Skip to main content

Advertisement

SpringerLink
Log in

A Comprehensive Review of the Diagnosis and Pharmacological Management of Crohn’s Disease in the Elderly Population

  • Review Article
  • Published:
Drugs & Aging Aims and scope Submit manuscript

Abstract

Crohn’s disease (CD) in the elderly is rising in prevalence, which is related to an increase in its incidence and improving life expectancies. There are differences in the presentation, natural history, and treatment of CD between adult-onset patients who progress to older age and patients who are initially diagnosed at an older age. Presentation at an older age may also delay or make diagnosis challenging due to accumulating co-morbidities that mimic inflammatory bowel disease. Differences exist between adult- and older-onset disease, yet many guidelines do not specifically distinguish the management of these two distinct populations. Identifying patients at high risk for progression or aggressive disease is particularly important as elderly patients may respond differently to medical and surgical treatment, and may be at higher risk for adverse effects. Despite newer agents being approved for CD, the data regarding efficacy and safety in the elderly are currently limited. Balancing symptom management with risks of medical and surgical therapy is an ongoing challenge and requires special consideration in these two distinct populations.

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

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ortman JM VV, Hogan H. An aging nation: the older population in the United States, current population reports. Washington, DC: U.S. Census Bureau; 2014. p. 25–1140. http://www.census.gov/content/dam/Census/library/publications/2014/demo/p25-1140.pdf. Accessed 5 Oct 2018.

  2. Jeuring SF, van den Heuvel TR, Zeegers MP, Hameeteman WH, Romberg-Camps MJ, Oostenbrug LE, 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.

    Article  PubMed  Google Scholar 

  3. Kelsen J, Baldassano RN. Inflammatory bowel disease: the difference between children and adults. Inflamm Bowel Dis. 2008;14(Suppl 2):S9–11.

    PubMed  Google Scholar 

  4. Loftus EV Jr, Silverstein MD, Sandborn WJ, Tremaine WJ, Harmsen WS, Zinsmeister AR. Crohn’s disease in Olmsted County, Minnesota, 1940–1993: incidence, prevalence, and survival. Gastroenterology. 1998;114:1161–8.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  6. Shivashankar R, Tremaine WJ, Harmsen WS, Loftus EV Jr. Incidence and prevalence of Crohn's disease and ulcerative colitis in Olmsted County, Minnesota from 1970 through 2010. Clin Gastroenterol Hepatol. 2017;15(6):857–863.

    Article  PubMed  Google Scholar 

  7. Benchimol EI, Manuel DG, Guttmann A, Nguyen GC, Mojaverian N, Quach P, et al. Changing age demographics of inflammatory bowel disease in Ontario, Canada: a population-based cohort study of epidemiology trends. Inflamm Bowel Dis. 2014;20:1761–9.

    Article  PubMed  Google Scholar 

  8. Duricova D, Pedersen N, Elkjaer M, Gamborg M, Munkholm P, Jess T. Overall and cause-specific mortality in Crohn’s disease: a meta-analysis of population-based studies. Inflamm Bowel Dis. 2010;16:347–53.

    Article  PubMed  Google Scholar 

  9. Charpentier C, Salleron J, Savoye G, Fumery M, Merle V, Laberenne JE, et al. Natural history of elderly-onset inflammatory bowel disease: a population-based cohort study. Gut. 2014;63:423–32.

    Article  PubMed  Google Scholar 

  10. Min H, Montecino-Rodriguez E, Dorshkind K. Reduction in the developmental potential of intrathymic T cell progenitors with age. J Immunol. 2004;173:245–50.

    Article  CAS  PubMed  Google Scholar 

  11. Min H, Montecino-Rodriguez E, Dorshkind K. Effects of aging on early B- and T-cell development. Immunol Rev. 2005;205:7–17.

    Article  CAS  PubMed  Google Scholar 

  12. Schiffrin EJ, Morley JE, Donnet-Hughes A, Guigoz Y. The inflammatory status of the elderly: the intestinal contribution. Mutat Res. 2010;690:50–6.

    Article  CAS  PubMed  Google Scholar 

  13. van Tongeren SP, Slaets JP, Harmsen HJ, Welling GW. Fecal microbiota composition and frailty. Appl Environ Microbiol. 2005;71:6438–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Tiihonen K, Ouwehand AC, Rautonen N. Human intestinal microbiota and healthy ageing. Ageing Res Rev. 2010;9:107–16.

    Article  PubMed  Google Scholar 

  15. Pilotto A, Franceschi M, Leandro G, Di Mario F. NSAID and aspirin use by the elderly in general practice: effect on gastrointestinal symptoms and therapies. Drugs Aging. 2003;20:701–10.

    Article  CAS  PubMed  Google Scholar 

  16. Felder JB, Korelitz BI, Rajapakse R, Schwarz S, Horatagis AP, Gleim G. Effects of nonsteroidal antiinflammatory drugs on inflammatory bowel disease: a case-control study. Am J Gastroenterol. 2000;95:1949–54.

    Article  CAS  PubMed  Google Scholar 

  17. Ananthakrishnan AN, Higuchi LM, Huang ES, Khalili H, Richter JM, Fuchs CS, et al. Aspirin, nonsteroidal anti-inflammatory drug use, and risk for Crohn disease and ulcerative colitis: a cohort study. Ann Intern Med. 2012;156:350–9.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Omari AH, Khammash MR, Qasaimeh GR, Shammari AK, Yaseen MK, Hammori SK. Acute appendicitis in the elderly: risk factors for perforation. World J Emerg Surg. 2014;9:6.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Kaplan GG, Jackson T, Sands BE, Frisch M, Andersson RE, Korzenik J. The risk of developing Crohn’s disease after an appendectomy: a meta-analysis. Am J Gastroenterol. 2008;103:2925–31.

    Article  PubMed  Google Scholar 

  20. Clough J, Mendall M, Braim D, Hong A. PWE-015 inflammatory bowel disease in the elderly: characteristics and risk factors for disease. Gut. 2016;65:A144–5.

    Article  CAS  Google Scholar 

  21. Pang S, Subramaniam M, Abdin E, Lee SP, Chua BY, Shafie SB, et al. Prevalence and predictors of tobacco use in the elderly. Int J Geriatr Psychiatry. 2016;31:716–22.

    Article  PubMed  Google Scholar 

  22. Lugo A, La Vecchia C, Boccia S, Murisic B, Gallus S. Patterns of smoking prevalence among the elderly in Europe. Int J Environ Res Public Health. 2013;10:4418–31.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Jamal A, Phillips E, Gentzke AS, Homa DM, Babb SD, King BA, et al. Current cigarette smoking among adults—United States, 2016. MMWR Morb Mortal Wkly Rep. 2018;67:53–9.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Han DY, Fraser AG, Dryland P, Ferguson LR. Environmental factors in the development of chronic inflammation: a case-control study on risk factors for Crohn’s disease within New Zealand. Mutat Res. 2010;690:116–22.

