Inflammatory Bowel Disease in the Baby to Baby Boomer: Pediatric and Elderly Onset of IBD
Purpose of review
Early- and late-onset of inflammatory bowel disease (IBD) may perhaps be etiologically distinct and potentially attributed to genetics, environmental or microbial factors. We review disease factors and clinical characteristics, as well as unique management and treatment strategies to consider when caring for the “baby” or “baby boomer” with IBD.
Around 25% of cases of initial diagnosis of IBD is made before the age of 18 years old, and another 15–20% made after the age of 60. Crohn’s disease (CD) typically presents as ileocolonic and stricturing or penetrating phenotype among early-onset, whereas among late-onset, it is mainly colonic and inflammatory. Pediatric ulcerative colitis (UC) is mostly pan-colonic versus primarily left-sided among the elderly. Treatment goal for both age groups is primarily symptom control, with growth and development also considered among pediatric patients. Due to alterations in pharmacokinetics, careful monitoring and reduced dose should be considered. A multidisciplinary care team is necessary to ensure better clinical outcomes.
Onset of disease at either spectrum of age requires careful management and treatment, with both unique disease- and age-appropriate factors carefully considered.
KeywordsPediatric IBD Elderly IBD Early-onset and late-onset IBD Pediatric-adult transition of IBD care
Afzali A: performed the research and wrote the paper. Katz S: contributed critical revision and intellectual content.
Compliance with ethical standards
Conflict of interest
Anita Afzali reports grants from Abbvie and UCB; honoraria from Abbvie, UCB, Takeda, Janssen, and IBD Horizons, and payment and travel accommodations from UCB, Takeda, Abbvie, IBD Horizons and Janssen.
Seymour Katz has no conflict of interests to disclose.
Human and animal rights and informed consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
References and Recommended Reading
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 3.Sandler RS, Eisen GM. Epidemiology of inflammatory bowel disease. In: Kirsner JB, editor. Inflammatory bowel disease. 5th ed. Philadelphia: Saunders; 2000. p. 89–112.Google Scholar
- 4.Shashidar H, Integlia MJ, Grand RJ. Clinical manifestations of pediatric inflammatory bowel disease. In: Kirsner JB, editor. Inflammatory bowel disease. 5th ed. Philadelphia: Saunders; 2000. p. 326–34.Google Scholar
- 17.Gasparetto M and Guariso G. Gastroenterology research and practice. Volume 2013, Article ID 829040, 12 pages.Google Scholar
- 22.Manosa M, Calafat M, de Frandisco R, et al. Phenotype and natural history of elderly onset inflammatory bowel disease: a multicenter, case-control study. Aliment Pharmacol Ther. 2018:1–10.Google Scholar
- 40.• Levine A, Griffiths A, Markowitz J, Wilson DC, Turner D, Russell RK, et al. Pediatric modification of the Montreal classification for inflammatory bowel disease: the Paris Classification. Inflamm Bowel Dis. 2011;17:1314–21. Given differences in disease characteristics and natural course history of early and very-early onset of IBD, the authors propose a modification of the Montreal classification of IBD.CrossRefPubMedGoogle Scholar
- 72.Everhov AH, Halfvarson J, Myrelid P, et al. Incidence and treatment of patients diagnosed with inflammatory bowel diseases at 60 years or older in Sweden. Gastroenterology. 2017:1–11.Google Scholar
- 75.Stokes AL, Kulaylat AN, Rocourt DV, et al. Rates and trends for inpatient surgeries in pediatric Crohn’s disease in the United States form 2003-2012. J Pediatr Surg 2017.Google Scholar
- 88.Beaugerie L, Brousse N, Bouvier AM, Colombel JF, Lémann M, Cosnes J, et al. CESAME Study Group. Lymphoproliferative disorders in patients receiving thiopurines for inflammatory bowel disease: a prospective observational cohort study. Lancet. 2009;374:1617–25.CrossRefPubMedPubMedCentralGoogle Scholar