Subhaharan D, Ramaswamy PK, Willmann L, Moattar H, Bhullar M, Ishaq N, Dorrington A, Shukla D, McIvor C, Edwards J, Mohsen W. Older adults with acute severe ulcerative colitis have similar steroid non-response and colectomy rates as younger adults. World J Gastroenterol 2023; 29(16): 2469-2478 [PMID: 37179589 DOI: 10.3748/wjg.v29.i16.2469]
Corresponding Author of This Article
Deloshaan Subhaharan, MD, Doctor, Department of Digestive Diseases, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Gold Coast 4215, Queensland, Australia. deloshaan.subhaharan@health.qld.gov.au
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
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/
World J Gastroenterol. Apr 28, 2023; 29(16): 2469-2478 Published online Apr 28, 2023. doi: 10.3748/wjg.v29.i16.2469
Older adults with acute severe ulcerative colitis have similar steroid non-response and colectomy rates as younger adults
Deloshaan Subhaharan, Pradeep Kakkadasam Ramaswamy, Laura Willmann, Hadi Moattar, Maneesha Bhullar, Naveed Ishaq, Alexander Dorrington, Dheeraj Shukla, Carolyn McIvor, John Edwards, Waled Mohsen
Deloshaan Subhaharan, Pradeep Kakkadasam Ramaswamy, Laura Willmann, Hadi Moattar, Maneesha Bhullar, Naveed Ishaq, Alexander Dorrington, Dheeraj Shukla, John Edwards, Waled Mohsen, Department of Digestive Diseases, Gold Coast University Hospital, Gold Coast 4215, Queensland, Australia
Carolyn McIvor, Department of Gastroenterology, Logan Hospital, Logan 4131, Queensland, Australia
Author contributions: Subhaharan D, Ramaswamy PK and Mohsen W designed the study and performed data analysis; Subhaharan D, Ramaswamy PK, Willmann L, Moattar H, Bhullar M, Ishaq N, Dorrington A, Shukla D, McIvor C, Edwards J, and Mohsen W performed literature review and manuscript writing; and all authors have read and approve the final manuscript.
Institutional review board statement: The study was approved by the Gold Coast Health Service Human Research Ethics Committee (Ref: LNR/2020/QGC/67173).
Informed consent statement: Due to the retrospective design of the study, the requirement for informed consent was waived by the Institutional Review Board.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Deloshaan Subhaharan, MD, Doctor, Department of Digestive Diseases, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Gold Coast 4215, Queensland, Australia. deloshaan.subhaharan@health.qld.gov.au
Received: November 15, 2022 Peer-review started: November 15, 2022 First decision: February 2, 2023 Revised: February 11, 2023 Accepted: March 24, 2023 Article in press: March 24, 2023 Published online: April 28, 2023 Processing time: 160 Days and 10.6 Hours
ARTICLE HIGHLIGHTS
Research background
The management of older adults with acute severe ulcerative colitis (ASUC) is uniquely challenging due to their numerous medical and social factors. Up to 20% of patients with ulcerative colitis have late-onset disease with their first flare occurring after the age of 60.
Research motivation
There is minimal data available on the outcomes of older adults with ASUC. Previous studies report higher treatment failure rates in older adults who are commenced on their first biologic. We planned this study to define both short and long term outcomes for this cohort and determine if they have similar outcomes compared to the younger cohort.
Research objectives
We aimed to determine the steroid non-response rates for older adults with ASUC during index admission. We also aimed to study their response to medical rescue therapy and colectomy rates up to 12 mo from initial presentation.
Research methods
We conducted a retrospective cohort study investigating the short and long term outcomes among 226 ASUC episodes between January 2013 and July 2020 at two tertiary hospitals in Queensland, Australia. Clinical characteristics, laboratory parameters, and disease outcomes, including mortality, were compared between older and younger adults. A modified Poisson regression model was used for analysis.
Research results
The prevalence of older adults with ASUC was 19.9%. Steroid non-response rate in older adults were comparable to younger adults (42.2% vs 47%, P = 0.62). Response rates to medical rescue therapy was also comparable between the two groups (76.5% vs 85.7%, P = 0.46). Index admission colectomy (13.3% vs 10.5%, P = 0.60), colectomy at 3 mo (20% vs 16.6%, P = 0.66), and colectomy at 12 mo (20% vs 23.2%, P = 0.68) were also similar between the two groups.
Research conclusions
Older adults with ASUC have similar outcomes compared to younger patients less than 60 years of age for rates of steroid non-response, medical rescue therapy, and colectomy at index admission, 3 and 12 mo.
Research perspectives
Clinical decisions for older adults with ASUC remains to be a challenge however should still be determined by disease severity rather than chronological age alone. Future prospective studies will allow further improvement in their management.