    Article  CAS  PubMed  Google Scholar 

  25. Corrao G, Tragnone A, Caprilli R, Trallori G, Papi C, Andreoli A, et al. Risk of inflammatory bowel disease attributable to smoking, oral contraception and breastfeeding in Italy: a nationwide case-control study. Cooperative Investigators of the Italian Group for the Study of the Colon and the Rectum (GISC). Int J Epidemiol. 1998;27:397–404.

    Article  CAS  PubMed  Google Scholar 

  26. Aldhous MC, Satsangi J. The impact of smoking in Crohn’s disease: no smoke without fire. Frontline Gastroenterol. 2010;1:156–64.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Hou JK, Feagins LA, Waljee AK. Characteristics and behavior of elderly-onset inflammatory bowel disease: a multi-center US study. Inflamm Bowel Dis. 2016;22:2200–5.

    Article  PubMed  Google Scholar 

  28. Manosa M, Calafat M, de Francisco R, Garcia C, Casanova MJ, Huelin P, et al. Phenotype and natural history of elderly onset inflammatory bowel disease: a multicentre, case-control study. Aliment Pharmacol Ther. 2018;47:605–14.

    Article  CAS  PubMed  Google Scholar 

  29. Sturm A, Maaser C, Mendall M, Karagiannis D, Karatzas P, Ipenburg N, et al. European Crohn’s and colitis organisation topical review on IBD in the elderly. J Crohns Colitis. 2017;11:263–73.

    Article  PubMed  Google Scholar 

  30. Everhov AH, Halfvarson J, Myrelid P, Sachs MC, Nordenvall C, Soderling J, et al. Incidence and treatment of patients diagnosed with inflammatory bowel diseases at 60 years or older in Sweden. Gastroenterology. 2018;154(518–528):e515.

    Google Scholar 

  31. Mayberry JF, Ballantyne KC, Hardcastle JD, Mangham C, Pye G. Epidemiological study of asymptomatic inflammatory bowel disease: the identification of cases during a screening programme for colorectal cancer. Gut. 1989;30:481–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Sakata T, Niwa Y, Goto H, Hirooka Y, Hayakawa T, Ohmiya N, et al. Asymptomatic inflammatory bowel disease with special reference to ulcerative colitis in apparently healthy persons. Am J Gastroenterol. 2001;96:735–9.

    Article  CAS  PubMed  Google Scholar 

  33. Rodriguez-Lago I, Merino O, Azagra I, Maiz A, Zapata E, Higuera R, et al. Characteristics and progression of preclinical inflammatory bowel disease. Clin Gastroenterol Hepatol. 2018;16:1459–66.

    Article  PubMed  Google Scholar 

  34. Butcher RO, Mehta SJ, Ahmad OF, Boyd CA, Anand RL, Stein J, et al. Mo1302 incidental diagnosis of inflammatory bowel disease in a British bowel cancer screening cohort: a multi-centre study. Gastroenterology. 2013;144:S-630–1.

    Article  Google Scholar 

  35. Ananthakrishnan AN, Shi HY, Tang W, Law CC, Sung JJ, Chan FK, et al. Systematic review and meta-analysis: phenotype and clinical outcomes of older-onset inflammatory bowel disease. J Crohns Colitis. 2016;10:1224–36.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Lakatos PL, David G, Pandur T, Erdelyi Z, Mester G, Balogh M, 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.

    Article  PubMed  Google Scholar 

  37. Duricova D, Sarter H, Savoye G, Leroyer A, Pariente B, Armengol-Debeir L, EPIMAD Group, et al. Impact of extra-intestinal manifestations at diagnosis on disease outcome in pediatric- and elderly-onset Crohn’s disease: a French population-based study. Inflamm Bowel Dis. 2019;25:394–402.

    Article  PubMed  Google Scholar 

  38. Fumery M, Pariente B, Sarter H, Charpentier C, Armengol Debeir L, Dupas JL, et al. Natural history of Crohn’s disease in elderly patients diagnosed over the age of 70 years: a population-based study. Inflamm Bowel Dis. 2016;22:1698–707.

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Nguyen GC, Bernstein CN, Benchimol EI. Risk of surgery and mortality in elderly-onset inflammatory bowel disease: a population-based cohort study. Inflamm Bowel Dis. 2017;23:218–23.

    Article  PubMed  Google Scholar 

  41. Duncan GW, Tan MP, Newton JL, Reeve P, Parry SW. Vasovagal syncope in the older person: differences in presentation between older and younger patients. Age Ageing. 2010;39:465–70.

    Article  PubMed  Google Scholar 

  42. Wagtmans MJ, Verspaget HW, Lamers CB, van Hogezand RA. Crohn’s disease in the elderly: a comparison with young adults. J Clin Gastroenterol. 1998;27:129–33.

    Article  CAS  PubMed  Google Scholar 

  43. 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;146:753–5.

    Article  CAS  PubMed  Google Scholar 

  44. Yoon SY, Jung SA, Na SK, Ryu JI, Yun HW, Lee MJ, et al. What’s the clinical features of colitis in elderly people in long-term care facilities? Intest Res. 2015;13:128–34.

    Article  PubMed  PubMed Central  Google Scholar 

  45. McKinsey JF, Gewertz BL. Acute mesenteric ischemia. Surg Clin N Am. 1997;77:307–18.

    Article  CAS  PubMed  Google Scholar 

  46. Cudnik MT, Darbha S, Jones J, Macedo J, Stockton SW, Hiestand BC. The diagnosis of acute mesenteric ischemia: a systematic review and meta-analysis. Acad Emerg Med. 2013;20:1087–100.

    Article  PubMed  Google Scholar 

  47. Hansen KJ, Wilson DB, Craven TE, Pearce JD, English WP, Edwards MS, et al. Mesenteric artery disease in the elderly. J Vasc Surg. 2004;40:45–52.

    Article  PubMed  Google Scholar 

  48. Wilson DB, Mostafavi K, Craven TE, Ayerdi J, Edwards MS, Hansen KJ. Clinical course of mesenteric artery stenosis in elderly americans. Arch Intern Med. 2006;166:2095–100.

    Article  PubMed  Google Scholar 

  49. van den Heijkant TC, Aerts BA, Teijink JA, Buurman WA, Luyer MD. Challenges in diagnosing mesenteric ischemia. World J Gastroenterol. 2013;19:1338–41.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Brandt L, Boley S, Goldberg L, Mitsudo S, Berman A. Colitis in the elderly. A reappraisal. Am J Gastroenterol. 1981;76:239–45.

    CAS  PubMed  Google Scholar 

  51. Mosele M, Cardin F, Inelmen EM, Coin A, Perissinotto E, Sergi G, et al. Ischemic colitis in the elderly: predictors of the disease and prognostic factors to negative outcome. Scand J Gastroenterol. 2010;45:428–33.

    Article  PubMed  Google Scholar 

  52. Peery AF, Barrett PR, Park D, Rogers AJ, Galanko JA, Martin CF, et al. A high-fiber diet does not protect against asymptomatic diverticulosis. Gastroenterology. 2012;142(266–272):e261.

    Google Scholar 

  53. Etzioni DA, Mack TM, Beart RW Jr, Kaiser AM. Diverticulitis in the United States: 1998–2005: changing patterns of disease and treatment. Ann Surg. 2009;249:210–7.

