Published online Apr 28, 2023. doi: 10.3748/wjg.v29.i16.2469
Peer-review started: November 15, 2022
First decision: February 2, 2023
Revised: February 11, 2023
Accepted: March 24, 2023
Article in press: March 24, 2023
Published online: April 28, 2023
The management of older adults with acute severe ulcerative colitis (ASUC) is uniquely challenging due to their numerous medical and social factors. Up to 20% of patients with ulcerative colitis have late-onset disease with their first flare occurring after the age of 60.
There is minimal data available on the outcomes of older adults with ASUC. Previous studies report higher treatment failure rates in older adults who are commenced on their first biologic. We planned this study to define both short and long term outcomes for this cohort and determine if they have similar outcomes compared to the younger cohort.
We aimed to determine the steroid non-response rates for older adults with ASUC during index admission. We also aimed to study their response to medical rescue therapy and colectomy rates up to 12 mo from initial presentation.
We conducted a retrospective cohort study investigating the short and long term outcomes among 226 ASUC episodes between January 2013 and July 2020 at two tertiary hospitals in Queensland, Australia. Clinical characteristics, laboratory parameters, and disease outcomes, including mortality, were compared between older and younger adults. A modified Poisson regression model was used for analysis.
The prevalence of older adults with ASUC was 19.9%. Steroid non-response rate in older adults were comparable to younger adults (42.2% vs 47%, P = 0.62). Response rates to medical rescue therapy was also comparable between the two groups (76.5% vs 85.7%, P = 0.46). Index admission colectomy (13.3% vs 10.5%, P = 0.60), colectomy at 3 mo (20% vs 16.6%, P = 0.66), and colectomy at 12 mo (20% vs 23.2%, P = 0.68) were also similar between the two groups.
Older adults with ASUC have similar outcomes compared to younger patients less than 60 years of age for rates of steroid non-response, medical rescue therapy, and colectomy at index admission, 3 and 12 mo.
Clinical decisions for older adults with ASUC remains to be a challenge however should still be determined by disease severity rather than chronological age alone. Future prospective studies will allow further improvement in their management.