A study in a general population, carried out by the EPIMAD registry between 1988 and 2006, has shed some light on the natural history of these diseases. This age bracket represents 12% of all cases of ulcerative colitis (UC) and 6% of cases of Crohn's disease (CD) diagnosed during that period, with a median age at diagnosis of 69 for UC and 70 for CD. The median diagnosis delay is identical to that observed for the rest of the population. The mean duration of follow-up is 6 years.

For UC, the initial localization in 29% of cases was limited to the rectum (stage E1) (as in children), while in 45% of cases it did not reach beyond the left angle (E2) and in 26% of cases it attained the entire colon (E3).

The topography of the lesions showed very little evolution over time in these patients; indeed, 85% of stages E1 and E2 remained identical.

After ten years of evolution, 40% of patients had been given cortiocotherapy, 16% had received immunosuppressors, 2% received biotherapy and 8% of patients benefitted from surgical treatment (colectomy).

More fine-tuned analysis showed that corticoid treatment in the first month following diagnosis significantly increased the risk of need for surgery.

For CD, the colon was the most frequent site (90% of cases) with a higher frequency of anal fistula. As was the case for UC, but even more strikingly, there existed an absence of extension of the lesions over time (in 95% of patients). 8% of patients presented ano-perineal lesions at the time of diagnosis, with this figure reaching 17% at the end of follow-up.

After 10 years of evolution, half of the patients had been given corticoids, 27% had received immunosuppressors, 9% had undergone biotherapy and one out of 3 had undergone intestinal resection.

In conclusion, and contrary to the rest of the population, older subjects show more frequent UC, the colon is most often involved and the disease evolves very little with time.

References

UEGW, May 2012