    Article  PubMed  Google Scholar 

  54. Hadithi M, Cazemier M, Meijer GA, Bloemena E, Felt-Bersma RJ, Mulder CJ, et al. Retrospective analysis of old-age colitis in the Dutch inflammatory bowel disease population. World J Gastroenterol. 2008;14:3183–7.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Bokhari M, Vernava AM, Ure T, Longo WE. Diverticular hemorrhage in the elderly—is it well tolerated? Dis Colon Rectum. 1996;39:191–5.

    Article  CAS  PubMed  Google Scholar 

  56. Olesen M, Eriksson S, Bohr J, Jarnerot G, Tysk C. Microscopic colitis: a common diarrhoeal disease. An epidemiological study in Orebro, Sweden, 1993–1998. Gut. 2004;53:346–50.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Bohr J, Tysk C, Eriksson S, Jarnerot G. Collagenous colitis in Orebro, Sweden, an epidemiological study 1984–1993. Gut. 1995;37:394–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  58. Matteoni CA, Goldblum JR, Wang N, Brzezinski A, Achkar E, Soffer EE. Celiac disease is highly prevalent in lymphocytic colitis. J Clin Gastroenterol. 2001;32:225–7.

    Article  CAS  PubMed  Google Scholar 

  59. Fernandez-Banares F, Esteve M, Espinos JC, Rosinach M, Forne M, Salas A, et al. Drug consumption and the risk of microscopic colitis. Am J Gastroenterol. 2007;102:324–30.

    Article  PubMed  Google Scholar 

  60. Fernandez-Banares F, Salas A, Esteve M, Espinos J, Forne M, Viver JM. Collagenous and lymphocytic colitis: evaluation of clinical and histological features, response to treatment, and long-term follow-up. Am J Gastroenterol. 2003;98:340–7.

    Article  PubMed  Google Scholar 

  61. Chan JL, Tersmette AC, Offerhaus GJ, Gruber SB, Bayless TM, Giardiello FM. Cancer risk in collagenous colitis. Inflamm Bowel Dis. 1999;5:40–3.

    Article  CAS  PubMed  Google Scholar 

  62. Grinvalsky HT, Bowerman CI. Stercoraceous ulcers of the colon: relatively neglected medical and surgical problem. J Am Med Assoc. 1959;171:1941–6.

    Article  CAS  PubMed  Google Scholar 

  63. Serpell JW, Nicholls RJ. Stercoral perforation of the colon. Br J Surg. 1990;77:1325–9.

    Article  CAS  PubMed  Google Scholar 

  64. Edden Y, Shih SS, Wexner SD. Solitary rectal ulcer syndrome and stercoral ulcers. Gastroenterol Clin N Am. 2009;38:541–5.

    Article  Google Scholar 

  65. Torpy JM, Lynm C, Glass RM. JAMA patient page. Frailty in older adults. JAMA. 2006;296:2280.

    Article  CAS  PubMed  Google Scholar 

  66. Hubbard RE, O’Mahony MS, Savva GM, Calver BL, Woodhouse KW. Inflammation and frailty measures in older people. J Cell Mol Med. 2009;13:3103–9.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Li H, Manwani B, Leng SX. Frailty, inflammation, and immunity. Aging Dis. 2011;2:466–73.

    PubMed  PubMed Central  Google Scholar 

  68. Soysal P, Stubbs B, Lucato P, Luchini C, Solmi M, Peluso R, et al. Inflammation and frailty in the elderly: a systematic review and meta-analysis. Ageing Res Rev. 2016;31:1–8.

    Article  CAS  PubMed  Google Scholar 

  69. Lahousse L, Ziere G, Verlinden VJ, Zillikens MC, Uitterlinden AG, Rivadeneira F, et al. Risk of frailty in elderly with COPD: a population-based study. J Gerontol A Biol Sci Med Sci. 2016;71:689–95.

    Article  CAS  PubMed  Google Scholar 

  70. Lasithiotakis K, Petrakis J, Venianaki M, Georgiades G, Koutsomanolis D, Andreou A, et al. Frailty predicts outcome of elective laparoscopic cholecystectomy in geriatric patients. Surg Endosc. 2013;27:1144–50.

    Article  PubMed  Google Scholar 

  71. Mosquera C, Spaniolas K, Fitzgerald TL. Impact of frailty on surgical outcomes: the right patient for the right procedure. Surgery. 2016;160:272–80.

    Article  PubMed  Google Scholar 

  72. Murali-Krishnan R, Iqbal J, Rowe R, Hatem E, Parviz Y, Richardson J, et al. Impact of frailty on outcomes after percutaneous coronary intervention: a prospective cohort study. Open Heart. 2015;2:e000294.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Pedersen M, Cromwell J, Nau P. Sarcopenia is a predictor of surgical morbidity in inflammatory bowel disease. Inflamm Bowel Dis. 2017;23:1867–72.

    Article  PubMed  Google Scholar 

  74. Bryant RV, Ooi S, Schultz CG, Goess C, Grafton R, Hughes J, et al. Low muscle mass and sarcopenia: common and predictive of osteopenia in inflammatory bowel disease. Aliment Pharmacol Ther. 2015;41:895–906.

    Article  CAS  PubMed  Google Scholar 

  75. Bamba S, Sasaki M, Takaoka A, Takahashi K, Imaeda H, Nishida A, et al. Sarcopenia is a predictive factor for intestinal resection in admitted patients with Crohn’s disease. PLoS One. 2017;12:e0180036.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  76. Shaughness G, Howard R, Englesbe M. Patient-centered surgical prehabilitation. Am J Surg. 2018;216:636–8.

    Article  PubMed  Google Scholar 

  77. Lim WC, Wang Y, MacDonald JK, Hanauer S. Aminosalicylates for induction of remission or response in Crohn’s disease. Cochrane Database Syst Rev. 2016;7:Cd008870.

    PubMed  Google Scholar 

  78. Bonovas S, Peyrin-Biroulet L, Danese S. Is mesalamine effective for the induction of remission in Crohn’s disease? Inflamm Bowel Dis. 2017;23:E22–e23.

    Article  PubMed  Google Scholar 

  79. Ford AC, Kane SV, Khan KJ, Achkar JP, Talley NJ, Marshall JK, et al. Efficacy of 5-aminosalicylates in Crohn’s disease: systematic review and meta-analysis. Am J Gastroenterol. 2011;106:617–29.

    Article  CAS  PubMed  Google Scholar 

  80. Lichtenstein GR, Loftus EV, Isaacs KL, Regueiro MD, Gerson LB, Sands BE. ACG clinical guideline: management of Crohn’s disease in adults. Am J Gastroenterol. 2018;113:481–517.

    Article  PubMed  Google Scholar 

  81. Lichtenstein GR, Feagan BG, Cohen RD, Salzberg BA, Diamond RH, Langholff W, et al. Drug therapies and the risk of malignancy in Crohn’s disease: results from the TREAT Registry. Am J Gastroenterol. 2014;109:212–23.

