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Treatment of Inflammatory Bowel Disease in the Elderly

An Update

  • Therapy In Practice
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Abstract

Inflammatory bowel disease (IBD) is most common in young adults, but it can also present in the elderly. Furthermore, with the aging of the population, the number of elderly patients with IBD is expected to grow. Other conditions, such as diverticulitis and ischaemic colitis, may be more common in the elderly and need to be considered in the differential diagnosis. Management of elderly patients with IBD follows the same principles as in younger patients, with a few exceptions.

For patients with mild-to-moderate colitis, a 5-aminosalicylate drug is often used (sulfasalazine, olsalazine, mesalazine, balsalazide). Topical therapy may be sufficient for those with distal colitis, whereas an oral preparation is used for more extensive disease. In those with more severe or refractory symptoms, corticosteroids are used, although the elderly appear to be at increased risk for corticosteroid-associated complications. For patients with corticosteroid-dependent or corticosteroid-refractory disease, immunosuppression with azathioprine or mercaptopurine may help avoid surgery. In patients with Crohn’s disease, a similar approach is followed, with the additional consideration that the formulation of drug used must ensure delivery of drug to the site of inflammation. In fistulising Crohn’s disease, antibacterials, immunosuppressive drugs, infliximab and surgery are often used in combination. Controlled trials and clinical experience have shown that infliximab is a significant addition to the therapeutic armamentarium for patients with Crohn’s disease.

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Notes

  1. Use of the registered name is for identification purposes only and does not imply endorsement.

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Acknowledgements

Dr. M. Camilleri is supported by grants RO1 DK54681-2 and K24 DK02638-2 from the US National Institutes of Health.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Mayo Clinic and Foundation, Rochester, Minnesota, USA

    Darrell S. Pardi, Edward V. Loftus Jr & Michael Camilleri

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  1. Darrell S. Pardi
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  2. Edward V. Loftus Jr
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  3. Michael Camilleri
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Correspondence to Darrell S. Pardi.

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Pardi, D.S., Loftus, E.V. & Camilleri, M. Treatment of Inflammatory Bowel Disease in the Elderly. Drugs Aging 19, 355–363 (2002). https://doi.org/10.2165/00002512-200219050-00004

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