Hasan Vosoghinia
1 
, Bahar Saberzadeh-Ardestani
2, Amir Anushiravani
2* , Fariborz Mansour-Ghanaei
3, Hafez Fakheri
4, Homayoon Vahedi
2, Farshad Sheikhesmaeili
5, Abbas Yazdanbod
6, Seyed Hamid Moosavy
7, Iradj Maleki
4, Siavosh Nasseri-Moghaddam
2, Bardia Khosravi
2, Masoud Malekzadeh
2, Amir Kasaeian
2,8, Sudabeh Alatab
2, Anahita Sadeghi
2, Shadi Kolahdoozan
2, Mohammad Amani
2, Seyedeh Naeimeh Saberhosseini
9, Maryam Rayatpisheh
2, Mitra Ahadi
9, Jean-Frederic Colombel
10, Ryan C. Ungaro
10, Ali Reza Sima
2,11, Reza Malekzadeh
21 Gastroenterology and Hepatology Department, Faculty of Medicine, Ghaem Hospital, Mashhad, Iran
2 Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
3 Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
4 Gut and Liver Research Center, Mazandaran University of Medical Sciences, Sari, Iran
5 Liver and Digestive Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
6 Gastroenterology and Hepatology Department, Digestive Diseases Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
7 Shahid Mohammadi Hospital, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
8 Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
9 Mashhad University of Medical Sciences, Mashhad, Iran
10 The Henry D. Janowitz Division of Gastroenterology Icahn School of Medicine at Mount Sinai, New York, USA
11 Sasan Alborz Biomedical Research Center, Masoud Gastroenterology and Hepatology Center, Tehran, Iran
Abstract
Background: It is unknown if the clinical manifestations and phenotype of disease are comparable between early- and elderly-onset inflammatory bowel disease (IBD). We aimed to seek differences in disease phenotype, course, complications, and treatment between early- and elderly-onset IBD patients.
Methods: This retrospective cohort study on registered IBD patients in the Iranian Registry of Crohn’s and Colitis (IRCC) compared demographics, disease phenotype, disease activity, IBD-related surgery and medications between early- and elderly-onset IBD. A generalized linear regression model was used to investigate the relative risk of age at diagnosis adjusted for gender and disease duration for the outcomes.
Results: From 10048 IBD patients, 749 with early-onset (7.5%), and 472 (4.7%) elderly-onset IBD were enrolled: 855 (63.1%) ulcerative colitis (UC) and 366 (26.9%) Crohn’s disease (CD). Left-sided colitis was more frequent among elderly-onset UC patients (P<0.001). Ileum and ileocolonic locations were the most common types in elderly-onset and early-onset CD patients, respectively. In comparison with elderly-onset UC, early-onset cases more often used prednisolone (22.1% vs. 11.4%, P=0.001), immunomodulators (44.9% vs 25.2%, P<0.001) and anti-tumor necrosis factors (TNF) (20.1% vs 11.9%, P=0.002). Elderly-onset UC patients had 0.7 times lower risk of aggressive phenotype (95%CI:0.6‒0.9, P=0.005). Early-onset CD was associated with higher use of prednisolone (27.7% vs 8.1%, P<0.001), immunomodulators (58.7% vs 41.8%, P=0.005) and anti-TNF (49.6% vs 35.4%, P=0.006).
Conclusion: Early-onset IBD was associated with a more aggressive phenotype and higher prednisolone, immunomodulators, and anti-TNF use.