Characteristics of late-onset IBD

Introduction: Inflammatory bowel disease (IBD) primarily affects adults, with a peak incidence between 20–30 years. A second, less frequent peak occurs between 50–70 years. Late-onset IBD, diagnosed after age 60, represents a distinct entity with potential comorbidities and unique clinical features. This study aimed to analyze the epidemiological, clinical, therapeutic, and disease course characteristics of IBD in late-onset IBD patients.

Materials and Methods: We conducted a single-center, retrospective, descriptive study over six years (July 2018–July 2025). Among 465 IBD patients followed at our center, 20 were diagnosed after age 60. Both sexes with documented Crohn’s disease (CD) or ulcerative colitis (UC) were included. Epidemiological, clinical, therapeutic, and disease course data were collected.

Results: Of the 20 patients (4.4%), 11 had UC (55%), 7 had CD (35%), and 2 (10%) had indeterminate colitis. The mean age at diagnosis was 69 years [60–82], with a female-to-male ratio of 1.2. Twelve patients (60%) had at least one comorbidity. UC was pancolonic in 28%, left-sided in 36%, and distal in 36%. CD was ileal in 28.5%, ileocolonic in 28.5%, and colonic in 42.8%, with stricturing phenotype in 43%, inflammatory in 43%, and fistulizing in 14%. Extra-intestinal manifestations occurred in six patients (30%). Maintenance therapy included aminosalicylates for UC (100%), immunosuppressants (57.1%), and anti-TNF therapy (42.9%) for CD. Three patients (15%) underwent surgery. Remission was maintained in 18 patients (90%).

Conclusion: Late-onset IBD is a distinct entity, often presenting with no family history, frequent comorbidities, milder clinical features, and good response to medical therapy. Reduced use of immunosuppressants and biologics reflects disease profile and age-related considerations. Prospective studies on larger cohorts are needed to optimize management in this growing population.