Elderly-onset IBD

June 3, 2025

Issue 11

Clinical Question

Do patients with elderly-onset IBD have different risks for surgery, complications, mortality?

Editor’s Bottom Line

Patients with elderly-onset IBD have general health outcomes similar to age-matched controls, but receive different IBD therapy, with reduced use of thiopurines and biologics and more abdominal surgery.

Reference

Ben Hur D, Issaschar G, Moshe R, et al. Risk of Age-related and Disease-related Complications and Mortality in Elderly-onset Inflammatory Bowel Disease – A Population-based Study. Clin Gastroenterol Hepatol. Epub ahead of print March 2025; https://doi.org/10.1016/j.cgh.2025.01.020

Synopsis

This nationwide population-based study from Israel examined age-related complications, mortality and disease-related outcomes in patients with elderly-onset IBD (EO-IBD), defined as diagnosis at age 65 years or older.

Using data from the Israeli IBD Research Nucleus (epi-IIRN) database, which covers 98% of the population, researchers identified 2,826 patients with EO-IBD diagnosed between 2005–2020. They compared these patients with two control groups: 6,486 age-, sex- and district-matched elderly individuals without IBD for age-related outcomes, and 11,304 adult-onset IBD patients (aged 18–65 years at diagnosis) matched by IBD subtype, sex and district for disease-related outcomes.

Of the EO-IBD cases, 52.8% had ulcerative colitis (UC) and 47.2% had Crohn’s disease (CD), with a median age at diagnosis of 71.5 years. The median follow-up was 73 months for the EO-IBD, 74 months for the elderly control comparison and 96 months for the adult-onset IBD comparison.

Patients with EO-IBD showed similar risks for age-related complications compared to elderly non-IBD controls. Mortality rates were 292.32 vs. 291.24 per 1,000 person-years (p=0.79), respectively. The adjusted hazard ratios (aHR) for EO-IBD patients showed no increased risk for pneumonia (aHR: 1.04; 95% Confidence Interval [CI], 0.84–1.29), osteoporotic fractures (aHR: 1.03; 95% CI, 0.82–1.29), bacteremia (aHR: 2.16; 95% CI, 0.87–5.40), or venous thromboembolism (aHR: 0.58; 95% CI, 0.27–1.23). The main causes of death were similar between groups, with malignancy (6.4% vs. 6%) and heart disease (3.9% vs. 4.2%) being the leading causes.

Compared to adult-onset IBD, patients with EO-IBD had significantly different treatment patterns and surgical outcomes. EO-IBD patients had lower exposure to thiopurines (aHR: 0.44; 95% CI, 0.39–0.49) and anti-tumor necrosis factor (TNF) agents (aHR: 0.37; 95% CI, 0.32–0.42). At three years from diagnosis, only 11% of EO-IBD patients used thiopurines compared to 23% of adult-onset patients, and 6.1% used anti-TNF therapy, compared to 15% of adult-onset patients. Corticosteroid use was not reduced in EO-IBD patients compared to adult-onset patients.

The risk for abdominal surgery was elevated in both EO-CD (aHR: 1.23; 95% CI, 1.04–1.46) and EO-UC (aHR: 1.51; 95% CI, 2.04–3.08), compared to adult-onset patients. Patients with EO-CD had a lower risk for perianal surgery (HR: 0.27; 95% CI, 0.16–0.47). The calculated rates of repeat perianal surgery three years after initial surgery were 7.1% in the EO-CD group versus 36% in the adult-onset CD group.

The study found that 13.9% of EO-IBD patients underwent abdominal surgery, with a median time to surgery of 17 months. Repeat abdominal surgery rates at 3 years were 29% for EO-CD compared to 21% for adult-onset CD.

Among EO-CD patients who underwent surgery, 5.8% received anti-TNF therapy at 1 year post-operatively, compared to 24% of adult-onset patients.

Details

Study Design: Population-based cohort study
Funding: Not stated
Allocation: Not applicable
Setting: Multicenter
Level of Evidence: 2b