Therapeutic challenges of managing inflammatory bowel disease in the elderly patient

Expert Review of Gastroenterology and Hepatology

Volumn 10, Issue 9, 2016, Pages 1005-1010

  Ahmed, Osman ^a   Nguyen, Geoffrey C ^a  

^a UNIVERSITY OF TORONTO   (Canada)

Author keywords

Elderly; hospitalization; inflammatory bowel disease; medical management; surgery

Indexed keywords

ALLOPURINOL; AZATHIOPRINE; BUDESONIDE; INFLIXIMAB; MESALAZINE; METHOTREXATE; PREDNISOLONE; SALAZOSULFAPYRIDINE; USTEKINUMAB; VEDOLIZUMAB; BIOLOGICAL PRODUCT; GASTROINTESTINAL AGENT; IMMUNOSUPPRESSIVE AGENT;

ANEMIA; CLOSTRIDIUM DIFFICILE INFECTION; COHORT ANALYSIS; COMORBIDITY; CONGESTIVE HEART FAILURE; CROHN DISEASE; DECISION MAKING; DRUG EFFICACY; DRUG HYPERSENSITIVITY; DRUG SAFETY; FECES INCONTINENCE; GASTROINTESTINAL DISEASE; HEMATOLOGIC DISEASE; HOSPITALIZATION; HUMAN; ILEAL POUCH ANAL ANASTOMOSIS; ILEOANAL ANASTOMOSIS; ILEOSTOMY; INTERNATIONAL NORMALIZED RATIO; KIDNEY DISEASE; KIDNEY FAILURE; LEUKOPENIA; LIVER DISEASE; META ANALYSIS (TOPIC); NEPHROTOXICITY; NEUROLOGIC DISEASE; NON MELANOMA SKIN CANCER; NONHODGKIN LYMPHOMA; OSTEOLYSIS; POLYPHARMACY; POSTOPERATIVE PERIOD; PRESCRIPTION; PROCTOCOLECTOMY; QUALITY OF LIFE; RETROSPECTIVE STUDY; REVIEW; SIDE EFFECT; SKIN MANIFESTATION; SYSTEMATIC REVIEW (TOPIC); THROMBOEMBOLISM; TREATMENT RESPONSE; ULCERATIVE COLITIS; ABDOMINAL SURGERY; AGE; AGED; DRUG INTERACTION; GERIATRIC ASSESSMENT; INFLAMMATORY BOWEL DISEASE; MIDDLE AGED; PREVALENCE; RISK ASSESSMENT; RISK FACTOR; TREATMENT OUTCOME; VERY ELDERLY;

AGE FACTORS; AGED; AGED, 80 AND OVER; BIOLOGICAL PRODUCTS; COMORBIDITY; DIGESTIVE SYSTEM SURGICAL PROCEDURES; DRUG INTERACTIONS; GASTROINTESTINAL AGENTS; GERIATRIC ASSESSMENT; HOSPITALIZATION; HUMANS; IMMUNOSUPPRESSIVE AGENTS; INFLAMMATORY BOWEL DISEASES; MIDDLE AGED; POLYPHARMACY; PREVALENCE; RISK ASSESSMENT; RISK FACTORS; TREATMENT OUTCOME;

EID: 84966670326     PISSN: 17474124     EISSN: 17474132     Source Type: Journal    
DOI: 10.1080/17474124.2016.1179579     Document Type: Review

References (60)

