Washington University LogoUlcerative colitis a type of an inflammatory bowel disease may be difficult to treat. In case of severity, patients seem to undergo a surgery for colon removal. A latest research triggered by the Washington University School of Medicine in St. Louis claims that people suffering from ulcerative colitis after age 50 are more prone to attain remission from their symptoms than patients diagnosed at younger ages. The results were possibly noted after providing similar treatments to all the patients.

During the study, patients were treated with drugs like5-aminosalicylates (5-ASAs) and immunosuppressive therapies known as steroids. The infliximab medication that targets certain proteins in the body’s immune system was employed to handle inflammation. Crohn’s disease which is supposedly related to this aliment appears to affect any part of the gastrointestinal tract. However ulcerative colitis seems to produce inflammation in the lining of the large intestine or colon alone. Diarrhea, bloody stool, weight loss and fever may be held responsible for this ailment.

Matthew A. Ciorba, MD, an assistant professor of medicine at Washington University and the lead investigator said, “At the start of the study, our early and late-onset patient groups were about equal in terms of the severity of their symptoms. However, after a year of treatment, those who had developed colitis later in life had better outcomes. More of them were in clinical remission at one year, compared to those diagnosed when they were younger.”

The study was undertaken on 295 patients with this disease. All the study subjects were treated at the inflammatory bowel disease clinics in the School of Medicine for a seven-year period from 2001-08. On completion of the treatment, 64 percent of patients diagnosed after the age of 50 were in remission than 49 percent of those who developed colitis at younger ages.

Ciorba alleged, “The age at which patients are affected tends to split into two specific waves. In the clinic, we see a number of patients who get the disease from their late teens to their mid 20s. Then there’s a second peak of patients who aren’t affected until after the age of 50.”

Though clinical symptoms of colitis were claimed to be absent in remission patients, they did have inflammation. Such patients may need to continue treatment with 5-ASA drugs, without employing steroids. Genetic influences too appeared to play a major role in the disease with patients having family members suffering from inflammatory bowel disease were apparently diagnosed early in life.

Ciorba quoted, “We know from research by other investigators that as people age their immune systems tend to quiet down, and the results from our study may reflect that finding. Ulcerative colitis is driven by an over-active immune response in the gut, so it makes sense that people whose immune systems are less active might have better outcomes. Conversely, younger patients are more likely to have robust inflammatory responses, so their disease is harder to quiet down.”

A family history of inflammatory bowel disease was ascertained by more than one in five patients under the age of 30. It has been assumed that later-onset disease is associated to alterations in aging immune system and environmental influences like smoking. Almost 52 percent in the late-onset group seemed to be former smokers as compared to 13.5 percent of the younger patients. The experts highlight smoking to be a known risk factor for colitis.

Ciorba highlighted, “Steroids have long been used as a therapy, but they are a ‘dual-edged sword’ in many cases. They improve symptoms, but we are not sure that they actually promote healing in the colon. The good news is that for many patients, regardless of their age at disease onset, aggressive, early therapy is related to relatively high remission rates.”

Younger and elder patients were mainly treated with 5-ASAs and steroids. Oral or intravenous steroids were given to nearly 63 percent of early onset patients and 68 percent of late-onset patients in the first year of treatment. However, more investigations ascertaining the environmental and genetic factors that discern late- versus early onset disease can be conducted. Further research may help evaluate if older or younger patients respond in an efficient manner to various therapeutic combinations or novel investigative therapies.

The study is published in the August issue of Clinical Gastroenterology and Hepatology.