The Positive Influences of Increasing Age at Diagnosis of Inflammatory Bowel Disease on Disease Prognostication in Asian Perspective

Abstract

confounded by differences in disease location and duration when compared with younger patients. For the UC, Ha CY et al. revealed that patients with earlyonset (18−30 years old) and late-onset (>50 years old) have similar initial clinical presentations, but differ in disease risk factors. The late-onset UC patients have significantly achieved steroid-free clinical remission (64 vs. 49%; P=0.01) compared to the early-onset UC patients. In contrast, several other studies found no differences or similar response in clinical course and therapeutic responsiveness between younger and older patients presented with flare of UC. With the aging of the population globally, the incidence of late-onset CD and UC is expected to be increased. Currently, IBD in patients aged >60 accounts for 10−15% of cases of disease. Therefore, careful attention on the age of diagnosis of IBD is important for optimizing the therapy of IBD. To date, data on clinical course, therapeutic achievement and outcomes based on the Montreal Classification System in Asia are scarce. A retrospective large cohort study from the two tertiary referral centers in south-east Korea was used to compare clinical characteristic based on age at diagnosis according to Montreal Classification System. The authors found that the most common manifestation of IBD at diagnosis for old age group was haematochezia as opposed to abdominal pain for young patients. However, no difference was observed when patients were stratified into CD and UC. It is interesting to observe that in the sub-analysis of IBD cohort, there was no bimodal age distribution for CD cohort contrary to the western findings. The incidence and prevalence of ‘western disease’; an IBD is increasing steadily for the past 2−4 decades in Asia pacific region. Based on the western epidemiologic data of IBD, a bimodal age distribution for CD and UC is observed. An initial peak for CD and UC is in the third decade whereas the second peak is between the ages of 40 to 70 years old. IBD experts in western countries have experienced for many decades in various clinical spectrum of IBD. However, the knowledge of the influence and impact of age on the clinical course, prognostication and therapeutic achievement in patients with CD and UC is conflicting, limited and not well defined. Prior studies have identified specific differences between early-onset and adult-onset CD that may indicate the earlyonset disease represents a more severe form. The French IBD database had demonstrated that early-onset CD (<16 years old) were more likely to be considered to have active disease, higher cumulative risk of thiopurine and anti-tumour necrosis factor agent use than adult-onset CD. The study also highlighted that despite the rate of smoking being less, early-onset CD was more active, was treated more aggressively with medications as compared to adult-onset CD patients. Quezada SM et al. have shown that in their CD cohort, old age patients were

DOI: 10.5217/ir.2015.13.1.4

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Cite this paper

@inproceedings{Ali2015ThePI, title={The Positive Influences of Increasing Age at Diagnosis of Inflammatory Bowel Disease on Disease Prognostication in Asian Perspective}, author={Raja Affendi Raja Ali}, booktitle={Intestinal research}, year={2015} }