    Article  CAS  PubMed  Google Scholar 

  82. Stepaniuk P, Bernstein CN, Targownik LE, Singh H. Characterization of inflammatory bowel disease in elderly patients: a review of epidemiology, current practices and outcomes of current management strategies. Can J Gastroenterol Hepatol. 2015;29:327–33.

    Article  PubMed  PubMed Central  Google Scholar 

  83. Limdi JK. Aminosalicylates and elderly-onset colonic Crohn’s disease-more than meets the eye? [letter]. J Crohns Colitis. 2017;11:1022.

    Article  PubMed  Google Scholar 

  84. Jay M, Digenis GA, Foster TS, Antonow DR. Retrograde spreading of hydrocortisone enema in inflammatory bowel disease. Dig Dis Sci. 1986;31:139–44.

    Article  CAS  PubMed  Google Scholar 

  85. Taleban S, Colombel JF, Mohler MJ, Fain MJ. Inflammatory bowel disease and the elderly: a review. J Crohns Colitis. 2015;9:507–15.

    Article  PubMed  Google Scholar 

  86. Schroeder KW. Is mesalamine safe? Gastroenterol Hepatol (N Y). 2007;3:878–9.

    Google Scholar 

  87. de Jong DJ, Tielen J, Habraken CM, Wetzels JF, Naber AH. 5-Aminosalicylates and effects on renal function in patients with Crohn’s disease. Inflamm Bowel Dis. 2005;11:972–6.

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  89. Stein RB, Hanauer SB. Comparative tolerability of treatments for inflammatory bowel disease. Drug Saf. 2000;23:429–48.

    Article  CAS  PubMed  Google Scholar 

  90. Wells PS, Holbrook AM, Crowther NR, Hirsh J. Interactions of warfarin with drugs and food. Ann Intern Med. 1994;121:676–83.

    Article  CAS  PubMed  Google Scholar 

  91. de Boer NK, Wong DR, Jharap B, de Graaf P, Hooymans PM, Mulder CJ, et al. Dose-dependent influence of 5-aminosalicylates on thiopurine metabolism. Am J Gastroenterol. 2007;102:2747–53.

    Article  CAS  PubMed  Google Scholar 

  92. Benchimol EI, Seow CH, Steinhart AH, Griffiths AM. Traditional corticosteroids for induction of remission in Crohn’s disease. Cochrane Database Syst Rev 2008:Cd006792.

  93. Brassard P, Bitton A, Suissa A, Sinyavskaya L, Patenaude V, Suissa S. Oral corticosteroids and the risk of serious infections in patients with elderly-onset inflammatory bowel diseases. Am J Gastroenterol. 2014;109:1795–802 (quiz 1803).

    Article  CAS  PubMed  Google Scholar 

  94. Tilg H, Moschen AR, Kaser A, Pines A, Dotan I. Gut, inflammation and osteoporosis: basic and clinical concepts. Gut. 2008;57:684–94.

    Article  CAS  PubMed  Google Scholar 

  95. Tremaine WJ, Hanauer SB, Katz S, Winston BD, Levine JG, Persson T, et al. Budesonide CIR capsules (once or twice daily divided-dose) in active Crohn’s disease: a randomized placebo-controlled study in the United States. Am J Gastroenterol. 2002;97:1748–54.

    Article  CAS  PubMed  Google Scholar 

  96. Johnson SL, Bartels CM, Palta M, Thorpe CT, Weiss JM, Smith MA. Biological and steroid use in relationship to quality measures in older patients with inflammatory bowel disease: a US Medicare cohort study. BMJ Open. 2015;5:e008597.

    Article  PubMed  PubMed Central  Google Scholar 

  97. Akerkar GA, Peppercorn MA, Hamel MB, Parker RA. Corticosteroid-associated complications in elderly Crohn’s disease patients. Am J Gastroenterol. 1997;92:461–4.

    CAS  PubMed  Google Scholar 

  98. Cerullo MA. Expect psychiatric side effects from corticosteroid use in the elderly. Geriatrics. 2008;63:15–8.

    PubMed  Google Scholar 

  99. Rushworth RL, Torpy DJ. A descriptive study of adrenal crises in adults with adrenal insufficiency: increased risk with age and in those with bacterial infections. BMC Endocr Disord. 2014;14:79.

    Article  PubMed  PubMed Central  Google Scholar 

  100. Juneja M, Baidoo L, Schwartz MB, Barrie A 3rd, Regueiro M, Dunn M, et al. Geriatric inflammatory bowel disease: phenotypic presentation, treatment patterns, nutritional status, outcomes, and comorbidity. Dig Dis Sci. 2012;57:2408–15.

    Article  PubMed  Google Scholar 

  101. Greenwald DA, Brandt LJ. Inflammatory bowel disease after age 60. Curr Treat Options Gastroenterol. 2003;6:213–25.

    Article  PubMed  Google Scholar 

  102. Colombel JF, Sandborn WJ, Reinisch W, Mantzaris GJ, Kornbluth A, Rachmilewitz D, et al. Infliximab, azathioprine, or combination therapy for Crohn’s disease. N Engl J Med. 2010;362:1383–95.

    Article  CAS  PubMed  Google Scholar 

  103. Lennard L, Van Loon JA, Weinshilboum RM. Pharmacogenetics of acute azathioprine toxicity: relationship to thiopurine methyltransferase genetic polymorphism. Clin Pharmacol Ther. 1989;46:149–54.

    Article  CAS  PubMed  Google Scholar 

  104. Ansari A, Patel N, Sanderson J, O’Donohue J, Duley JA, Florin TH. Low-dose azathioprine or mercaptopurine in combination with allopurinol can bypass many adverse drug reactions in patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2010;31:640–7.

    Article  CAS  PubMed  Google Scholar 

  105. Govani SM, Higgins PD. Combination of thiopurines and allopurinol: adverse events and clinical benefit in IBD. J Crohns Colitis. 2010;4:444–9.

    Article  PubMed  Google Scholar 

  106. Cheddani H, Dauchet L, Fumery M, Charpentier C, Marie Bouvier A, Dupas JL, et al. Cancer in elderly onset inflammatory bowel disease: a population-based study. Am J Gastroenterol. 2016;111:1428–36.

    Article  PubMed  Google Scholar 

  107. Beaugerie L, Brousse N, Bouvier AM, Colombel JF, Lemann M, Cosnes J, et al. Lymphoproliferative disorders in patients receiving thiopurines for inflammatory bowel disease: a prospective observational cohort study. Lancet. 2009;374:1617–25.

    Article  CAS  PubMed  Google Scholar 

  108. Kandiel A, Fraser AG, Korelitz BI, Brensinger C, Lewis JD. Increased risk of lymphoma among inflammatory bowel disease patients treated with azathioprine and 6-mercaptopurine. Gut. 2005;54:1121–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  109. Kotlyar DS, Lewis JD, Beaugerie L, Tierney A, Brensinger CM, Gisbert JP, et al. Risk of lymphoma in patients with inflammatory bowel disease treated with azathioprine and 6-mercaptopurine: a meta-analysis. Clin Gastroenterol Hepatol. 2015;13:847–858.e844 (quiz e848–e850).

