She has lived with ulcerative colitis for 70 years and feels vulnerable and weak for the first time. Today, an elderly IBD patient is not a rarity. One-fifth of IBD patients are older than 60 years. Stella has a mild flare-up of UC pancolitis with five loose stools per day and light bleeding.
She has no abdominal pain, and the flare-up does not affect her general health. The CRP value is normal, and the faecal calprotectin level has increased to 356. According to current national and international guidelines, a high-dose oral 5-ASA+5-ASA enema should be started.
Stella is asymptomatic at eight weeks and has a stool calprotectin level of 104. She is continuing maintenance therapy with oral 5-ASA alone at the dose recommended by ECCO.
One year later, Stella has a moderate UC flare (slightly elevated CRP 7 mg/dL, stool calprotectin 556, reports seven bloody stools per day and mild faecal incontinence). At Stella, 5-ASA therapy has been optimized: with a high oral dose + restarting the 5-ASA enema. After four weeks, he was initiated on additional topical corticosteroid therapy due to the partial response. Complete remission is achieved after eight weeks.
Suppose mild flare-ups of UC occur in elderly patients. In that case, it is important to avoid systemic steroids because of the risk of severe infections and exacerbation of some co-morbidities (e.g., diabetes). Therefore, optimization of 5-ASA therapy is crucial in this patient population.
Do you like what you see? Share with a friend.