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. 1997 Apr;73(858):225–229. doi: 10.1136/pgmj.73.858.225

Prognosis and management of Crohn's disease in the over-55 age group.

R S Walmsley 1, C D Gillen 1, R N Allan 1
PMCID: PMC2431282  PMID: 9156125

Abstract

The course, prognosis and management of 62 patients with Crohn's disease aged 55 years or over at diagnosis has been reviewed. The distal ileus was the commonest site of disease in the older patient, where the characteristic presentation was acute after initially mild symptoms. Early local resection was often required, particularly where there was diagnostic doubt or suspicion of caecal malignancy. Recurrence rates were much lower in the older patient than after resection in younger patients. Medical treatment played a minor role in the management of patients with distal ileal disease, in part because stricture formation was present at diagnosis and the acute nature of symptoms at presentation led to early surgical treatment. Colonic Crohn's disease was usually confined to the distal or left side of the colon and initially could be difficult to distinguish from diverticular disease. Extensive colonic Crohn's disease was rare. The apparently limited disease was not necessarily associated with a good prognosis, since disease at this site sometimes progressed rapidly, necessitating urgent surgical resection. Medical treatment (corticosteriod therapy, with or without azathioprine) was usually effective initially for treatment of symptomatic colonic Crohn's disease, but sustained remission was rare. Those patients with persistent symptoms were restored to good health with surgical treatment but at a price, in that nearly half eventually required a permanent stoma.

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Selected References

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  1. Almdahl S. M., Jenssen T. G., Samdal F. A., Burhol P. G. The effect of pancreatectomy and gastroenterectomy on the release of somatostatin and vasoactive intestinal polypeptide in experimental fecal peritonitis. Scand J Gastroenterol. 1988 Jan;23(1):31–34. doi: 10.3109/00365528809093843. [DOI] [PubMed] [Google Scholar]
  2. Andrews H. A., Keighley M. R., Alexander-Williams J., Allan R. N. Strategy for management of distal ileal Crohn's disease. Br J Surg. 1991 Jun;78(6):679–682. doi: 10.1002/bjs.1800780614. [DOI] [PubMed] [Google Scholar]
  3. Andrews H. A., Lewis P., Allan R. N. Prognosis after surgery for colonic Crohn's disease. Br J Surg. 1989 Nov;76(11):1184–1190. doi: 10.1002/bjs.1800761123. [DOI] [PubMed] [Google Scholar]
  4. BOLEY S. J., SCHWARTZ S., LASH J., STERNHILL V. Reversible vascular occlusion of the colon. Surg Gynecol Obstet. 1963 Jan;116:53–60. [PubMed] [Google Scholar]
  5. Binder V., Hendriksen C., Kreiner S. Prognosis in Crohn's disease--based on results from a regional patient group from the county of Copenhagen. Gut. 1985 Feb;26(2):146–150. doi: 10.1136/gut.26.2.146. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. De Dombal F. T., Burton I. L., Clamp S. E., Goligher J. C. Short-term course and prognosis of Crohn's disease. Gut. 1974 Jun;15(6):435–443. doi: 10.1136/gut.15.6.435. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Fabricius P. J., Gyde S. N., Shouler P., Keighley M. R., Alexander-Williams J., Allan R. N. Crohn's disease in the elderly. Gut. 1985 May;26(5):461–465. doi: 10.1136/gut.26.5.461. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Farmer R. G., Whelan G., Fazio V. W. Long-term follow-up of patients with Crohn's disease. Relationship between the clinical pattern and prognosis. Gastroenterology. 1985 Jun;88(6):1818–1825. doi: 10.1016/0016-5085(85)90006-x. [DOI] [PubMed] [Google Scholar]
  9. Harper P. C., McAuliffe T. L., Beeken W. L. Crohn's disease in the elderly. A statistical comparison with younger patients matched for sex and duration of disease. Arch Intern Med. 1986 Apr;146(4):753–755. doi: 10.1001/archinte.146.4.753. [DOI] [PubMed] [Google Scholar]
  10. Hughes L. E. Postmortem survey of diverticular disease of the colon. I. Diverticulosis and diverticulitis. Gut. 1969 May;10(5):336–344. doi: 10.1136/gut.10.5.336. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. LOCKHART-MUMMERY H. E., MORSON B. C. Crohn's disease (regional enteritis) of the large intestine and its distinction from ulcerative colitis. Gut. 1960 Jun;1:87–105. doi: 10.1136/gut.1.2.87. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Lee F. I., Giaffer M. Crohn's disease of late onset in Blackpool. Postgrad Med J. 1987 Jun;63(740):471–473. doi: 10.1136/pgmj.63.740.471. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Puntis J., McNeish A. S., Allan R. N. Long term prognosis of Crohn's disease with onset in childhood and adolescence. Gut. 1984 Apr;25(4):329–336. doi: 10.1136/gut.25.4.329. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Ritchie J. K., Lennard-Jones J. E. Crohn's disease of the distal large bowel. Scand J Gastroenterol. 1976;11(5):433–436. [PubMed] [Google Scholar]
  15. Rose J. D., Roberts G. M., Williams G., Mayberry J. F., Rhodes J. Cardiff Crohn's disease jubilee: the incidence over 50 years. Gut. 1988 Mar;29(3):346–351. doi: 10.1136/gut.29.3.346. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Tchirkow G., Lavery I. C., Fazio V. W. Crohn's disease in the elderly. Dis Colon Rectum. 1983 Mar;26(3):177–181. doi: 10.1007/BF02560166. [DOI] [PubMed] [Google Scholar]
  17. Tobin M. V., Logan R. F., Langman M. J., McConnell R. B., Gilmore I. T. Cigarette smoking and inflammatory bowel disease. Gastroenterology. 1987 Aug;93(2):316–321. doi: 10.1016/0016-5085(87)91021-3. [DOI] [PubMed] [Google Scholar]
  18. Webberley M. J., Hart M. T., Melikian V. Thromboembolism in inflammatory bowel disease: role of platelets. Gut. 1993 Feb;34(2):247–251. doi: 10.1136/gut.34.2.247. [DOI] [PMC free article] [PubMed] [Google Scholar]

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