Clinical Characteristics and Long-term Prognosis of Elderly-Onset Ulcerative Colitis in a Population-Based Cohort in the Songpa- Kangdong District of Seoul, Korea

Inflammatory bowel disease in Korea: epidemiology and pathophysiology

Inflammatory bowel disease (IBD) refers to a group of disorders, including Crohn's disease and ulcerative colitis, that exhibit similar but distinct manifestations. These diseases are characterized by refractory and chronic inflammation of the bowel. IBD is usually accompanied by severe symptoms. When a patient presents with suspected IBD, physicians encounter various challenges in terms of diagnosis and treatment. In addition, given such characteristics, the associated medical expenses gradually increase. Although IBD was formerly known as a disease of Western countries, the incidence and prevalence are increasing in Korea. Korean investigators have accumulated a great deal of knowledge about the regional characteristics and epidemiology of the disease, especially via well-organized, joint cohort studies. Against this background, this article describes the epidemiology of IBD in Korea compared to that in the West. In addition, an overview of the pathophysiology of the disease is provided, focusing on the latest results.

Ulcerative Colitis in Adulthood and in Older Patients: Same Disease, Same Outcome, Same Risks?

The number of patients with inflammatory bowel disease (IBD) approaching an older age, together with the number of over-60-year-old patients newly diagnosed with IBD, is steadily increasing, reaching 25% of all patients. The present review focuses on late-onset ulcerative colitis (UC) and its initial disease course in comparison with that observed in younger adults in terms of extension at onset and the risk of proximal disease progression, medical treatment, surgery and hospitalization in the first years after diagnosis. We summarize the clues pointing to a milder disease course in a population which frequently presents major frailty due to comorbidities. With increasing age and thus increasing comorbidities, medical and surgical therapies frequently represent a challenge for treating physicians. The response, persistence, and risks of adverse events of conventional therapies indicated for late onset/older UC patients are examined, emphasizing the risks in this particular population, who are still being treated with prolonged corticosteroid therapy. Finally, we concentrate on data on biotechnological agents for which older patients were mostly excluded from pivotal trials. Real-life data from newer agents such as vedolizumab and ustekinumab show encouraging efficacy and safety profiles in the population of older UC patients.

Rectal administration of Panax notoginseng and Colla Corii Asini suppositories in ulcerative colitis: clinical effect and influence on immune function

OBJECTIVE

This study was designed to evaluate the efficacy of rectal administration of different doses of Panax notoginseng and Colla Corii Asini (CCA) suppositories in the treatment of ulcerative colitis (UC) and the effect on immune function and recurrence.

METHODS

Totally 120 UC patients admitted to our hospital from February 2019 to February 2020 were enrolled and randomized into experimental group (n=60) and control group (n=60). The experimental group received rectal administration of a high dose of Panax notoginseng and CCA suppositories, while the control group received a low dose. After three months of treatment, clinical symptom scores, inflammatory factor levels, scores of rectal mucosa, immune function, recurrence rates, adverse reaction rates, and clinical efficacy were compared between the two groups.

RESULTS

After treatment, the experimental group obtained significantly lower clinical symptom scores, inflammatory factors, and scores of rectal mucosa than the control group (all P<0.001). The immune function of the observation group was significantly better than that of the control group (P<0.001). At 6, 8, and 12 months after treatment, the recurrence rates in the experimental group were all significantly lower than those in the control group (all P<0.001). The two groups showed no significant difference in the incidence of adverse reaction (P>0.05), and the experimental group obtained a higher clinical efficacy than the control group (P<0.001).

CONCLUSION

For patients with UC, the rectal administration of Panax notoginseng and CCA suppositories can exert positive effects on their inflammatory factors, immune functions, UC severity, clinical symptoms, and recovery. In addition, higher doses were associated with better effects without increased adverse events.

Clinical characteristics of ulcerative colitis in elderly patients

The incidence of ulcerative colitis (UC) in elderly patients is increasing. Elderly UC patients are likely to exhibit distinct features both at diagnosis and during follow-up. Age-related problems, including complications, immune dysfunction, and multidrug use, make the diagnosis and treatment of elderly UC more challenging. Suboptimal treatment considering adverse events leads to poor clinical outcome in elderly UC patients. Here, we reviewed the epidemiology, clinical presentation, medical therapy, colorectal cancer surveillance of UC in elderly patients.

The elderly IBD patient in the modern era: changing paradigms in risk stratification and therapeutic management

The incidence and prevalence of inflammatory bowel disease (IBD) is rising in the elderly population. Compared with patients with onset during their younger years, patients with elderly onset IBD have a distinct clinical presentation, disease phenotype, and natural history. Genetics contribute less to pathogenesis of disease, whereas biological changes associated with aging including immunosenescence, dysbiosis, and frailty have a greater impact on disease outcomes. With the advent of an increasingly wider array of biologic and small-molecule therapeutic options, data regarding efficacy and safety of these agents in elderly IBD patients specifically are paramount, given the unique characteristics of this population.

[Treatment of Inflammatory Bowel Disease in Elderly Patients - What Are Different and What Should We Know?]

As the incidence of inflammatory bowel disease (IBD) are increasing with an ageing population, the incidence and prevalence of IBD in the elderly continue to increase. Older IBD patients can be classified into two groups; elderly-onset IBD patients and elderly IBD patients who were diagnosed at a young age and transitioning into advanced age. Clinicians must consider elderly-onset specific phenotypes or prognosis and age-related concerns in the treatment of elderly IBD patients. There is a paucity of evidence whether there is a different disease process when IBD occurs in older age yet. Clinicians may expect similar therapeutic effects in older and younger patients in drug selection, but since older patients are often excluded from clinical trials, evidence to support this assumption is currently lacking. Also, the risk of side effects may be higher in elderly patients. Therefore, when making management decisions in the elderly, clinicians should assess an individual's frailty rather than only considering an individual's chronological and biological age. Knowing specific requirements for managing older IBD patients may help to make an appropriate therapeutic strategy for this patient group.