Abstract Background The incidence ofelderly-onset ulcerative colitis (EO-UC) has been gradually increasing. Compared with adult-onset ulcerative colitis (AO-UC) patients, the unique characteristics of clinical manifestations, therapeutic strategies, and prognosis in EO-UC patients remain unclear. Methods We retrospectively analyzed ulcerative colitis (UC) patients from March 2010 to June 2024 in Peking University Third Hospital and Peking University International Hospital. We recruited 68 EO-UC patients (age of diagnosis≥60 years) and 136 AO-UC patients (age of diagnosis 16-49 years, matched ratio = 1:2), and analyzed the differences of clinical manifestations, therapeutic strategies, and prognosis between the two groups. Results The male-to-female ratio in the EO-UC group was 1.8:1, with milder clinical manifestations (abdominal pain 58.5% vs. 75.0%, P = 0.022; Mucous bloody stool 50.0% vs. 74.3%, P 0.001), higher comorbidity burden (P 0.001), and higher left-sided colon involvement (22.1% vs. 18.4%, P = 0.001). The use of corticosteroid and biologics was significantly lower in the EO-UC group before hospitalization than that in the AO-UC group (13.2% vs. 42.6%, P 0.001; 0.0% vs. 13.2%, P = 0.002). No significant differences were observed between the two groups in the concurrent infections, clinical remission rates, relapse patterns, rehospitalization, or complication occurrence. During follow-up, six surgical cases occurred in the adult-onset group, while two mortality cases were in the elderly-onset group. Conclusion The EO-UC group exhibited a male predominance, higher rate of comorbidities and polypharmacy, milder clinical manifestations, and predominant left-sided colon involvement, presenting significant challenges for clinical diagnosis. 5-aminosalicylic acid (5-ASA) remains the first-line therapeutic regimen, and the EO-UC group demonstrated lower utilization rates of immunosuppressants and biologics, which may contribute to suboptimal therapeutic efficacy and poorer prognostic outcomes in elderly-onset cases. References: 1. Higashiyama M, Sugita A, Koganei K, et al. Management of elderly ulcerative colitis in Japan. J Gastroenterol. 2019;54(7):571-586. 2. Stepaniuk P, Bernstein CN, Targownik LE, Singh H. Characterization of inflammatory bowel disease in elderly patients: A review of epidemiology, current practices and outcomes of current management strategies. Can J Gastroenterol Hepatol. 2015;29(6):327-333. 3. Sawahashi M, Moroi R, Kakuta Y, et al. Differences in Clinical Practice and Disease Course Between Elderly-Onset and Long-Standing Elderly Ulcerative Colitis: A Single-Center Study in Japan. Tohoku J Exp Med. 2024;264(3):109-116. 4. Gonzalez MB, Olmedo Martin RV, Morales Bermudez AI, Jimenez Perez M. Characterization of Inflammatory Bowel Disease in the Elderly According to Age of Onset. J Clin Med. 2024;13(24). Conflict of interest: Mr. Li, Hailong: No conflict of interest Li, Jun: No conflict of interest Meng, Qiao: No conflict of interest Lin, Xiangchun: No conflict of interest Ding, Shigang: No conflict of interest
Li et al. (Thu,) studied this question.