    Article  CAS  PubMed  Google Scholar 

  110. Siegel CA, Marden SM, Persing SM, Larson RJ, Sands BE. Risk of lymphoma associated with combination anti-tumor necrosis factor and immunomodulator therapy for the treatment of Crohn’s disease: a meta-analysis. Clin Gastroenterol Hepatol. 2009;7:874–81.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  111. Rogers HW, Weinstock MA, Feldman SR, Coldiron BM. Incidence estimate of nonmelanoma skin cancer (keratinocyte carcinomas) in the U.S. population, 2012. JAMA Dermatol. 2015;151:1081–6.

    Article  PubMed  Google Scholar 

  112. Singh H, Nugent Z, Demers AA, Bernstein CN. Increased risk of nonmelanoma skin cancers among individuals with inflammatory bowel disease. Gastroenterology. 2011;141:1612–20.

    Article  PubMed  Google Scholar 

  113. Walder BK, Robertson MR, Jeremy D. Skin cancer and immunosuppression. Lancet. 1971;2:1282–3.

    Article  CAS  PubMed  Google Scholar 

  114. Moloney FJ, Comber H, O’Lorcain P, O’Kelly P, Conlon PJ, Murphy GM. A population-based study of skin cancer incidence and prevalence in renal transplant recipients. Br J Dermatol. 2006;154:498–504.

    Article  CAS  PubMed  Google Scholar 

  115. Long MD, Herfarth HH, Pipkin CA, Porter CQ, Sandler RS, Kappelman MD. Increased risk for non-melanoma skin cancer in patients with inflammatory bowel disease. Clin Gastroenterol Hepatol. 2010;8:268–74.

    Article  PubMed  PubMed Central  Google Scholar 

  116. Abbas AM, Almukhtar RM, Loftus EV Jr, Lichtenstein GR, Khan N. Risk of melanoma and non-melanoma skin cancer in ulcerative colitis patients treated with thiopurines: a nationwide retrospective cohort. Am J Gastroenterol. 2014;109:1781–93.

    Article  CAS  PubMed  Google Scholar 

  117. Pasternak B, Svanstrom H, Schmiegelow K, Jess T, Hviid A. Use of azathioprine and the risk of cancer in inflammatory bowel disease. Am J Epidemiol. 2013;177:1296–305.

    Article  PubMed  Google Scholar 

  118. Bourrier A, Carrat F, Colombel JF, Bouvier AM, Abitbol V, Marteau P, et al. Excess risk of urinary tract cancers in patients receiving thiopurines for inflammatory bowel disease: a prospective observational cohort study. Aliment Pharmacol Ther. 2016;43:252–61.

    Article  CAS  PubMed  Google Scholar 

  119. Patel V, Wang Y, MacDonald JK, McDonald JW, Chande N. Methotrexate for maintenance of remission in Crohn’s disease. Cochrane Database Syst Rev 2014:Cd006884.

  120. Wolfe F, Michaud K. Lymphoma in rheumatoid arthritis: the effect of methotrexate and anti-tumor necrosis factor therapy in 18,572 patients. Arthritis Rheum. 2004;50:1740–51.

    Article  CAS  PubMed  Google Scholar 

  121. Mariette X, Matucci-Cerinic M, Pavelka K, Taylor P, van Vollenhoven R, Heatley R, et al. Malignancies associated with tumour necrosis factor inhibitors in registries and prospective observational studies: a systematic review and meta-analysis. Ann Rheum Dis. 2011;70:1895–904.

    Article  PubMed  Google Scholar 

  122. Saibeni S, Bollani S, Losco A, Michielan A, Sostegni R, Devani M, et al. The use of methotrexate for treatment of inflammatory bowel disease in clinical practice. Dig Liver Dis. 2012;44:123–7.

    Article  CAS  PubMed  Google Scholar 

  123. Seinen ML, Ponsioen CY, de Boer NK, Oldenburg B, Bouma G, Mulder CJ, et al. Sustained clinical benefit and tolerability of methotrexate monotherapy after thiopurine therapy in patients with Crohn’s disease. Clin Gastroenterol Hepatol. 2013;11:667–72.

    Article  CAS  PubMed  Google Scholar 

  124. Toruner M, Loftus EV Jr, Harmsen WS, Zinsmeister AR, Orenstein R, Sandborn WJ, et al. Risk factors for opportunistic infections in patients with inflammatory bowel disease. Gastroenterology. 2008;134:929–36.

    Article  PubMed  Google Scholar 

  125. Desai A, Zator ZA, de Silva P, Nguyen DD, Korzenik J, Yajnik V, et al. Older age is associated with higher rate of discontinuation of anti-TNF therapy in patients with inflammatory bowel disease. Inflamm Bowel Dis. 2013;19:309–15.

    Article  PubMed  Google Scholar 

  126. 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 Pharmacol Ther. 2015;42:441–51.

    Article  CAS  PubMed  Google Scholar 

  127. Cottone M, Kohn A, Daperno M, Armuzzi A, Guidi L, D’Inca R, 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. 2011;9:30–5.

    Article  CAS  PubMed  Google Scholar 

  128. Singh S, Stitt LW, Zou G, Khanna R, Dulai PS, Sandborn WJ, et al. Early combined immunosuppression may be effective and safe in older patients with Crohn’s disease: post hoc analysis of REACT. Aliment Pharmacol Ther. 2019. https://doi.org/10.1111/apt.15214 (Epub 2019 Mar 19).

    Article  PubMed  PubMed Central  Google Scholar 

  129. Fidder H, Schnitzler F, Ferrante M, Noman M, Katsanos K, Segaert S, et al. Long-term safety of infliximab for the treatment of inflammatory bowel disease: a single-centre cohort study. Gut. 2009;58:501–8.

    Article  CAS  PubMed  Google Scholar 

  130. Lichtenstein GR, Hanauer SB, Sandborn WJ. Management of Crohn’s disease in adults. Am J Gastroenterol. 2009;104:465–83 (quiz 464, 484).

    Article  PubMed  Google Scholar 

  131. Kwon HJ, Cote TR, Cuffe MS, Kramer JM, Braun MM. Case reports of heart failure after therapy with a tumor necrosis factor antagonist. Ann Intern Med. 2003;138:807–11.

    Article  PubMed  Google Scholar 

  132. Chung ES, Packer M, Lo KH, Fasanmade AA, Willerson JT. 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;107:3133–40.

    Article  CAS  PubMed  Google Scholar 

  133. Mann DL, McMurray JJ, Packer M, Swedberg K, Borer JS, Colucci WS, et al. Targeted anticytokine therapy in patients with chronic heart failure: results of the Randomized Etanercept Worldwide Evaluation (RENEWAL). Circulation. 2004;109:1594–602.

    Article  CAS  PubMed  Google Scholar 

  134. Sinagra E, Perricone G, Romano C, Cottone M. Heart failure and anti tumor necrosis factor-alpha in systemic chronic inflammatory diseases. Eur J Intern Med. 2013;24:385–92.