1. E.V.LoftusJr., M.D.Silverstein, W.J.Sandborn, et al. Crohn’s disease in Olmsted County, Minnesota, 1940-1993:incidence, prevalence, and survival. Gastroenterology. 1998;114(6):1161–1168.
2. P.Piront, E.Louis, P.Latour, et al. Epidemiology of inflammatory bowel diseases in the elderly in the province of Liege. Gastroenterol Clin Biol. 2002;26(2):157–161.
3. S.Katz, R.Feldstein Inflammatory bowel disease of the elderly:a wake-up call. Gastroenterol Hepatol (N Y). 2008;4(5):337–347.
4. C.Gower-Rousseau, F.Vasseur, M.Fumery, et al. Epidemiology of inflammatory bowel diseases:new insights from a French population-based registry (EPIMAD). Dig Liver Dis. 2013;45(2):89–94.
5. P.C.Harper, T.L.McAuliffe, W.L.Beeken. Crohn’s disease in the elderly. A statistical comparison with younger patients matched for sex and duration of disease. Arch Intern Med. 1986;146(4):753–755.
6. C.Charpentier, J.Salleron, G.Savoye, et al. Natural history of elderly-onset inflammatory bowel disease:a population-based cohort study. Gut. 2014;63(3):423–432.•• A French-population cohort study looking at the presentation and natural history of elderly-onset inflammatory bowel disease. Study showed that elderly patients have milder disease with less progression.
7. J.Ruel, D.Ruane, S.Mehandru, et al. IBD across the age spectrum:is it the same disease? Nat Rev Gastroenterol Hepatol. 2014;11(2):88–98.
8. S.R.Vavricka, G.Rogler. Treatment of severe ulcerative colitis:differences in elderly patients? Dig Dis. 2009;27(3):315–321.
9. G.R.Lichtenstein, S.B.Hanauer, W.J.Sandborn. Management of Crohn’s disease in adults. Am J Gastroenterol. 2009;104(2):465–483. quiz 64, 84.
10. A.Kornbluth, D.B.Sachar. Ulcerative colitis practice guidelines in adults:American college of gastroenterology, practice parameters committee. Am J Gastroenterol. 2010;105(3):501–523. quiz 24.
11. A.Dignass, G.Van Assche, J.O.Lindsay, et al. The second European evidence-based Consensus on the diagnosis and management of Crohn’s disease:current management. J Crohns Colitis. 2010;4(1):28–62.
12. A.Dignass, J.O.Lindsay, A.Sturm, et al. Second European evidence-based consensus on the diagnosis and management of ulcerative colitis part 2:current management. J Crohns Colitis. 2012;6(10):991–1030.
13. D.M.Qato, G.C.Alexander, R.M.Conti, et al. Use of prescription and over-the-counter medications and dietary supplements among older adults in the United States. Jama. 2008;300(24):2867–2878.
14. M.Juneja, L.Baidoo, M.B.Schwartz, et al. Geriatric inflammatory bowel disease:phenotypic presentation, treatment patterns, nutritional status, outcomes, and comorbidity. Dig Dis Sci. 2012;57(9):2408–2415.
15. A.F.Muller, P.E.Stevens, A.S.McIntyre, et al. Experience of 5-aminosalicylate nephrotoxicity in the United Kingdom. Aliment Pharmacol Ther. 2005;21(10):1217–1224.
16. J.P.Gisbert, Y.Gonzalez-Lama, J.Mate. 5-Aminosalicylates and renal function in inflammatory bowel disease:a systematic review. Inflamm Bowel Dis. 2007;13(5):629–638.
17. S.Katz, D.S.Pardi. Inflammatory bowel disease of the elderly:frequently asked questions (FAQs). Am J Gastroenterol. 2011;106(11):1889–1897.
18. N.K.de Boer, D.R.Wong, B.Jharap, et al. Dose-dependent influence of 5-aminosalicylates on thiopurine metabolism. Am J Gastroenterol. 2007;102(12):2747–2753.
19. A.Stallmach, S.Hagel, A.Gharbi, et al. Medical and surgical therapy of inflammatory bowel disease in the elderly - prospects and complications. J Crohns Colitis. 2011;5(3):177–188.
20. C.Y.Ha. Medical management of inflammatory bowel disease in the elderly:balancing safety and efficacy. Clin Geriatr Med. 2014;30(1):67–78.
21. A.C.Ford, K.J.Khan, W.J.Sandborn, et al. Once-daily dosing vs. conventional dosing schedule of mesalamine and relapse of quiescent ulcerative colitis:systematic review and meta-analysis. Am J Gastroenterol. 2011;106(12):2070–2077. quiz 78.
