Background & Aims

The incidence of inflammatory bowel diseases (IBDs) in older adults is increasing. We performed a systematic review and meta-analysis to evaluate progression of elderly onset (EO) IBD in population-based cohorts and compared it with adult onset (AO) IBD.

Methods

In a systematic review through June 1, 2019, we identified population-based cohort studies of EO IBD reporting the cumulative risk of hospitalization, surgery, mortality, treatment patterns, escalation, and/or malignancy. Data were synthesized using random-effects meta-analysis as cumulative risk of events at 1 year, 5 years, and 10 years, and compared with data from patients with AO IBD in the same cohorts.

Results

We identified 9 studies, comprising 14,765 patients with EO IBD. In patients with EO Crohn’s disease (CD), the cumulative 5-year risk of surgery was 22.6% (95% CI, 18.7–27.2) and was similar to that of patients with AO CD (relative risk [RR], 1.04; 95% CI, 0.80–1.34). Overall exposure to corticosteroids was comparable between patients with EO CD vs AO CD (5-year risk: 55.4%; 95% CI, 53.4–57.4; RR, 0.88; 95% CI, 0.78–1.00), but exposure to immunomodulators (31.5%; 95% CI, 29.7–33.4; RR, 0.62; 95% CI, 0.51–0.77) or biologic agents (6.5%; 95% CI, 5.6–7.6; RR, 0.36; 95% CI, 0.25–0.52) was significantly lower for patients with EO CD than for patients with AO CD. Similarly, in patients with EO ulcerative colitis (UC), the cumulative 5-year risk of surgery was 7.8% (95% CI, 5.0–12.0), similar to the risk for patients with AO UC (RR, 1.29; 95% CI, 0.79–2.11). Overall exposure to corticosteroids was comparable between patients with EO UC vs AO UC (5-year risk: 57.2%; 95% CI, 55.6–58.7; RR, 0.98; 95% CI, 0.91–1.06), but exposure to immunomodulators (16.1%; 95% CI, 15.0–17.2; RR, 0.58; 95% CI, 0.54–0.62) or biologic agents (2.0%; 95% CI, 1.6–2.5; RR, 0.36; 95% CI, 0.24–0.52) was significantly lower for patients with EO UC than for patients with AO UC. Patients with EO IBD appeared to have increased mortality, but not malignancy, compared with the general population. There were few data on comorbidities or adverse effects of medications.

Conclusions

In a systematic review and meta-analysis, we found that patients with EO IBD have a similar risk of surgery as patients with AO IBD. However, patients with EO IBD are less likely to receive treatment with immunomodulators or biologic agents.

中文翻译：

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老年炎症性肠病的进展：基于人群的队列研究的系统评价和荟萃分析。

背景与目标

老年人炎症性肠病 (IBD) 的发病率正在增加。我们进行了一项系统回顾和荟萃分析，以评估基于人群的队列中老年发病 (EO) IBD 的进展，并将其与成人发病 (AO) IBD 进行比较。

方法

在截至 2019 年 6 月 1 日的系统评价中，我们确定了基于人群的 EO IBD 队列研究，报告了住院、手术、死亡率、治疗模式、升级和/或恶性肿瘤的累积风险。使用随机效应荟萃分析合成数据，作为 1 年、5 年和 10 年的累积事件风险，并与来自同一队列的 AO IBD 患者的数据进行比较。

结果

我们确定了 9 项研究，包括 14,765 名 EO IBD 患者。在 EO 克罗恩病 (CD) 患者中，5 年累积手术风险为 22.6%（95% CI，18.7-27.2），与 AO CD 患者相似（相对风险 [RR]，1.04；95 % CI，0.80–1.34）。EO CD 与 AO CD 患者皮质类固醇的总体暴露量相当（5 年风险：55.4%；95% CI，53.4-57.4；RR，0.88；95% CI，0.78-1.00），但暴露于免疫调节剂（31.5 %；95% CI，29.7–33.4；RR，0.62；95% CI，0.51–0.77）或生物制剂（6.5%；95% CI，5.6–7.6；RR，0.36；95% CI，0.25–0.52） EO CD 患者明显低于 AO CD 患者。同样，在 EO 溃疡性结肠炎 (UC) 患者中，手术的累积 5 年风险为 7.8%（95% CI，5.0-12.0），与 AO UC 患者的风险相似（RR，1.29；95% CI , 0.79–2。11)。EO UC 与 AO UC 患者皮质类固醇的总体暴露量相当（5 年风险：57.2%；95% CI，55.6-58.7；RR，0.98；95% CI，0.91-1.06），但暴露于免疫调节剂（16.1 %；95% CI，15.0–17.2；RR，0.58；95% CI，0.54–0.62）或生物制剂（2.0%；95% CI，1.6–2.5；RR，0.36；95% CI，0.24–0.52） EO UC 患者显着低于 AO UC 患者。与一般人群相比，EO IBD 患者的死亡率似乎有所增加，但恶性肿瘤并未增加。关于药物合并症或不良反应的数据很少。62) 或生物制剂 (2.0%; 95% CI, 1.6-2.5; RR, 0.36; 95% CI, 0.24-0.52) EO UC 患者显着低于 AO UC 患者。与一般人群相比，EO IBD 患者的死亡率似乎有所增加，但恶性肿瘤并未增加。关于药物合并症或不良反应的数据很少。62) 或生物制剂 (2.0%; 95% CI, 1.6-2.5; RR, 0.36; 95% CI, 0.24-0.52) EO UC 患者显着低于 AO UC 患者。与一般人群相比，EO IBD 患者的死亡率似乎有所增加，但恶性肿瘤并未增加。关于药物合并症或不良反应的数据很少。

结论

在系统评价和荟萃分析中，我们发现 EO IBD 患者与 AO IBD 患者的手术风险相似。然而，EO IBD 患者接受免疫调节剂或生物制剂治疗的可能性较小。