Mild Endoscopic Disease Activity Is Associated With Adverse Outcomes Among Older Adults With Inflammatory Bowel Disease

Background The benefits of achieving endoscopic remission among older adults with inflammatory bowel disease (IBD) who have mild persistent disease activity are unknown. Methods This was a retrospective study of adults ≥ 60 with IBD who had mild or no disease activity on endoscopy from January 1, 2018–January 1, 2023. The primary outcome was a composite of major IBD‐specific adverse events (hospitalizations, surgery, and prescription of corticosteroids for IBD‐related symptoms) within 1 year of endoscopic assessment. Our secondary outcome was a composite of 1‐year morbidity‐related events (mortality, all‐cause hospitalization, infection requiring antibiotics, venous thromboembolism, cardiovascular events, and osteoporotic fractures). We also assessed outcomes at 5 years. Results Among 504 patients, 192 (38.1%) had mild endoscopic disease and 312 (61.9%) were in endoscopic remission, with a median disease duration of 11 years. On multivariable analysis, mild endoscopic disease activity increased the odds of a 1‐year adverse IBD‐specific outcome (aOR 4.16, 95% CI 2.10–8.24), with similar results at 5 years. Furthermore, mild endoscopic disease was associated with increased odds of experiencing an adverse morbidity‐related outcome within 1 year as compared to endoscopic remission (aOR 1.56, 95% CI 1.01–2.43). Conclusions Among older adults with prevalent IBD, mild endoscopic disease activity, as compared to endoscopic remission, was associated with increased odds of adverse IBD‐specific and morbidity‐related outcomes at 1 year, with this risk persisting for IBD‐specific outcomes at 5 years. These findings highlight the importance of achieving endoscopic remission, which may confer both short‐ and longer‐term benefits in this population.