    Article  CAS  PubMed  Google Scholar 

  135. Subramaniam K, D’Rozario J, Pavli P. Lymphoma and other lymphoproliferative disorders in inflammatory bowel disease: a review. J Gastroenterol Hepatol. 2013;28:24–30.

    Article  CAS  PubMed  Google Scholar 

  136. Williams CJ, Peyrin-Biroulet L, Ford AC. Systematic review with meta-analysis: malignancies with anti-tumour necrosis factor-alpha therapy in inflammatory bowel disease. Aliment Pharmacol Ther. 2014;39:447–58.

    Article  CAS  PubMed  Google Scholar 

  137. Kopylov U, Vutcovici M, Kezouh A, Seidman E, Bitton A, Afif W. Risk of lymphoma, colorectal and skin cancer in patients with IBD treated with immunomodulators and biologics: a Quebec claims database study. Inflamm Bowel Dis. 2015;21:1847–53.

    Article  PubMed  Google Scholar 

  138. Long MD, Martin CF, Pipkin CA, Herfarth HH, Sandler RS, Kappelman MD. Risk of melanoma and nonmelanoma skin cancer among patients with inflammatory bowel disease. Gastroenterology. 2012;143(390–399):e391.

    Google Scholar 

  139. Singh S, Nagpal SJ, Murad MH, Yadav S, Kane SV, Pardi DS, et al. Inflammatory bowel disease is associated with an increased risk of melanoma: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2014;12:210–8.

    Article  PubMed  Google Scholar 

  140. Rogiers A, van den Oord JJ, Garmyn M, Stas M, Kenis C, Wildiers H, et al. Novel therapies for metastatic melanoma: an update on their use in older patients. Drugs Aging. 2015;32:821–34.

    Article  CAS  PubMed  Google Scholar 

  141. Whiteman DC, Green AC, Olsen CM. The growing burden of invasive melanoma: projections of incidence rates and numbers of new cases in six susceptible populations through 2031. J Invest Dermatol. 2016;136:1161–71.

    Article  CAS  PubMed  Google Scholar 

  142. Yajnik V, Khan N, Dubinsky M, Axler J, James A, Abhyankar B, et al. Efficacy and safety of vedolizumab in ulcerative colitis and Crohn’s disease patients stratified by age. Adv Ther. 2017;34:542–59.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  143. Navaneethan U, Edminister T, Zhu X, Kommaraju K, Glover S. Vedolizumab is safe and effective in elderly patients with inflammatory bowel disease [letter]. Inflamm Bowel Dis. 2017;23:E17.

    Article  PubMed  Google Scholar 

  144. Adar T, Faleck D, Sasidharan S, Cushing K, Borren NZ, Nalagatla N, et al. Comparative safety and effectiveness of tumor necrosis factor α antagonists and vedolizumab in elderly IBD patients: a multicentre study. Aliment Pharmacol Ther. 2019;49(7):873–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  145. Card T, Xu J, Liang H, Bhayat F. What is the risk of progressive multifocal leukoencephalopathy in patients with ulcerative colitis or Crohn’s disease treated with vedolizumab? Inflamm Bowel Dis. 2018;24:953–9.

    Article  PubMed  PubMed Central  Google Scholar 

  146. Feagan BG, Sandborn WJ, Gasink C, Jacobstein D, Lang Y, Friedman JR, et al. Ustekinumab as induction and maintenance therapy for Crohn’s disease. N Engl J Med. 2016;375:1946–60.

    Article  CAS  PubMed  Google Scholar 

  147. Sandborn WJ, Rutgeerts P, Gasink C, Jacobstein D, Zou B, Johanns J, et al. Long-term efficacy and safety of ustekinumab for Crohn’s disease through the second year of therapy. Aliment Pharmacol Ther. 2018;48:65–77.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  148. Kalb RE, Fiorentino DF, Lebwohl MG, Toole J, Poulin Y, Cohen AD, et al. Risk of serious infection with biologic and systemic treatment of psoriasis: results from the Psoriasis Longitudinal Assessment and Registry (PSOLAR). JAMA Dermatol. 2015;151:961–9.

    Article  PubMed  Google Scholar 

  149. Hayashi M, Umezawa Y, Fukuchi O, Ito T, Saeki H, Nakagawa H. Efficacy and safety of ustekinumab treatment in elderly patients with psoriasis. J Dermatol. 2014;41:974–80.

    Article  CAS  PubMed  Google Scholar 

  150. Heresbach D, Alexandre JL, Bretagne JF, Cruchant E, Dabadie A, Dartois-Hoguin M, et al. Crohn’s disease in the over-60 age group: a population based study. Eur J Gastroenterol Hepatol. 2004;16:657–64.

    Article  PubMed  Google Scholar 

  151. Khan KJ, Ullman TA, Ford AC, Abreu MT, Abadir A, Marshall JK, et al. Antibiotic therapy in inflammatory bowel disease: a systematic review and meta-analysis. Am J Gastroenterol. 2011;106:661–73.

    Article  CAS  PubMed  Google Scholar 

  152. Dejaco C, Harrer M, Waldhoer T, Miehsler W, Vogelsang H, Reinisch W. Antibiotics and azathioprine for the treatment of perianal fistulas in Crohn’s disease. Aliment Pharmacol Ther. 2003;18:1113–20.

    Article  CAS  PubMed  Google Scholar 

  153. Kim GK. The risk of fluoroquinolone-induced tendinopathy and tendon rupture: what does the clinician need to know? J Clin Aesthet Dermatol. 2010;3:49–54.

    PubMed  PubMed Central  Google Scholar 

  154. Corrao G, Zambon A, Bertu L, Mauri A, Paleari V, Rossi C, et al. Evidence of tendinitis provoked by fluoroquinolone treatment: a case-control study. Drug Saf. 2006;29:889–96.

    Article  CAS  PubMed  Google Scholar 

  155. Pepin J, Saheb N, Coulombe MA, Alary ME, Corriveau MP, Authier S, et al. Emergence of fluoroquinolones as the predominant risk factor for Clostridium difficile-associated diarrhea: a cohort study during an epidemic in Quebec. Clin Infect Dis. 2005;41:1254–60.

    Article  CAS  PubMed  Google Scholar 

  156. Briasoulis A, Agarwal V, Pierce WJ. QT prolongation and torsade de pointes induced by fluoroquinolones: infrequent side effects from commonly used medications. Cardiology. 2011;120:103–10.

    Article  PubMed  Google Scholar 

  157. Prantera C. Probiotics for Crohn’s disease: what have we learned? Gut. 2006;55:757–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  158. Lopez J, Konijeti GG, Nguyen DD, Sauk J, Yajnik V, Ananthakrishnan AN. Natural history of Crohn’s disease following total colectomy and end ileostomy. Inflamm Bowel Dis. 2014;20:1236–41.

    Article  PubMed  Google Scholar 

  159. Rutgeerts P, Geboes K, Vantrappen G, Beyls J, Kerremans R, Hiele M. Predictability of the postoperative course of Crohn’s disease. Gastroenterology. 1990;99:956–63.

