Clinical profiles and management strategies in older adults with mild-to-moderate ulcerative colitis: a multicenter, comparative, real-world study

Background/Aims: The growing prevalence of mild-to-moderate ulcerative colitis (UC) among elderly individuals ( ≥60 years) poses unique clinical challenges due to age-related vulnerabilities, while real-world evidence on outpatient management and age-based differences remains limited. Methods: This multicenter cross-sectional study recruited 429 patients with mild-to-moderate UC from 47 inflammatory bowel disease centers. A Delphi-developed questionnaire was applied to assess clinical profiles and medication adherence. All statistical analyses were performed using R 4.5.0, with P-value < 0.05 set as the significance level. Results: Older patients had a longer median disease duration (6.0 years vs. 4.0 years; P= 0.001) and a higher proportion with moderate disease activity (60.4% vs. 51.8%; P= 0.029) compared with non-older patients. Diagnostic efficiency, disease extent, and extraintestinal manifestations did not differ between groups. Use of 5-aminosalicylic acid (5-ASA) remained the first-line therapy in both groups, with lower corticosteroid use among older patients (8.8% vs. 16.2%; P= 0.035). Older patients reported higher satisfaction with 5-ASA across several care domains (P= 0.019). Medication adherence was similar across age groups, and adherence analysis identified switching to biologics (odds ratio [OR], 0.31; P= 0.001), 3-4 physician visits for diagnosis (OR, 0.60; P= 0.048), and greater long-term efficacy satisfaction (OR, 0.64; P= 0.049) were associated with better adherence. Conclusions: Older adults with mild-to-moderate UC demonstrate distinct clinical phenotypes and divergent treatment priorities. Timely therapeutic escalation, the diagnostic process, and perceived treatment effectiveness are closely associated with medication adherence. These findings highlight the need for age-adapted management strategies in elderly UC patients.