22. P.L.Lakatos, G.David, T.Pandur, et al. IBD in the elderly population:results from a population-based study in Western Hungary, 1977-2008. J Crohns Colitis. 2011;5(1):5–13.
23. J.H.del Val. Old-age inflammatory bowel disease onset:a different problem? World J Gastroenterol. 2011;17(22):2734–2739.
24. O.Morgacheva, D.E.Furst. Use of MTX in the elderly and in patients with compromised renal function. Clin Exp Rheumatol. 2010;28(5 Suppl 61):S85–S94.
25. G.R.Lichtenstein, B.G.Feagan, R.D.Cohen, 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(9):1409–1422.
26. L.Beaugerie, N.Brousse, A.M.Bouvier, et al. Lymphoproliferative disorders in patients receiving thiopurines for inflammatory bowel disease:a prospective observational cohort study. Lancet. 2009;374(9701):1617–1625.
27. M.D.Long, C.F.Martin, C.A.Pipkin, et al. Risk of melanoma and nonmelanoma skin cancer among patients with inflammatory bowel disease. Gastroenterology. 2012;143(2):390–399 e1.
28. J.D.Lewis, J.S.Schwartz, G.R.Lichtenstein. Azathioprine for maintenance of remission in Crohn’s disease:benefits outweigh the risk of lymphoma. Gastroenterology. 2000;118(6):1018–1024.
29. T.Forslund, H.Borgmastars, F.Fyrquist. Captopril-associated leucopenia confirmed by rechallenge in patient with renal failure. Lancet. 1981;1(8212):166.
30. M.L.Seinen, D.P.van Asseldonk, N.K.De Boer, et al. The effect of allopurinol and low-dose thiopurine combination therapy on the activity of three pivotal thiopurine metabolizing enzymes:results from a prospective pharmacological study. J Crohns Colitis. 2013;7(10):812–819.
31. J.Bourre-Tessier, B.Haraoui. Methotrexate drug interactions in the treatment of rheumatoid arthritis:a systematic review. J Rheumatol. 2010;37(7):1416–1421.
32. M.Naganuma, R.Kunisaki, N.Yoshimura, et al. A prospective analysis of the incidence of and risk factors for opportunistic infections in patients with inflammatory bowel disease. J Gastroenterol. 2013;48(5):595–600.
33. T.Ali, D.Lam, M.S.Bronze, et al. Osteoporosis in inflammatory bowel disease. Am J Med. 2009;122(7):599–604.
34. C.M.Spencer, M.D.Budesonide. A review of its pharmacological properties and therapeutic efficacy in inflammatory bowel disease. Drugs. 1995;50(5):854–872.
35. E.J.Schoon, S.Bollani, P.R.Mills, et al. Bone mineral density in relation to efficacy and side effects of budesonide and prednisolone in Crohn’s disease. Clin Gastroenterol Hepatol. 2005;3(2):113–121.
36. G.R.Lichtenstein. Budesonide multi-matrix for the treatment of patients with ulcerative colitis. Dig Dis Sci. 2016;61(2):358–370.
37. M.C.Bautista, M.F.Otterson, Y.Zadvornova, et al. Surgical outcomes in the elderly with inflammatory bowel disease are similar to those in the younger population. Dig Dis Sci. 2013;58(10):2955–2962.
38. S.L.Johnson, C.M.Bartels, M.Palta, et al. 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(9):e008597.
39. T.Lobaton, M.Ferrante, P.Rutgeerts, et al. Efficacy and safety of anti-TNF therapy in elderly patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2015;42(4):441–451.• An observational and retrospective single-centre study looking at efficacy and adverse events in the use of anti-TNFa agents in the elderly populations (age greater than 65). Study showed lower response rates (at 10 weeks but not at 6 months) and higher adverse events in the elderly.
40. A.Desai, Z.A.Zator, P.de Silva, 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(2):309–315.
41. M.Cottone, A.Kohn, M.Daperno, 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(1):30–35.•• Important observational study characterizing the risk of severe infection associated with anti-TNF therapy in the eldelry compared.
42. J.A.Singh, G.A.Wells, R.Christensen, et al. Adverse effects of biologics:a network meta-analysis and Cochrane overview. Cochrane Database Syst Rev. 2011;(2):CD008794.
