intestinal manifestations pregnancy cancer surveillance surgery and ileo-anal pouch disorders. J Crohns Colitis 2017;11:649–70.
Jess T, Riis L, Vind I, et al. Changes in clinical characteristics, course, and prognosis of inflammatory bowel disease during the last 5 decades: a population-based study from Copenhagen. Denmark Inflamm Bowel Dis. 2007;13:481–9.
Van Limbergent J, Russell RK, Drummond HE, et al. Definition of phenotypic characteristics of childhood-onset inflammatory bowel disease. Gastroenterology. 2008;135:1114–22.
Vernier-Massouille G, Balde M, Salleron J, et al. Natural history of pediatric Crohn’s disease: a population-based cohort study. Gastroenterology. 2008;135:1106–13.
Crocco S, Martelossi S, Giurici N, Villanacci V, Ventura A. Upper gastrointestinal involvement in paediatric onset Crohn’s disease: prevalence and clinical implications. J Crohns Colitis. 2012;6:51–5.
Charpentier C, Salleron J, Savoye G, et al. Natural history of elderly-onset inflammatory bowel disease: a population-based cohort study. Gut. 2014;63:423–32.
Huang JG, Wong YKY, Chew KS, et al. Epidemiological characteristics of Asian children with inflammatory bowel disease at diagnosis: insights from an Asian-Pacific multi-centre registry network. World J Gastroenterol. 2022;28:1830–44.
Misra R, Limdi J, Cooney R, et al. Ethnic differences in inflammatory bowel disease: results from the United Kingdom inception cohort epidemiology study. World J Gastroenterol. 2019;25:6145–57.
Lakatos PL, David G, Pandur T, et al. IBD in the elderly population: results from a population-based study in Western Hungary, 1977–2008. J Crohns Colitis. 2011;5:5–13.
Pigneur B, Seksik P, Viola S, et al. Natural history of Crohn’s disease: comparison between childhood- and adult-onset disease. Inflamm Bowel Dis. 2010;16:953–61.
Polito JM 2nd, Childs B, Mellits ED, Tokayer AZ, Harris ML, Bayless TM. Crohn’s disease: influence of age at diagnosis on site and clinical type of disease. Gastroenterology. 1996;111:580–6.
Srivastava A, Sathiyasekharan M, Jagadisan B, et al. Paediatric inflammatory bowel disease in India a prospective multicentre study. Eur J Gastroenterol Hepatol. 2020;32:1305–11.
Sathiyasekaran M, Bavanandam S, Sankaranarayanan S, et al. A questionnaire survey of pediatric inflammatory bowel disease in India. Indian J Gastroenterol. 2014;33:543–9.
Poddar U, Yachha SK, Srivastava A, Kumari N. Pediatric inflammatory bowel disease: is it really uncommon in Asian children. JGH Open. 2020;4:860–6.
Ananthakrishnan AN, Shi HY, Tang W, et al. Systematic review and meta-analysis: phenotype and clinical outcomes of older-onset inflammatory bowel disease. J Crohns Colitis. 2016;10:1224–36.
Kalaria R, Desai D, Abraham P, Joshi A, Gupta T, Shah S. Temporal change in phenotypic behaviour in patients with Crohn’s disease: do Indian patients behave differently from western and other Asian patients. J Crohns Colitis. 2016;10:255–61.
Duricova D, Burisch J, Jess T, et al. Age-related differences in presentation and course of inflammatory bowel disease: an update on the population-based literature. J Crohns Colitis. 2014;8:1351–61.
Sawczenko A, Sandhu BK. Presenting features of inflammatory bowel disease in Great Britain and Ireland. Arch Dis Child. 2003;88:995–1000.
Gupta YK, Singh A, Narang V, et al. Clinical spectrum of elderly-onset inflammatory bowel disease in India. Intest Res. 2022. https://doi.org/10.5217/ir.2021.00177.
Gower-Rousseau C, Vasseur F, Fumery M, et al. Epidemiology of inflammatory bowel diseases: new insights from a French population-based registry (EPIMAD). Dig Liver Dis. 2013;45:89–94.
Ng SC, Zeng Z, Niewiadomski O, et al. Early course of inflammatory bowel disease in a population based inception cohort study from 8 countries in Asia and Australia. Gastroenterology. 2016;150:86–95.e3; quiz e13-4.
Zammarchi I, Lanzarotto F, Cannatelli R, et al. Elderly-onset vs adult-onset ulcerative colitis: a different natural history. BMC Gastroenterol. 2020;20:147.
Freeman HJ. Long-term prognosis of early-onset Crohn’s disease diagnosed in childhood or adolescence. Can J Gastroenterol. 2004;18:661–5.
Jakobsen C, Bartek J, Wewer V, et al. Differences in phenotype and disease course in adult and paediatric inflammatory bowel disease - a population-based study. Aliment Pharmacol Ther. 2011;34:1217–24.
Mañosa M, Calafat M, de Francisco R, et al. Phenotype and natural history of elderly onset inflammatory bowel disease: a multicentre, case-control study. Aliment Pharmacol Ther. 2018;47:605–14.
Jeuring SF, van den Heuvel TR, Zeegers MP, et al. Epidemiology and long-term outcome of inflammatory bowel disease diagnosed at elderly age-an increasing distinct entity. Inflamm Bowel Dis. 2016;22:1425–34.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
NB, DD, PA, TG, PDÂ and AJ declare no competing interests.
Ethics statementÂ
The study was performed conforming to the Helsinki Declaration of 1975, as revised in 2000 and 2008Â concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.
Disclaimer
The authors are solely responsible for the data and the contents of the paper. In no way, the Honorary Editor-in-Chief, Editorial Board Members, the Indian Society of Gastroenterology or the printer/publishers are responsible for the results/findings and content of this article.
Additional information
Publisher's note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Bhangale, N., Desai, D., Abraham, P. et al. A prospective study of inflammatory bowel disease phenotypes in extremes of age and comparison with adults. Indian J Gastroenterol 42, 404–410 (2023). https://doi.org/10.1007/s12664-023-01360-w
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12664-023-01360-w