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Age and severity of colitis

Ulcerative colitis tends to strike either young patients – between 18 and 30 – or older patients who are 50 and older. Doctors believe when the condition strikes younger people, it’s more likely to have a genetic component. In older patients, it’s believed to be related to changes in the immune system that come with aging. Now researchers at Washington University School of Medicine have found that both of those assertions may be true. More than one in five of the younger patients had a family history of the illness. In addition, a higher percentage of older patients achieved remission after a year of treatment. Symptoms tended to linger in younger adults, and more of them required steroid therapy for the disorder. The researchers say it’s possible that although the clinical symptoms are similar in older and younger patients, the root causes of the disorder may be different.

ABOUT 2 MILLION U.S. ADULTS HAVE ULCERATIVE COLITIS, AN INFLAMMATION OF THE LINING OF THE LARGE INTESTINE THAT CAN CAUSE DIARRHEA AND EVEN NECESSITATE COLON-REMOVAL SURGERY IN SEVERE CASES. AND A NEW STUDY FROM RESEARCHERS AT WASHINGTON UNIVERSITY SCHOOL OF MEDICINE IN ST. LOUIS FINDS THAT THE AGE AT WHICH AN ADULT IS DIAGNOSED WITH THE DISORDER MAY HAVE A LOT TO DO WITH HOW WELL THAT PERSON RESPONDS TO TREATMENT. JIM DRYDEN HAS THE STORY…

THE SYMPTOMS AND SEVERITY OF ULCERATIVE COLITIS TEND TO BE SIMILAR WHETHER A PERSON IS 25 OR 65 WHEN DIAGNOSED, BUT ADULTS WHO ARE OLDER WHEN THEY COME DOWN WITH THE DISORDER TEND TO DO A LITTLE BETTER WITH TREATMENT, ACCORDING TO WASHINGTON UNIVERSITY GASTROENTEROLOGIST MATTHEW CIORBA. HE SAYS THERE TEND TO BE TWO MAIN GROUPS OF PATIENTS WITH COLITIS.

(act) :24 o/c inflammatory condition

The late teens through the mid 20s, and then the second peak occurs

somewhere after age 50. So what we wanted to take a look at is,

clearly from the idea that there are these two different peaks in

disease incidence, it raises the question whether or not these are

two different, not necessarily disease entities, but predisposing

factors that lead people to develop this same type of chronic,

inflammatory condition.

CIORBA AND HIS COLLEAGUES STUDIED ALMOST 300 PEOPLE TREATED AT WASHINGTON UNIVERSITY’S INFLAMMATORY BOWEL DISEASE CLINICS. THEY FOUND THAT IN YOUNGER PATIENTS, COLITIS SEEMED RELATED MORE TO INHERITED AND GENETIC FACTORS. IN OLDER PEOPLE, THE ILLNESS APPEARED TO BE MORE RELATED TO THE AGING IMMUNE SYSTEM AND TO ENVIRONMENTAL INFLUENCES.

(act) :31 o/c ulcerative colitis

Patients who were young were more likely to have a family history

of someone with inflammatory bowel disease, which might suggest

that genetic aberrancies, or genetic mutations, may be a more common

risk factor in young patients; whereas it’s less common in patients

who develop colitis at a later age. Conversely, in those who develop

the disease after age 50, the late-onset cohort was quite significantly

more likely to be former smokers than the early-onset cohort. And

former cigarette smoking is a known risk factor for ulcerative colitis.

CIORBA SAYS PAST STUDIES HAD SUGGESTED THAT OLDER PEOPLE WITH ULCERATIVE COLITIS TENDED TO DO WORSE, BUT THOSE STUDIES WERE YEARS OLD, AND MODERN MEDICATIONS HADN’T YET BEEN DEVELOPED.

(act) :18 o/c first year

These studies were published from the 1960s and 1970s and

before our modern era of medications, so our study is the

first to look at a modern cohort with modern medications

and how patients in a routine referral practice responded

to therapy over the course of this first year.

CIORBA SAYS MANY OF THE PATIENTS IN REMISSION STILL TOOK DRUGS CALLED

5-ASAs, EVEN IN REMISSION, BUT THEY DIDN’T HAVE TO TAKE STEROIDS. STEROID DRUGS TEND TO IMPROVE SYMPTOMS, BUT THEY MAY NOT NECESSARILY LEAD TO HEALING IN THE COLON.

(act) :30 o/c early-onset cohort

Sixty-four percent of the late-onset cohort was able to achieve

what we call steroid-free clinical remission, compared to 49

percent of the younger cohort. So we looked at a sub-group of

patients – all those patients who had received steroids in the

first year – and while there was not a significant difference

in the total number of people who had taken steroids between the

early- and late-onset cohort, of those patients with this more

severe disease, or this marker of more severe disease, still more

of the late-onset cohort was able to enter into clinical remission

at one year, compared to the early-onset cohort.

CIORBA AND HIS COLLEAGUES REPORTED THEIR FINDINGS IN THE JOURNAL CLINICAL GASTROENTEROLOGY AND HEPATOLOGY. I’M JIM DRYDEN…

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