Clinical characteristics of the newly diagnosed Crohn's disease in the elderly / 中华老年医学杂志

ABSTRACT

Objective:To investigate a classification on age of diagnosis and its clinical characteristics in hospitalized elderly patients with first diagnosed Crohn's disease.Methods:This was retrospective case-control study.A total of 181 newly diagnosed CD patients were admitted to Huadong Hospital from January 2005 to December 2019.According to Montreal CD classification criteria based on the age at the time of diagnosis(sub-grouping A3 into A3 and A4 in this paper), 181 CD patients were classified into four groups the A1 group(≤16 years, n=4), A2 group(17-40 years, n=60)and A3 group(41-59 years, n=63)(above three as control groups), and the A4 group[≥60 years, with elder-onset Crhon's disease(EOCD), n=54]as a study group.Results:A total of 181 first diagnosed CD patients who met the diagnostic criteria were included in this study.During the investigation period, the total incidence rate of CD was 37.90/100, 000, and the total prevalence rate of CD was 142.79/100, 000.Among the 181 first diagnosed CD patients, there were 4 patients(2.2%)with age of diagnosis of ≤16 years(group A1), 60 patients(33.2%)with age of diagnosis of 16-40 years(A2), 63 patients(34.8%)with age of diagnosis of 41-59 years(A3)and 54 patients(29.8%)with age of diagnosis of ≥=60 years(A4). Of these first diagnosed CD patients, male were dominant in A2 group(51 males / 9 females), while the ratio of males and females tended to be the same(32 males /31 females)in A3 group, and the proportion of female patients was greater than that of male patients in A4 group(25 males /29 females)( P<0.0001). The main CD lesion was ileocolic type in the EOCD group, accounting for 57.4%( P=0.0077). The incidence rate of ileus type CD was 42.6%( P=0.1942). Among the 163 CD patients who underwent colonoscopy, under Simple Endoscopic Score for CD(SES-CD)evaluation, the proportion of SES-CD severity type in EOCD group was as high as 82.2%, which was higher than that in the A3 group(51.7%, P=0.0187). All CD patients underwent pathological examination.There were 173 cases(95.6%)with focal lymphocytic infiltration, 120 cases(66.3%)with inflammatory infiltration on the crypt epithelial and 82 cases(45.3%)with non-caseous granuloma tissue.In the EOCD group, non-caseous granuloma accounted for 61.1%, which was higher than that in the A3 and A2 groups( P=0.0318). In the EOCD group, the non-complication rate was 1.89%, and the incidence rates of 3, 4 and ≥5 complications were 14.8%, 22.2% and 24.1%, respectively( P<0.0001, P=0.0280, 0.0141 and 0.0013). The sulphasalazine(SASP)alone was the main treatment method, accounting for 42.6%( P=0.0038), and the surgery accounted for 24.1%( P=0.9598). Conclusions:The incidence and trend of EOCD are basically consistent with those of adult-onset CD and showed an rising volatility.Incidence rate of EOCD is higher in females than in males.EOCD lesions of visual observation under endoscope are serious.The detection rate of non-caseous granulomas and related scars is high under microscope.EOCD patients have many complications, and SASP alone is the main treatment method.