P0746 - Distinct Phenotypic and Treatment Differences in Late Onset Inflammatory Bowel Disease: A Large Population-Based Study

Osama Hamid, MD, MRCPI¹, Khaled Alsabbagh Alchirazi, MD¹, Ahmed Eltelbany, MD, MPH¹, Rama Nanah, MD¹, Khalid K. Ahmed, MD², Miguel Regueiro, MD^3
1Cleveland Clinic, Cleveland, OH; ²The Wright Center for GME, Scranton, PA; ³Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH

Introduction: Inflammatory bowel disease (IBD) exhibits a bimodal distribution. Prevalence of IBD among elderly people is gradually increasing at a rate of 5.2% per year. Thus, our aim is to investigate the characteristics associated with late onset IBD

Methods: Using TriNetX, a multi-institutional database, we identified IBD patients and categorized into 2 groups based on age of disease onset: patients between 10 and 30 yrs old as young onset and those diagnosed after the age of 60 as late onset. Within each group, we identified demographics, IBD symptoms, phenotype, extraintestinal manifestations and IBD medications. We conducted 1:1 propensity score matching for gender and race to assess IBD outcomes. Kaplan-Meier survival analysis is used to calculate 20-year survival rate. Adjusted odds ratios (aOR) with 95% confidence interval were calculated for the risk of each variable.

Results: A total of 573,025 IBD patients were identified, of which 323,498 (56.4%) had young onset IBD vs 83,372 (14.5%) had late onset IBD. Majority in both groups were white, with more noted in late onset cohort (81% vs 71.1%). African Americans were more likely to develop IBD early (9.7% vs. 5.9%), and similarly is Hispanics (4.9% vs. 2.1%). Both groups had a comparable pattern of abdominal pain and diarrhea, but late onset group had higher weight loss (15.2% vs. 11%), anemia (21.3% vs. 9.1%) and malnutrition (11.8% vs. 5.2%), all p < 0.001. Phenotypically, young onset IBD showed more UC pancolitis (12.2% vs 9.9%), while UC proctitis was more common in late onset group (5.3% vs 3.8%), p< 0.01. Young onset CD was more likely to involve both small and large bowel (19.2% vs 6.9%), p< 0.001. When examining medication patterns, late onset group are more likely to receive 5-ASA (16% vs 9.2%), whereas young onset group was more likely to receive biologics (17.8% vs 10.1%), p< 00.1. Late onset group had higher rates of cholangiocarcinoma (aOR 2.25 [1.89-2.67]), colorectal carcinoma (aOR 2.87 [2.65-3.09]), C-diff (aOR 1.26 [1.11-1.41]) and osteoporosis (aOR 5.48 [5.08-5.89]), Figure 1. All-cause mortality was higher in the late onset group (HR 5.63 [5.43-5.85]), Figure 2.

Discussion: Compared to young onset IBD, late onset IBD patients present with more limited disease and receive 5-ASA therapy more than biologics. The rates of IBD related cancers are higher in late onset patients. Awareness of differences in late onset IBD phenotypes and presentation is important in managing the increasing number of newly diagnosed elderly patients.




Disclosures:


Osama Hamid, MD, MRCPI¹, Khaled Alsabbagh Alchirazi, MD¹, Ahmed Eltelbany, MD, MPH¹, Rama Nanah, MD¹, Khalid K. Ahmed, MD², Miguel Regueiro, MD³. P0746 - Distinct Phenotypic and Treatment Differences in Late Onset Inflammatory Bowel Disease: A Large Population-Based Study, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.