Review
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. Feb 6, 2016; 7(1): 51-65
Published online Feb 6, 2016. doi: 10.4292/wjgpt.v7.i1.51
Elderly patients and inflammatory bowel disease
Danielle Nimmons, Jimmy K Limdi
Danielle Nimmons, Jimmy K Limdi, Inflammatory Bowel Diseases Section, The Pennine Acute Hospitals NHS Trust, Manchester BL97TD, United Kingdom
Jimmy K Limdi, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, University of Manchester, Manchester M13 9PT, United Kingdom
Author contributions: Nimmons D and Limdi JK wrote the paper.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jimmy K Limdi, FRCP (London and Edin), FEBGH, AGAF, FACG, Consultant Gastroenterologist and Clinical Lead (Inflammatory Bowel Diseases), Inflammatory Bowel Diseases Section, The Pennine Acute Hospitals NHS Trust, Manchester BL97TD, United Kingdom. jimmy.limdi@pat.nhs.uk
Telephone: +44-0161-7782642 Fax: +44-0161-7782659
Received: May 20, 2015
Peer-review started: June 9, 2015
First decision: August 31, 2015
Revised: November 27, 2015
Accepted: December 13, 2015
Article in press: December 14, 2015
Published online: February 6, 2016
Abstract

The incidence and prevalence of inflammatory bowel disease (IBD) is increasing globally. Coupled with an ageing population, the number of older patients with IBD is set to increase. The clinical features and therapeutic options in young and elderly patients are comparable but there are some significant differences. The wide differential diagnosis of IBD in elderly patients may result in a delay in diagnosis. The relative dearth of data specific to elderly IBD patients often resulting from their exclusion from pivotal clinical trials and the lack of consensus guidelines have made clinical decisions somewhat challenging. In addition, age specific concerns such as co-morbidity; loco-motor and cognitive function, poly-pharmacy and its consequences need to be taken into account. In applying modern treatment paradigms to the elderly, the clinician must consider the potential for more pronounced adverse effects in this vulnerable group and set appropriate boundaries maximising benefit and minimising harm. Meanwhile, clinicians need to make personalised decisions but as evidence based as possible in the holistic, considered and optimal management of IBD in elderly patients. In this review we will cover the clinical features and therapeutic options of IBD in the elderly; as well as addressing common questions and challenges posed by its management.

Keywords: Inflammatory bowel disease, Crohn’s disease, Ulcerative colitis, Elderly, Therapy, Clinical features

Core tip: Inflammatory bowel disease can be mis-diagnosed as its clinical features are similar in younger and elderly patients. Therapeutic regimes may be different with elderly patients being less likely to have immunosuppressant drugs and Anti-TNF’s either driven by clinican or patient preference and disease related factors. Important factors such as polypharmacy and co-morbidity must also be considered when making clinical decisions. Finally, complications may be more common in the elderly. Further evidence through clinical trials and consensus guidelines are needed to assist clinicians in making evidence based decisions in these patients.