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World J Gastroenterol. May 28, 2008; 14(20): 3183-3187
Published online May 28, 2008. doi: 10.3748/wjg.14.3183
Retrospective analysis of old-age colitis in the Dutch inflammatory bowel disease population
Muhammed Hadithi, Marcel Cazemier, Gerrit A Meijer, Elisabeth Bloemena, Richel J Felt-Bersma, Chris J Mulder, Stephan GM Meuwissen, Amado Salvador Peña, Adriaan A van Bodegraven
Muhammed Hadithi, Marcel Cazemier, Richel J Felt-Bersma, Chris J Mulder, Stephan GM Meuwissen, Adriaan A van Bodegraven, Department of Gastroenterology, VUmc University Medical Center, Amsterdam, PO Box 7057, Amsterdam 1007 MB, The Netherlands
Gerrit A Meijer, Elisabeth Bloemena, Amado Salvador Peña, Department of Pathology, VUmc University Medical Center, Amsterdam, PO Box 7057, Amsterdam 1007 MB, The Netherlands
Author contributions: All authors contributed equally to this article.
Correspondence to: Adriaan A van Bodegraven, Department of Gastroenterology, VUmc University Medical Center, Amsterdam, PO Box 7057, Amsterdam 1007 MB, The Netherlands. v.bodegraven@vumc.nl
Telephone: +31-20-4440613
Fax: +31-20-4440554
Received: December 25, 2007
Revised: March 16, 2008
Accepted: March 23, 2008
Published online: May 28, 2008
Abstract

AIM: To describe the characteristics of Dutch patients with chronic inflammatory bowel disease (IBD) first diagnosed above 60 years of age-a disease also known as old-age colitis (OAC) and to highlight a condition that has a similar appearance to IBD, namely segmental colitis associated with diverticular disease (SCAD).

METHODS: A retrospective longitudinal survey of patient demographic and clinical characteristics, disease characteristics, diagnostic methods, management and course of disease was performed. The median follow-up period was 10 years.

RESULTS: Of a total of 1100 IBD patients attending the Department of Gastroenterology, 59 (5%) [median age 82 years (range 64-101); 25 male (42%)] were identified. These patients were diagnosed with ulcerative colitis (n = 37, 61%), Crohn’s disease (n = 14, 24%), and indeterminate colitis (n = 8, 15%). Remission was induced in 40 (68%) patients within a median interval of 6 mo (range 1-21) and immunosuppressive therapy was well tolerated. Histological evaluation based on many biopsy samples and the course of the disease led to other diagnosis, namely SCAD instead of IBD in five (8%) patients.

CONCLUSION: OAC is not an infrequent problem for the gastroenterologist, and should be considered in the evaluation of older patients with clinical features suggestive of IBD. Extra awareness and extensive biopsy sampling are required in order to avoid an erroneous diagnosis purely based on histological mimicry of changes seen in SCAD, when diagnosing IBD in the presence of diverticulosis coli.

Keywords: Inflammatory bowel disease; Old-age colitis; Segmental colitis