Abstract Background Elderly-onset inflammatory bowel disease, onset 60 years of age, constitutes 10-15% of all incident IBD-patients. Elderly onset-IBD patients may be frailer and have more comorbidities compared to adult-onset IBD. The aim of the study was to compare symptoms and clinical presentation in adult onset-IBD patients to elderly onset-IBD patients. Methods The I-SCAN (IBD-Scandinavian cancer in IBD study) cohort includes all patients in Sweden, Norway and parts of Denmark with two ICD-codes for IBD (ICD-9 555, 556, 563.01, 563.10; ICD-10: K50, K51, K52.3) in national registers, 1987-2016 for inpatients and 1997-2016 for outpatients (1986-2018 for Denmark). From this cohort a case-cohort study was empaneled. For cancer cases, n = 2933, and a random sample of the cohort, n = 1279, detailed chart abstraction was done including information on disease behavior, disease extent and macroscopical and microscopical findings from endoscopic procedures. From the random non-cancer sub-cohort, we compared symptoms and clinical presentation in adult-onset IBD patients (18-59 years of age) to elderly onset-IBD patients (≥ 60 years of age). Results In total 1034 patients with IBD diagnosis ≥ 18 years of age were studied, 857 had adult onset-IBD and 177 elderly onset-IBD. No differences were seen between the groups for the distribution of diagnosis. Number of colonoscopies were equal for the first five years of disease, a median of two colonoscopies were conducted among both adult- and elderly onset IBD. Macroscopical inflammation in adult- and elderly onset Crohn’s disease (CD) as well as adult- and elderly onset Ulcerative colitis (UC) did not differ for colonoscopies with clinical indication (p = 0.57). Microscopical inflammation also did not differ between adult onset IBD (no activity 28.6%, mild 16.9%, moderate 23.8%, severe 30.7%) and elderly onset IBD (no activity 26.2%, mild 14.4%, moderate 27.2%, severe 32.2) for the first five years of disease (p = 0.43). In addition we found no differences in symptoms such as diarrhoea, mucus and blood in stools between adult- and elderly onset IBD patients. Patients with adult-onset CD had less anaemia, 7.9%, than elderly-onset UC, 18.8%. Adult-onset UC had less weight loss, 13.9% than elderly-onset UC, 22.2%. Conclusion The clinical presentation of elderly onset-IBD is comparable to that of adult onset-IBD regarding symptoms at diagnosis as well as inflammation on both the macroscopical and microscopical level. Conflict of interest: Dr. Bjorner, Kajsa: Advisory board member for Lilly, Advisory board member Takeda. Högdén, Amanda: Nothing to delclare Perrin, Vera: No conflict of interest Refsum, Erle: No conflict of interest Larsen, Lone: Speaker fee from Takeda, Eli Lilly, Abbvie Share holder Novo Nordisk A/S Advisory Board for Tillotts, Abbvie, Eli Lilly, Celltrion Consultancy for Eli Lilly Erichsen, Rune: No conflict of interest Gantzel, Rasmus Hvidbjerg: No conflict of interest Ye, Weimin: No conflict of interest Jess, Tine: Personal Fees: Consultancy for Ferring, Pfizer, Johnson & Johnson Kalager, Mette: No conflict of interest Thelin Schmidt, Peter: Advisory Board member for Gilead Nordic, Janssen Cilag, and Norgine and as invited speaker for MSD Blom, Johannes: No conflict of interest
Björner et al. (Thu,) studied this question.