Clinical Characteristics and Long-term Prognosis of Elderly-Onset Ulcerative Colitis in a Population-Based Cohort in the Songpa- Kangdong District of Seoul, Korea
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Background/Aims: We aimed to evaluate the clinical characteristics and long-term prognosis of elderly-onset ulcerative colitis (EOUC) in Korean patients over a 30-year period using a wellestablished population-based cohort in the Songpa-Kangdong district of Seoul, Korea. Methods: Clinical characteristics and prognosis were compared between two groups: EOUC, defined as UC diagnosed in individuals aged ≥60 years and non-EOUC (N-EOUC), defined as UC diagnosed in individuals aged 18 to 59 years. Results: We identified 99 patients with EOUC (10.3%) and 866 patients with N-EOUC (89.7%) between 1986 and 2015. During the median follow-up of 104.5 months, the overall exposure to medications was comparable between patients with EOUC and N-EOUC (p=0.091 for corticosteroids, p=0.794 for thiopurines, and p=0.095 for anti-tumor necrosis factor agents). The cumulative risks of disease outcomes were also comparable between patients with EOUC and N-EOUC (22.4% vs 30.4% for proximal disease extension [p=0.351], 11.9% vs 18.1% for hospitalization [p=0.240], and 2.3% vs 1.8% for colectomy [p=0.977]) at 10 years after diagnosis. Multivariate Cox regression analysis revealed that corticosteroid use at diagnosis was an independent predictor of proximal disease extension (hazard ratio [HR], 6.216; 95% confidence interval [CI], 1.314 to 28.826) and hospitalization (HR, 11.241; 95% CI, 3.027 to 41.742) in patients with EOUC. Conclusions: In this population-based study from Korea, the pattern of medication use seemed comparable between the EOUC and N-EOUC groups. Moreover, patients with EOUC and those with N-EOUC have a similar disease course in terms of proximal disease extension, hospitalization, and colectomy.
Abstract
Background/Aims: We aimed to evaluate the clinical characteristics and long-term prognosis of elderly-onset ulcerative colitis (EOUC) in Korean patients over a 30-year period using a wellestablished population-based cohort in the Songpa-Kangdong district of Seoul, Korea. Methods: Clinical characteristics and prognosis were compared between two groups: EOUC, defined as UC diagnosed in individuals aged ≥60 years and non-EOUC (N-EOUC), defined as UC diagnosed in individuals aged 18 to 59 years. Results: We identified 99 patients with EOUC (10.3%) and 866 patients with N-EOUC (89.7%) between 1986 and 2015. During the median follow-up of 104.5 months, the overall exposure to medications was comparable between patients with EOUC and N-EOUC (p=0.091 for corticosteroids, p=0.794 for thiopurines, and p=0.095 for anti-tumor necrosis factor agents). The cumulative risks of disease outcomes were also comparable between patients with EOUC and N-EOUC (22.4% vs 30.4% for proximal disease extension [p=0.351], 11.9% vs 18.1% for hospitalization [p=0.240], and 2.3% vs 1.8% for colectomy [p=0.977]) at 10 years after diagnosis. Multivariate Cox regression analysis revealed that corticosteroid use at diagnosis was an independent predictor of proximal disease extension (hazard ratio [HR], 6.216; 95% confidence interval [CI], 1.314 to 28.826) and hospitalization (HR, 11.241; 95% CI, 3.027 to 41.742) in patients with EOUC. Conclusions: In this population-based study from Korea, the pattern of medication use seemed comparable between the EOUC and N-EOUC groups. Moreover, patients with EOUC and those with N-EOUC have a similar disease course in terms of proximal disease extension, hospitalization, and colectomy.