    Article  CAS  PubMed  Google Scholar 

  160. Makary MA, Segev DL, Pronovost PJ, Syin D, Bandeen-Roche K, Patel P, et al. Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg. 2010;210:901–8.

    Article  PubMed  Google Scholar 

  161. Bollegala N, Jackson TD, Nguyen GC. Increased postoperative mortality and complications among elderly patients with inflammatory bowel diseases: an analysis of the National Surgical Quality Improvement Program Cohort. Clin Gastroenterol Hepatol. 2016;14:1274–81.

    Article  PubMed  Google Scholar 

  162. 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;15:182–9.

    Article  PubMed  Google Scholar 

  163. Shung DL, Abraham B, Sellin J, Hou JK. Medical and surgical complications of inflammatory bowel disease in the elderly: a systematic review. Dig Dis Sci. 2015;60:1132–40.

    Article  CAS  PubMed  Google Scholar 

  164. Selby L, Kane S, Wilson J, Balla P, Riff B, Bingcang C, et al. Receipt of preventive health services by IBD patients is significantly lower than by primary care patients. Inflamm Bowel Dis. 2008;14:253–8.

    Article  PubMed  Google Scholar 

  165. Lichtenstein GR, Feagan BG, Cohen RD, Salzberg BA, Diamond RH, Price S, 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;107:1409–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  166. Rubin LG, Levin MJ, Ljungman P, Davies EG, Avery R, Tomblyn M, et al. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis. 2014;58:309–18.

    Article  PubMed  Google Scholar 

  167. Farraye FA, Melmed GY, Lichtenstein GR, Kane SV. ACG clinical guideline: preventive care in inflammatory bowel disease. Am J Gastroenterol. 2017;112:241–58.

    Article  PubMed  Google Scholar 

  168. Mir FA, Kane SV. Health maintenance in inflammatory bowel disease. Curr Gastroenterol Rep. 2018;20:23.

    Article  PubMed  Google Scholar 

  169. Cullen G, Baden RP, Cheifetz AS. Varicella zoster virus infection in inflammatory bowel disease. Inflamm Bowel Dis. 2012;18:2392–403.

    Article  PubMed  Google Scholar 

  170. Khan N, Patel D, Trivedi C, Shah Y, Lichtenstein G, Lewis J, et al. Overall and comparative risk of herpes zoster with pharmacotherapy for inflammatory bowel diseases: a nationwide cohort study. Clin Gastroenterol Hepatol. 2018;16:1919–1927.e1913.

    Article  PubMed  Google Scholar 

  171. Chang K, Lee HS, Kim YJ, Kim SO, Kim SH, Lee SH, et al. Increased risk of herpes zoster infection in patients with inflammatory bowel diseases in Korea. Clin Gastroenterol Hepatol. 2018;16(1928–1936):e1922.

    Google Scholar 

  172. Gupta G, Lautenbach E, Lewis JD. Incidence and risk factors for herpes zoster among patients with inflammatory bowel disease. Clin Gastroenterol Hepatol. 2006;4:1483–90.

    Article  PubMed  Google Scholar 

  173. Long MD, Martin C, Sandler RS, Kappelman MD. Increased risk of herpes zoster among 108 604 patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2013;37:420–9.

    Article  CAS  PubMed  Google Scholar 

  174. Jiang HY, Wang SY, Deng M, Li YC, Ling ZX, Shao L, et al. Immune response to hepatitis B vaccination among people with inflammatory bowel diseases: a systematic review and meta-analysis. Vaccine. 2017;35:2633–41.

    Article  CAS  PubMed  Google Scholar 

  175. Ananthakrishnan AN, McGinley EL, Binion DG, Saeian K. Fracture-associated hospitalizations in patients with inflammatory bowel disease. Dig Dis Sci. 2011;56:176–82.

    Article  PubMed  Google Scholar 

  176. Unnanuntana A, Gladnick BP, Donnelly E, Lane JM. The assessment of fracture risk. J Bone Jt Surg Am. 2010;92:743–53.

    Article  Google Scholar 

  177. Loftus EV Jr, Crowson CS, Sandborn WJ, Tremaine WJ, O’Fallon WM, Melton LJ 3rd. Long-term fracture risk in patients with Crohn’s disease: a population-based study in Olmsted County, Minnesota. Gastroenterology. 2002;123:468–75.

    Article  PubMed  Google Scholar 

  178. Bernstein CN, Leslie WD, Leboff MS. AGA technical review on osteoporosis in gastrointestinal diseases. Gastroenterology. 2003;124:795–841.

    Article  PubMed  Google Scholar 

  179. Ali T, Lam D, Bronze MS, Humphrey MB. Osteoporosis in inflammatory bowel disease. Am J Med. 2009;122:599–604.

    Article  PubMed  PubMed Central  Google Scholar 

  180. Ooi CJ, Makharia GK, Hilmi I, Gibson PR, Fock KM, Ahuja V, et al. Asia-Pacific consensus statements on Crohn’s disease. Part 2: management. J Gastroenterol Hepatol. 2016;31:56–68.

    Article  PubMed  Google Scholar 

  181. Van Gossum A, Cabre E, Hebuterne X, Jeppesen P, Krznaric Z, Messing B, et al. ESPEN guidelines on parenteral nutrition: gastroenterology. Clin Nutr. 2009;28:415–27.

    Article  PubMed  Google Scholar 

  182. Donnellan CF, Yann LH, Lal S. Nutritional management of Crohn’s disease. Ther Adv Gastroenterol. 2013;6:231–42.

    Article  CAS  Google Scholar 

  183. Nguyen GC, Sam J. Rising prevalence of venous thromboembolism and its impact on mortality among hospitalized inflammatory bowel disease patients. Am J Gastroenterol. 2008;103:2272–80.

    Article  PubMed  Google Scholar 

  184. Grainge MJ, West J, Card TR. Venous thromboembolism during active disease and remission in inflammatory bowel disease: a cohort study. Lancet. 2010;375:657–63.

    Article  PubMed  Google Scholar 

  185. Nguyen GC, Bernstein CN, Bitton A, Chan AK, Griffiths AM, Leontiadis GI, et al. Consensus statements on the risk, prevention, and treatment of venous thromboembolism in inflammatory bowel disease: Canadian Association of Gastroenterology. Gastroenterology. 2014;146(835–848):e836.

    Google Scholar 

  186. Ananthakrishnan AN, Cagan A, Gainer VS, Cheng SC, Cai T, Scoville E, et al. Thromboprophylaxis is associated with reduced post-hospitalization venous thromboembolic events in patients with inflammatory bowel diseases. Clin Gastroenterol Hepatol. 2014;12:1905–10.

    Article  PubMed  PubMed Central  Google Scholar 

  187. Greenstein AJ, Sachar DB, Smith H, Janowitz HD, Aufses AH Jr. A comparison of cancer risk in Crohn’s disease and ulcerative colitis. Cancer. 1981;48:2742–5.

    Article  CAS  PubMed  Google Scholar 

  188. Weedon DD, Shorter RG, Ilstrup DM, Huizenga KA, Taylor WF. Crohn’s disease and cancer. N Engl J Med. 1973;289:1099–103.

