Note from CCFA's Patient Education Committee: Although a difference was found in disease severity between younger patients and those with late-onset ulcerative colitis,  it was modest.

Late-onset ulcerative colitis has better outcome

Last Updated: 2010-04-20 17:08:19 -0400 (Reuters Health)

By David Douglas

NEW YORK (Reuters Health) - Patients with late-onset ulcerative colitis (i.e., after age 50) have better outcomes than younger patients, researchers reported online April 5th in Clinical Gastroenterology and Hepatology.

When the investigators compared a group of patients diagnosed after age 50 with another group diagnosed at ages 18 to 30, they found that within a year of diagnosis, 64% of the older group had achieved steroid-free remission, significantly more than the 49% in the early-onset group.

"This was regardless of whether they required steroids -- prednisone -- in that first year, which is considered a marker of more severe disease," senior author Dr. Matthew A. Ciorba of Washington University in Saint Louis, Missouri, told Reuters Health by email.

In fact, the findings were similar in patients who required systemic steroids (50% steroid-free remission at one year in the older-onset group, versus 32% in the early-onset group).

"Given that older patients are at increased risk for steroid-related complications, this work underscores the importance of early initiation of maintenance therapy with 5-aminosalicylates and consideration to immunomodulator therapy," the researchers said.

Dr. Ciorba and colleagues conducted their retrospective study using data on 295 patients with ulcerative colitis, including 155 who were diagnosed at age 50 or later and 140 diagnosed between the ages of 18 and 30.

According to their article, the groups had similar disease extent and symptom severity at diagnosis. Overall, the types of medications used during the first year of disease were also similar.

The majority of early-onset (63.4%) and late-onset (67.9%) patients required an initial course of oral or intravenous steroids. Although more late-onset patients received oral 5-aminosalicylate, such therapy was common in both groups. Immunomodulators were used in 25.8% of early-onset patients and 29.3% of the late-onset group.

"Early-onset patients were more likely to have a positive family history of irritable bowel disease," Dr. Ciorba said. "Conversely, late-onset patients were more likely to have been former smokers. Together these findings suggest that genetics may play a more important role in early onset ulcerative colitis while environment may be more important in late-onset ulcerative colitis."

"Overall, the findings of our study underscore the need for additional research focusing on the therapeutic response to inflammatory bowel disease medications and safety in the late-onset...population to improve our understanding of management of these complex patients."

"Age of onset should also be considered when evaluating results of future pharmaceutical trials involving ulcerative colitis patients," he concluded.

Clin Gastroenterol Hepatol 2010.

Senior study author, Matthew Ciorba, M.D., is the recipient of a Career Development Award from the Crohn's & Colitis Foundation of America.