99 Inflammatory Bowel Disease in Eldery Patients: Epidemiology and Clinical Characteristics in a Tertiary Brazilian Public Hospital

Background: Inflammatory bowel diseases (IBD) are chronic, immune-mediated conditions associated with substantial morbidity and significant economic burden on healthcare systems. The epidemiological landscape of IBD is evolving, characterized by a rising incidence in developing regions and a growing proportion of elderly patients. The management of IBD in this subpopulation poses unique challenges, spanning from accurate diagnosis to therapeutic decision-making, as older individuals often present with multiple comorbidities and an increased susceptibility to infections and malignancies. Methods: A retrospective observational study included all patients with Crohn’s disease (CD) or ulcerative colitis (UC) followed since 2010 at a specialized IBD clinic in a tertiary hospital in Brazil, aged 60 years or older. Results: A total of 382 patients with IBD and age ≥60 years were included, 66.5% were female. The mean age was 70.2 years, whereas the mean age at diagnosis of IBD was 46.5 years. Notably, 13.6% of the patients in this cohort had a late-onset IBD, first presenting at an age of ≥60 years. Mean duration of disease (UC or CD) was 23.7 (SD 10.2) years. Most patients (55%) had a diagnosis of CD, of whom 65.7% presented with a more aggressive phenotype, characterized by either stenosing or fistulizing behavior (B2 or B3, according to the Montreal classification), and 20.9% had perianal disease. Patients with phenotypes B2/B3 had a significantly higher rate of surgical intervention compared to those with an inflammatory (B1) phenotype (71.7% vs 18.3%, respectively; P < 0.0001). Seventy-six percent of patients with CD were exposed to biologic therapy. Anti-TNF agents were the predominant class, used by 78.1% of them, while vedolizumab was used by 20%. On the other hand, in the UC cohort, most patients presented with pancolitis (57.5%), but exposure to immunobiologic therapy was only noted in 33.7% (29.6% received anti-TNFs and 15.1% were treated with vedolizumab). Seventy-eight patients (20.4%) developed a malignancy while treating for IBD. Among those, 71.8% were treated with immunobiologics and/or immunosuppressive therapies. In this cohort, neither a longer disease duration (>20 years) nor smoking history were found to be significantly associated with an increased risk of neoplasia (respectively, 19.8% vs 21.3%; P = 0.82 and 19.7% vs 20.9%; P = 0.88). Of note, opportunistic infections were reported in 52 individuals (13.6%), of whom 43 (82.7%) had been exposed to advanced therapies. Treatment with immunosuppressants or biologics was significantly associated with a higher risk of opportunistic infections (16.9% vs 4% for patients on other therapies; P = 0.0021). However, no such association was observed for neoplasia (19.8% vs 22%; P = 0.7431). Conclusions: The rising prevalence of elderly patients with inflammatory bowel disease (IBD) reflects evolving epidemiological trends and poses distinct clinical challenges. A comprehensive understanding of the demographic characteristics, therapeutic approaches, and clinical outcomes in this population is crucial to guide management strategies and enhance patient safety. Although the use of advanced therapies in older adults carries potential risks, these treatments are frequently required to achieve adequate disease control, particularly in individuals with an aggressive disease course.