Comparative Analysis of Management Strategies and Demographics in Older-Onset vs. Younger-Onset Inflammatory Bowel Disease

Background/Objectives: This study examines how demographics and treatment ap-proaches differ between adults with Ulcerative Colitis (UC) and Crohn’s Disease (CD) in two age groups: those diagnosed at 60 years or older and those diagnosed between 18 and 60 years. Methods: A retrospective study was performed to examine and contrast the clinical profiles and therapeutic approaches of patients diagnosed within the period spanning June 1993 to February 2023. Demographic, clinical, and therapeutic data were evaluated for both UC and CD groups across the two age categories. Patients were cat-egorized into older-onset (≥60 years) and younger-onset (18-60 years) groups. Results: The study cohort comprised 1245 patients, including 56 older-onset adults (4.5%, 73% male) and 1189 younger-onset adults (95.5%, 58% male). The median duration of follow-up was 11 years. Ulcerative colitis was significantly more prevalent among the older-onset group, with a rate of 69.6% (p=0.002). Active smokers were more frequent in the younger-onset group (23%, p=0.003). A family history of IBD was less common in the older-onset group (4% vs. %13, p=0.037). Thiopurine usage was more frequent in the younger-onset group (32.9% vs. 16.1%, p=0.008). Biological experience was less common in the older-onset group (26.8% vs. %49.3, p=0.001). No notable differences were observed between the older-onset and younger-onset groups regarding UC extension, CD location, disease behavior, or perianal involvement. Conclusions: Older-onset patients differ significantly from younger-onset patients in terms of clinical presentation and therapeutic approaches. The lower use of thiopurines and biological agents in older-onset patients may reflect concerns about drug-related risks. Customized therapeutic approaches are essential to enhance outcomes for this patient population.