When managing ulcerative colitis in older patients, understanding their overall health profile is key

  • Adis Medical WritersEmail author
Disease Management


Ulcerative colitis (UC) in patients aged > 60 years is increasingly common. The treatment of UC aims to induce and maintain clinical remission, with 5-aminosalicylates the mainstay for mild UC. In moderate-to-severe or refractory UC, oral corticosteroids, thiopurines, anti-TNF agents, vedolizumab and tofacitinib are treatment options to induce and/or maintain remission. To facilitate compliance and minimize adverse drug events, treatment should be tailored to patients’ general health status, comorbidities and existing medications.


Compliance with ethical standards


The preparation of this review was not supported by any external funding.

Conflict of interest

The article was adapted from Drugs & Aging 2019; 36(1):13–27 [1] by employees of Adis International Ltd/Springer Nature, who are responsible for the article content and declare no conflicts of interest.


  1. 1.
    Shrestha MP, Taleban S. Management of ulcerative colitis in the elderly. Drugs Aging. 2019;36(1):13–27.CrossRefGoogle Scholar
  2. 2.
    Loftus CG, Loftus EV Jr, Harmsen WS, et al. Update on the incidence and prevalence of Crohn’s disease and ulcerative colitis in Olmsted county, Minnesota, 1940–2000. Inflamm Bowel Dis. 2007;13(3):254–61.CrossRefGoogle Scholar
  3. 3.
    Matsumoto S, Miyatani H, Yoshida Y. Ulcerative colitis: comparison between elderly and young adult patients and between elderly patients with late-onset and long-standing disease. Dig Dis Sci. 2013;58(5):1306–12.CrossRefGoogle Scholar
  4. 4.
    Sturm A, Maaser C, Mendall M, et al. European Crohn’s and Colitis Organisation topical review on IBD in the elderly. J Crohns Colitis. 2017;11(3):263–73.Google Scholar
  5. 5.
    Katz S, Surawicz C, Pardi DS. Management of the elderly patients with inflammatory bowel disease: practical considerations. Inflamm Bowel Dis. 2013;19(10):2257–72.CrossRefGoogle Scholar
  6. 6.
    Gisbert JP, Gonzalez-Lama Y, Mate J. 5-aminosalicylates and renal function in inflammatory bowel disease: a systematic review. Inflamm Bowel Dis. 2007;13(5):629–38.CrossRefGoogle Scholar
  7. 7.
    Kim M, Katz S, Green J. Drug management in the elderly IBD patient. Curr Treat Options Gastroenterol. 2015;13(1):90–104.CrossRefGoogle Scholar
  8. 8.
    Muller AF, Stevens PE, McIntyre AS, et al. Experience of 5-aminosalicylate nephrotoxicity in the United Kingdom. Aliment Pharmacol Ther. 2005;21(10):1217–24.CrossRefGoogle Scholar
  9. 9.
    Pardi DS, Loftus EV Jr, Camilleri M. Treatment of inflammatory bowel disease in the elderly: an update. Drugs Aging. 2002;19(5):355–63.CrossRefGoogle Scholar
  10. 10.
    Lichtenstein GR, Travis S, Danese S, et al. Budesonide MMX for the induction of remission of mild to moderate ulcerative colitis: a pooled safety analysis. J Crohns Colitis. 2015;9(9):738–46.CrossRefGoogle Scholar
  11. 11.
    Alexakis C, Saxena S, Chhaya V, et al. Do thiopurines reduce the risk of surgery in elderly onset inflammatory bowel disease? A 20-year national population-based cohort study. Inflamm Bowel Dis. 2017;23(4):672–80.CrossRefGoogle Scholar
  12. 12.
    Benchimol EI, Cook SF, Erichsen R, et al. International variation in medication prescription rates among elderly patients with inflammatory bowel disease. J Crohns Colitis. 2013;7(11):878–89.CrossRefGoogle Scholar
  13. 13.
    Cottone M, Kohn A, Daperno M, et al. Advanced age is an independent risk factor for severe infections and mortality in patients given anti-tumor necrosis factor therapy for inflammatory bowel disease. Clin Gastroenterol Hepatol. 2011;9(1):30–5.CrossRefGoogle Scholar
  14. 14.
    Lobatόn T, Ferrante M, Rutgeerts P, et al. Efficacy and safety of anti-TNF therapy in elderly patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2015;42(4):441–51.CrossRefGoogle Scholar
  15. 15.
    Feagan BG, Rutgeerts P, Sands BE, et al. Vedolizumab as induction and maintenance therapy for ulcerative colitis. N Engl J Med. 2013;369(8):699–710.CrossRefGoogle Scholar
  16. 16.
    Navaneethan U, Edminister T, Zhu X, et al. Vedolizumab is safe and effective in elderly patients with inflammatory bowel disease. Inflamm Bowel Dis. 2017;23(4):E17.CrossRefGoogle Scholar
  17. 17.
    Sandborn WJ, Su C, Sands BE, et al. Tofacitinib as induction and maintenance therapy for ulcerative colitis. N Engl J Med. 2017;376(18):1723–36.CrossRefGoogle Scholar
  18. 18.
    Moskovitz DN, Van Assche G, Maenhout B, et al. Incidence of colectomy during long-term follow-up after cyclosporine induced remission of severe ulcerative colitis. Clin Gastroenterol Hepatol. 2006;4(6):760–5.CrossRefGoogle Scholar
  19. 19.
    Parian A, Ha CY. Older age and steroid use are associated with increasing polypharmacy and potential medication interactions among patients with inflammatory bowel disease. Inflamm Bowel Dis. 2015;21(6):1392–400.Google Scholar
  20. 20.
    Kane SV. Systematic review: adherence issues in the treatment of ulcerative colitis. Aliment Pharmacol Ther. 2006;23(5):577–85.CrossRefGoogle Scholar
  21. 21.
    Bewtra M, Newcomb CW, Wu Q, et al. Mortality associated with medical therapy versus elective colectomy in ulcerative colitis: a cohort study. Ann Intern Med. 2015;163(4):262–70.CrossRefGoogle Scholar
  22. 22.
    Van Assche G, Dignass A, Bokemeyer B, et al. Second European evidence-based consensus on the diagnosis and management of ulcerative colitis part 3: special situations. J Crohns Colitis. 2013;7(1):1–33.CrossRefGoogle Scholar
  23. 23.
    Shaukat A, Virnig DJ, Salfiti NI, et al. Is inflammatory bowel disease an important risk factor among older persons with colorectal cancer in the United States? A population-based case-control study. Dig Dis Sci. 2011;56(8):2378–83.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Springer NatureAucklandNew Zealand

Personalised recommendations