P242 Phenotypic characterisation of elderly – onset inflammatory bowel disease – IBD at the extremes
Bibliographic record
Abstract
Background: The incidence of Inflammatory bowel disease (IBD) is increasing globally at a rate outpacing what genetic influences alone could instigate. Data on elderly onset IBD (age 60 and over) are limited. The aim of our study was to study the phenotypic characteristics of elderly-onset IBD. Methods: We conducted a retrospective analysis of 140 patients diagnosed with IBD at 60 years or above at our institution between 1995 and 2016. We collected data including demographics, disease characteristics (Montreal classification) and treatment using electronic case records. Results: Of 140 patients, 70 were male. Median age was 71 years (range 62–91) and median age at diagnosis was 65 years (range 60–85). 49 patients had Crohn's disease (CD) (35.0%), 80 had Ulcerative colitis (UC) (57.1%) and 11 (7.9%) had IBD-unspecified (IBDU). Disease classification for UC was: E1 (27), E2 (30) and E3 (21) and 2 patients with UC proctosigmoiditis have not yet been classified. Montreal classification for CD was L1 B2 (18): L2 B1 (14)and L2 B2 disease in 4. L3 disease was found in 12 (7 B1 and 5 B2). At diagnosis 88 patients were prescribed 5ASA's (18 topical and 6 in combination with oral preparations). Steroid induction at diagnosis occurred in 44 (31.4%) patients. Azathioprine was used in 3 (2 E3 and 1 L2B2) and 3 patients commenced Infliximab at diagnosis (L3B1 & L1B2 CD and E3 UC). Median CRP at diagnosis was 32.0mg/L At most recent follow up 26 patients were on corticosteroids, 35 were on immunomodulation (26 on Azathioprine, 5 on 6MP and 4 on Methotrexate) with a mean time to immunomodulation being 29.4 months (range 0–137). 14 were on biologic therapy (12 Infliximab and 2 Adalimumab) with a mean time to therapy of 37.1 months (range 0–189 months). 15 patients (10.7%) had surgery related to IBD: 2 UC vs 13 CD with median time to surgery 20 months (range 0–132). 2 patients were diagnosed with CD at emergency surgery. Colon cancer was diagnosed in 1 patient with L2B1 and curative resection undertaken. 4 deaths occurred: 1 from CLL (not on immunomodulation), 1 Klebsiella pneumonia on Azathioprine, 1 from cryptococcal meningitis on Azathioprine and Infliximab and 1 from metastatic prostate cancer. Conclusions: We noted a higher prevalence of UC with left sided and pancolonic disease and a colonic phenotype in CD corroborating with data from the EPIMAD registry [1]. A large proportion of patients received immunomodulation, which is an area of concern and needs careful consideration. There is an urgent need for more data on disease presentation, natural history and treatment paradigms for the considered and optimal management of elderly patients with IBD. References: [1] Charpentier C et al, (2014), Natural history of elderly-onset inflammatory bowel disease: a population-based cohort study, Gut, 423–32
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".