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Copyright ©2011 Baishideng Publishing Group Co.
World J Gastroenterol. Jun 14, 2011; 17(22): 2734-2739
Published online Jun 14, 2011. doi: 10.3748/wjg.v17.i22.2734
Table 1 Differential diagnostic of colitis in patients older than 60 years
DiseaseClinical characteristicsEndoscopic findings
Colitis associated to diverticulosisRectal bleeding, abdominal pain, diarrheaSegmentary distribution, peridiverticular, sigma affected, rectum and proximal colon are normal
Ischemic colitisAbdominal pain rectorragia acute onsetSegmentary colitis (sigma/left colitis), majority are non-obstructive
Microscopic colitisWatery diarrhea, no rectal bleeding, no fever, frequent cause of diarrhea in the elderyNormal endoscopy, multiple biopsies from colon, celiac disease association
Infectious colitisDisenteriforme diarrhea, different agents, C.difficile to be ruled outDifuse effects on the colon Increased morbidity and mortality in older-aged population
NSAIDs colitisRecurrent abdominal pain; obstruction, perforation, hemorrhage; chronic anemiaAny part of the intestine, isolated lesions, aggravate previous UC and CD
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