Published online Aug 14, 2019. doi: 10.3748/wjg.v25.i30.4158
Peer-review started: April 19, 2019
First decision: June 10, 2019
Revised: June 27, 2019
Accepted: July 2, 2019
Article in press: July 3, 2019
Published online: August 14, 2019
Processing time: 120 Days and 10.2 Hours
High-quality data remains scarce in terms of optimal management strategies in the elderly inflammatory bowel disease (IBD) population. Indeed, available trials have been mostly retrospective, of small sample size, likely owing to under-representation of such a population in the major randomized controlled trials. However, in the last five years, there has been a steady increase in the number of published trials, helping clarify the estimated benefits and toxicity of the existing IBD armamentarium. In the Everhov trial, prescription strategies were recorded over an average follow-up of 4.2 years. A minority of elderly IBD patients (1%-3%) were treated with biologics within the five years following diagnosis, whilst almost a quarter of these patients were receiving corticosteroid therapy at year five of follow-up, despite its multiple toxicities. The low use of biologic agents in real-life settings likely stems from limited data suggesting lower efficacy and higher toxicity. This minireview will aim to highlight current outcome measurements as it portends the elderly IBD patient, as well as summarize the available therapeutic strategies in view of a growing body of evidence.
Core tip: Two types of inflammatory bowel disease (IBD) exist in the elderly (patients aged 60 or over): adult-onset vs elderly-onset. Disease phenotypes, outcomes and drug regimens may change based on the type of IBD. Recently, population-based trials have suggested increased corticosteroid use and decreased utilization of biologic agents in the elderly IBD population compared to their younger counterparts, likely owing to the perceived high rates of infections and malignancy from anti-tumor necrosis factor (TNF) agents. This article reviews the current available literature on the management of inflammatory bowel disease in the elderly patients, including anti-TNF agents, anti-integrin molecules, anti-interleukin 12/23 agents and IBD-related surgeries.