The management of small bowel Crohn's disease in older age

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PURPOSE OF REVIEW: The prevalence of inflammatory bowel disease (IBD) amongst older adults (≥60 years old) is rising, encompassing individuals with a preexisting diagnosis and those newly diagnosed. Projections estimate that by 2030, one-third of patients with IBD will be older adults. Managing older adults with IBD poses unique challenges, including frailty, multimorbidity and polypharmacy. This review summarises the approach to managing older adults with small bowel Crohn's disease (SBCD), a distinct IBD sub-type. RECENT FINDINGS: The 2024 "State of IBD care in the United Kingdom (UK)" report revealed a median delay of 8 months from onset of Crohn's disease symptoms to diagnosis. Diagnostic delay in Crohn's disease is associated with stricturing and penetrating complications. Diagnostic challenges in SBCD include its insidious presentation in older adults and the poor utility of calprotectin as a biomarker, with a positive predictive value of only 23.1% with a calprotectin over 200 μg/g. Management should be tailored to patient preference and frailty, given the paucity of evidence pertaining to nutritional, medical and surgical treatment approaches in older adults. SUMMARY: Older adults with IBD represent a heterogenous cohort. Optimising the recruitment of older adults to clinical trials and stratifying outcomes according to frailty are key research priorities.

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