Comparison of early and late-onset inflammatory bowel diseases in terms of disease course, treatment response and prognosis

Introduction and Aim: The rate of onset at a late age in Inflammatory Bowel Diseases (IBD) has increased over the years. Compared to those who started at an early age, the course of the disease and treatment response remain uncertain in this age group. In this study, it was aimed to evaluate the disease course, treatment response and prognosis of late and early-onset patients with IBD who were followed up in the Istanbul Medical Faculty Gastroenterology Outpatient Clinic. Material and Method: In this study, the files of 1060 patients diagnosed with IBD and followed for more than 6 months in the Gastroenterology Polyclinic of Istanbul Medical Faculty were retrospectively scanned. Thirty-nine patients with late onset (≥60 years) were included in the study. As the control group, 50 early-onset patients with similar demographic findings with the late-onset patient group were included. A total of 89 patients with early and late onset were recruited. Disease type, demographic data, treatments, treatment-related side effects and toxicities, mortality rates, presence of extraintestinal and hepatobiliary involvement, complication development, disease activity, endoscopic and clinical remission were compared between the early and late-onset groups. Results: The mean age of the patients at the time of diagnosis was 49.2±17.5 years, and 53 (59.6%) were male. The mean age of late-onset patients at diagnosis was 66.3±5.5 years, and the mean age of early-onset patients at diagnosis was 35.8±10.7 years. Twenty-five (64.1%) of 39 late-onset patients were UC, 14 (35.9%) CD; Of 50 early-onset patients, 28 (56.0%) were UC and 22 (44.0%) CD. The mean follow-up period of the patients was 91.3±47.4 months, the mean follow-up time of the late-onset patients was 75.1±53.1 months, and the mean follow-up period of the early-onset patients was 103.9±38.5 months. Clinical (94% vs. 86.8%) and endoscopic remission rates (49% vs. 33.3%) and AZT toxicity (28% vs 20.5%) were similar in both groups (p>0.05). Mortality (33.3% vs. 2%) and complication rates in late-onset UC were higher in the late-onset patient group (32% vs. 7.1%) than in the early-onset patients (p<0.05). Although the development of malignancy was higher in the late-onset patient group than in the early-onset patients, it was not statistically significant (15.4% vs. 6%, p>0.05). Conclusion: Late-onset patients are similar to early-onset patients in terms of disease course and drug side effects. The mortality rate is higher in late-onset patients. The rate of development of malignancy is higher in the advanced age group. Therefore, malignancy follow-up is important in this patient group. Keywords: Inflammatory Bowel Disease, Ulcerative Colitis, Crohn's disease, late-onset, early onset, prognosis