43. D.Khanna, M.McMahon, D.E.Furst. Anti-tumor necrosis factor alpha therapy and heart failure:what have we learned and where do we go from here? Arthritis Rheum. 2004;50(4):1040–1050.
44. S.Singh, S.J.Nagpal, M.H.Murad, et al. Inflammatory bowel disease is associated with an increased risk of melanoma:a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2014;12(2):210–218.
45. B.Pariente, D.Laharie. Review article:why, when and how to de-escalate therapy in inflammatory bowel diseases. Aliment Pharmacol Ther. 2014;40(4):338–353.
46. G.Almogy, D.B.Sachar, C.A.Bodian, et al. Surgery for ulcerative colitis in elderly persons:changes in indications for surgery and outcome over time. Arch Surg. 2001;136(12):1396–1400.
47. N.Bollegala, T.D.Jackson, G.C.Nguyen. 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. 2015. [Epub ahead of print].•• One of the largest reported multicenter retrospective study quantifying postoperative complications and mortality in patients age greater than 65 undergoing IBD-related surgery as compared to younger populations.
48. C.P.Delaney, V.W.Fazio, F.H.Remzi, et al. Prospective, age-related analysis of surgical results, functional outcome, and quality of life after ileal pouch-anal anastomosis. Ann Surg. 2003;238(2):221–228.
49. G.G.Kaplan, J.Hubbard, R.Panaccione, et al. Risk of comorbidities on postoperative outcomes in patients with inflammatory bowel disease. Arch Surg. 2011;146(8):959–964.
50. M.Bewtra, C.W.Newcomb, Q.Wu, et al. Mortality associated with medical therapy versus elective colectomy in ulcerative colitis:a cohort study. Ann Intern Med. 2015;163(4):262–270.
51. A.N.Ananthakrishnan, E.L.McGinley, D.G.Binion. Inflammatory bowel disease in the elderly is associated with worse outcomes:a national study of hospitalizations. Inflamm Bowel Dis. 2009;15(2):182–189.• A cross-sectional study looking at outcomes in IBD-related hospitalizations in elderly patients (age greater than 65) compared with younger populations. Study showed worst outcomes in elderly patients that have IBD-related hospitalizations.
52. G.C.Nguyen, N.Bollegala, C.A.Chong. Factors associated with readmissions and outcomes of patients hospitalized for inflammatory bowel disease. Clin Gastroenterol Hepatol. 2014;12(11):1897–1904 e1.
53. A.N.Ananthakrishnan, R.Guzman-Perez, V.Gainer, et al. Predictors of severe outcomes associated with Clostridium difficile infection in patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2012;35(7):789–795.
54. G.C.Nguyen, J.Sam. Rising prevalence of venous thromboembolism and its impact on mortality among hospitalized inflammatory bowel disease patients. Am J Gastroenterol. 2008;103(9):2272–2280.
55. C.Y.Ha, S.Katz. Clinical outcomes and management of inflammatory bowel disease in the older patient. Curr Gastroenterol Rep. 2013;15(2):310.
56. S.K.Wasan, S.E.Baker, P.R.Skolnik, et al. A practical guide to vaccinating the inflammatory bowel disease patient. Am J Gastroenterol. 2010;105(6):1231–1238.
57. S.Ghosh, M.Iacucci. Should we establish standards of care for management of elderly patients with inflammatory bowel disease? Can J Gastroenterol Hepatol. 2015;29(5):236.
58. M.E.van der Valk, M.J.Mangen, M.Leenders, et al. Healthcare costs of inflammatory bowel disease have shifted from hospitalisation and surgery towards anti-TNFalpha therapy:results from the COIN study. Gut. 2014;63(1):72–79.
59. M.van der Have, M.J.Mangen, M.E.van der Valk, et al. Effect of aging on healthcare costs of inflammatory bowel disease:a glimpse into the future. Inflamm Bowel Dis. 2014;20(4):637–645.
60. G.C.Nguyen, L.Sheng, E.I.Benchimol. Health Care utilization in elderly onset inflammatory bowel disease:a population-based study. Inflamm Bowel Dis. 2015;21(4):777–782.