참고문헌 (31)
- Ungaro R, "Ulcerative colitis", Lancet, 389, pp.1756~1770 (2017)
- Aniwan S, "Epidemiology, natural history, and risk stratification of Crohn's disease", Gastroenterol Clin North Am, 46, pp.463~480 (2017)
- Coward S, "Past and future burden of inflammatory bowel diseases based on modeling of population-based data", Gastroenterology, 156, pp.1345~1353 (2019)
- Park SH, "A 30-year trend analysis in the epidemiology of inflammatory bowel disease in the Songpa-Kangdong district of Seoul, Korea in 1986-2015", J Crohns Colitis, 13, pp.1410~1417 (2019)
- Lapidus A, "Incidence of Crohn's disease in Stockholm County 1955-1989", Gut, 41, pp.480~486 (1997)
- Benchimol EI, "Changing age demographics of inflammatory bowel disease in Ontario, Canada : a population-based cohort study of epidemiology trends", Inflamm Bowel Dis, 20, pp.1761~1769 (2014)
- Jeuring SF, "Epidemiology and long-term outcome of inflammatory bowel disease diagnosed at elderly age-an increasing distinct entity?", Inflamm Bowel Dis, 22, pp.1425~1434 (2016)
- Ananthakrishnan AN, "Systematic review and meta-analysis : phenotype and clinical outcomes of older-onset inflammatory bowel disease", J Crohns Colitis, 10, pp.1224~1236 (2016)
- Gisbert JP, "Systematic review with metaanalysis : inflammatory bowel disease in the elderly", Aliment Pharmacol Ther, 39, pp.459~477 (2014)
- Borren NZ, "Safety of biologic therapy in older patients with immune-mediated diseases : a systematic review and meta-analysis", Clin Gastroenterol Hepatol, 17, pp.1736~1743 (2019)
- Lewis JD, "Increased mortality rates with prolonged corticosteroid therapy when compared with antitumor necrosis factor-α-directed therapy for inflammatory bowel disease", Am J Gastroenterol, 113, pp.405~417 (2018)
- Mañosa M, "Phenotype and natural history of elderly onset inflammatory bowel disease : a multicentre, case-control study", Aliment Pharmacol Ther, 47, pp.605~614 (2018)
- Song EM, "Clinical characteristics and long-term prognosis of elderly onset ulcerative colitis", J Gastroenterol Hepatol, 33, pp.172~179 (2018)
- Zammarchi I, "Elderly-onset vs adult-onset ulcerative colitis: a different natural history?", BMC Gastroenterol, 20, pp.147~ (2020)
- Shi HY, "Natural history of elderly-onset ulcerative colitis : results from a territorywide inflammatory bowel disease registry", J Crohns Colitis, 10, pp.176~185 (2016)
- Mak JWY, "Epidemiology and natural history of elderly-onset inflammatory bowel disease : results from a territory-wide Hong Kong IBD registry", J Crohns Colitis, 15, pp.401~408 (2021)
- Rozich JJ, "Progression of elderly onset inflammatory bowel diseases : a systematic review and meta-analysis of population-based cohort studies", Clin Gastroenterol Hepatol, 18, pp.2437~2447 (2020)
- Charpentier C, "Natural history of elderly-onset inflammatory bowel disease : a populationbased cohort study", Gut, 63, pp.423~432 (2014)
- Lakatos PL, "IBD in the elderly population : results from a population-based study in Western Hungary, 1977-2008", J Crohns Colitis, 5, pp.5~13 (2011)
- Loftus EV Jr, "Ulcerative colitis in Olmsted County, Minnesota, 1940-1993 : incidence, prevalence, and survival", Gut, 46, pp.336~343 (2000)
- Cha JM, "Long-term prognosis of ulcerative colitis and its temporal changes between 1986 and 2015 in a population-based cohort in the Songpa-Kangdong district of Seoul, Korea", Gut, 69, pp.1432~1440 (2020)
- Burisch J, "Natural disease course of ulcerative colitis during the first five years of follow-up in a European population-based inception cohort-an Epi-IBD study", J Crohns Colitis, 13, pp.198~208 (2019)
- Jeuring SF, "Improvements in the long-term outcome of Crohn's disease over the past two decades and the relation to changes in medical management : results from the population-based IBDSL Cohort", Am J Gastroenterol, 112, pp.325~336 (2017)
- Choon Jin Ooi, "Best practices on immunomodulators and biologic agents for ulcerative colitis and Crohn’s disease in Asia", Intestinal research, 17(3), pp.285~310 (2019), 대한장연구학회[DOI]
- Alexakis C, "Do thiopurines reduce the risk of surgery in elderly onset inflammatory bowel disease? A 20-year national populationbased cohort study", Inflamm Bowel Dis, 23, pp.672~680 (2017)
- Everhov ÅH, "Incidence and treatment of patients diagnosed with inflammatory bowel diseases at 60 years or older in Sweden", Gastroenterology, 154, pp.518~528 (2018)
- Fung BM, "Ethnoracial, geographic, and socioeconomic disparities and variations in inflammatory bowel disease", Clin Gastroenterol Hepatol, 16, pp.1176~1177 (2018)
- Singh S, "Early combined immunosuppression may be effective and safe in older patients with Crohn's disease : post hoc analysis of REACT", Aliment Pharmacol Ther, 49, pp.1188~1194 (2019)
- Cheng D, "Safety and efficacy of tumor necrosis factor antagonists in older patients with ulcerative colitis : patient-level pooled analysis of data from randomized trials", Clin Gastroenterol Hepatol, 19, pp.939~946 (2021)
- Kochar B, "Pretreatment frailty is independently associated with increased risk of infections after immunosuppression in patients with inflammatory bowel diseases", Gastroenterology, 158, pp.2104~2111 (2020)
- Thia KT, "An update on the epidemiology of inflammatory bowel disease in Asia", Am J Gastroenterol, 103, pp.3167~3182 (2008)