    Article  CAS  PubMed  Google Scholar 

  189. Gyde SN, Prior P, Macartney JC, Thompson H, Waterhouse JA, Allan RN. Malignancy in Crohn’s disease. Gut. 1980;21:1024–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  190. Mazzola P, Radhi S, Mirandola L, Annoni G, Jenkins M, Cobos E, et al. Aging, cancer, and cancer vaccines. Immun Ageing. 2012;9:4.

    Article  PubMed  PubMed Central  Google Scholar 

  191. Bernstein CN, Blanchard JF, Kliewer E, Wajda A. Cancer risk in patients with inflammatory bowel disease: a population-based study. Cancer. 2001;91:854–62.

    Article  CAS  PubMed  Google Scholar 

  192. Gillen CD, Andrews HA, Prior P, Allan RN. Crohn’s disease and colorectal cancer. Gut. 1994;35:651–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  193. Brackmann S, Andersen SN, Aamodt G, Langmark F, Clausen OP, Aadland E, et al. Relationship between clinical parameters and the colitis-colorectal cancer interval in a cohort of patients with colorectal cancer in inflammatory bowel disease. Scand J Gastroenterol. 2009;44:46–55.

    Article  PubMed  Google Scholar 

  194. Shi HY, Chan FK, Leung WK, Li MK, Leung CM, Sze SF, et al. Natural history of elderly-onset ulcerative colitis: results from a territory-wide inflammatory bowel disease registry. J Crohns Colitis. 2016;10:176–85.

    Article  PubMed  Google Scholar 

  195. Warren JL, Klabunde CN, Mariotto AB, Meekins A, Topor M, Brown ML, et al. Adverse events after outpatient colonoscopy in the Medicare population. Ann Intern Med. 2009;150(849–857):w152.

    Google Scholar 

  196. Crispin A, Birkner B, Munte A, Nusko G, Mansmann U. Process quality and incidence of acute complications in a series of more than 230,000 outpatient colonoscopies. Endoscopy. 2009;41:1018–25.

    Article  CAS  PubMed  Google Scholar 

  197. Navaneethan U, Parasa S, Venkatesh PG, Trikudanathan G, Shen B. Prevalence and risk factors for colonic perforation during colonoscopy in hospitalized inflammatory bowel disease patients. J Crohns Colitis. 2011;5:189–95.

    Article  PubMed  Google Scholar 

  198. Taleban S, Toosizadeh N, Junna S, Golden T, Ghazala S, Wadeea R, et al. Frailty assessment predicts acute outcomes in patients undergoing screening colonoscopy. Dig Dis Sci. 2018;63:3272–80.

    Article  PubMed  Google Scholar 

  199. Baars JE, Kuipers EJ, van Haastert M, Nicolai JJ, Poen AC, van der Woude CJ. Age at diagnosis of inflammatory bowel disease influences early development of colorectal cancer in inflammatory bowel disease patients: a nationwide, long-term survey. J Gastroenterol. 2012;47:1308–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  200. Farraye FA, Odze RD, Eaden J, Itzkowitz SH. AGA technical review on the diagnosis and management of colorectal neoplasia in inflammatory bowel disease. Gastroenterology. 2010;138:746–774.e741–744 (quiz e712–e743).

    Article  PubMed  Google Scholar 

  201. Itzkowitz SH, Present DH. Consensus conference: colorectal cancer screening and surveillance in inflammatory bowel disease. Inflamm Bowel Dis. 2005;11:314–21.

    Article  PubMed  Google Scholar 

  202. Bergquist A, von Seth E. Epidemiology of cholangiocarcinoma. Best Pract Res Clin Gastroenterol. 2015;29:221–32.

    Article  PubMed  Google Scholar 

  203. Erichsen R, Jepsen P, Vilstrup H, Ekbom A, Sorensen HT. Incidence and prognosis of cholangiocarcinoma in Danish patients with and without inflammatory bowel disease: a national cohort study, 1978–2003. Eur J Epidemiol. 2009;24:513–20.

    Article  PubMed  Google Scholar 

  204. Khaderi SA, Sussman NL. Screening for malignancy in primary sclerosing cholangitis (PSC). Curr Gastroenterol Rep. 2015;17:17.

    Article  PubMed  Google Scholar 

  205. Claessen MM, Vleggaar FP, Tytgat KM, Siersema PD, van Buuren HR. High lifetime risk of cancer in primary sclerosing cholangitis. J Hepatol. 2009;50:158–64.

    Article  PubMed  Google Scholar 

  206. Jess T, Winther KV, Munkholm P, Langholz E, Binder V. Intestinal and extra-intestinal cancer in Crohn’s disease: follow-up of a population-based cohort in Copenhagen County, Denmark. Aliment Pharmacol Ther. 2004;19:287–93.

    Article  CAS  PubMed  Google Scholar 

  207. von Roon AC, Reese G, Teare J, Constantinides V, Darzi AW, Tekkis PP. The risk of cancer in patients with Crohn’s disease. Dis Colon Rectum. 2007;50:839–55.

    Article  Google Scholar 

  208. Shaukat A, Virnig DJ, Howard D, Sitaraman SV, Liff JM, Lederle FA. Crohn’s disease and small bowel adenocarcinoma: a population-based case-control study. Cancer Epidemiol Biomark Prev. 2011;20:1120–3.

    Article  CAS  Google Scholar 

  209. Cahill C, Gordon PH, Petrucci A, Boutros M. Small bowel adenocarcinoma and Crohn’s disease: any further ahead than 50 years ago? World J Gastroenterol. 2014;20:11486–95.

    Article  PubMed  PubMed Central  Google Scholar 

  210. Palascak-Juif V, Bouvier AM, Cosnes J, Flourie B, Bouche O, Cadiot G, et al. Small bowel adenocarcinoma in patients with Crohn’s disease compared with small bowel adenocarcinoma de novo. Inflamm Bowel Dis. 2005;11:828–32.

    Article  PubMed  Google Scholar 

  211. Taleban S, Elquza E, Gower-Rousseau C, Peyrin-Biroulet L. Cancer and inflammatory bowel disease in the elderly. Dig Liver Dis. 2016;48:1105–11.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Banner University Medical Center, Tucson, AZ, USA

    David Kim

  2. Division of Gastroenterology and Hepatology, University of Arizona School of Medicine, Tucson, AZ, USA

    David Kim & Sasha Taleban

  3. Arizona Center on Aging, University of Arizona, Tucson, AZ, USA

    Sasha Taleban

Authors
  1. David Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sasha Taleban
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sasha Taleban.

Ethics declarations

Conflict of interest

Sasha Taleban has received educational grants from Janssen, Takeda, Celgene, and Pfizer, and has served on the Advisory Board of Janssen. David Kim declares that he has no conflict of interest.

Funding

No sources of funding were received for this review.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, D., Taleban, S. A Comprehensive Review of the Diagnosis and Pharmacological Management of Crohn’s Disease in the Elderly Population. Drugs Aging 36, 607–624 (2019). https://doi.org/10.1007/s40266-019-00672-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40266-019-00672-x

Search

Navigation