Old-age inflammatory bowel disease onset: A different problem?

Table 1 Differential diagnostic of colitis in patients older than 60 years

Disease	Clinical characteristics	Endoscopic findings
Colitis associated to diverticulosis	Rectal bleeding, abdominal pain, diarrhea	Segmentary distribution, peridiverticular, sigma affected, rectum and proximal colon are normal
Ischemic colitis	Abdominal pain rectorragia acute onset	Segmentary colitis (sigma/left colitis), majority are non-obstructive
Microscopic colitis	Watery diarrhea, no rectal bleeding, no fever, frequent cause of diarrhea in the eldery	Normal endoscopy, multiple biopsies from colon, celiac disease association
Infectious colitis	Disenteriforme diarrhea, different agents, C.difficile to be ruled out	Difuse effects on the colon Increased morbidity and mortality in older-aged population
NSAIDs colitis	Recurrent abdominal pain; obstruction, perforation, hemorrhage; chronic anemia	Any part of the intestine, isolated lesions, aggravate previous UC and CD

NSAIDs: Non-steroid anti-inflammatory drugs; UC: Ulcerative colitis; CD: Crohn’s disease.

Table 2 Summary of inflammatory bowel disease onset in the elderly

Home messages
10%-15% patients with inflammatory bowel disease > 60 years
12% UC patients
16% CD patients
Differential diagnosis with colitis associated to diverticulosis, ischemic colitis, infectious colitis (C.difficile)
Ulcerative colitis: proctitis/left colitis is more frequent
CD: Granulomatous colitis > frequent than ileocecal
Medical treatment
Same treatment options as younger patients
Increased rate of complications with steroids
Similar response, but recurrence less frequent
Surgery: Equal indications, ileoanal reservoir is secure
More hospitalizations
Similar mortality, increased in hospitalized patients, comorbidity

UC: Ulcerative colitis; CD: Crohn’s disease.