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Late-Onset Ulcerative Colitis Responds Better to Therapy

Patients more likely to achieve steroid-free remission at one year than with early-onset disease

THURSDAY, Aug. 5 (HealthDay News) -- Patients with onset of ulcerative colitis at age 50 or older are more likely to achieve steroid-free remission within one year than are patients who developed the illness between the ages of 18 and 30, according to research published in the August issue of Clinical Gastroenterology and Hepatology.

Christina Y. Ha, M.D., of the Washington University School of Medicine in St. Louis, and colleagues conducted a retrospective cohort study of 295 adult patients with ulcerative colitis. The patients were placed into two groups: those with early-onset ulcerative colitis between the ages of 18 and 30, and those with late-onset ulcerative colitis at age 50 or older. The objective of the study was to determine if the disease and its clinical outcomes differed between the two groups.

The researchers found that, at diagnosis, the two groups were similar in terms of disease extent and symptom severity, but there was a significant difference in steroid-free remission one year after diagnosis between the late-onset and the early-onset groups (64 versus 49 percent). Among patients who did require steroids during the follow-up year, 50 percent of the late-onset patients were in steroid-free remission at one year, compared to only 32 percent of the early-onset patients. Risk factors differed between the two groups, with late-onset patients more likely to have been former smokers and less likely to have a family history of ulcerative colitis than early-onset patients.

"The combination of age-related immune compromise and a higher susceptibility to infections may predispose older patients to dysregulation of the T-cell response leading to ulcerative colitis. However, this relative state of immunodeficiency in the older population may attenuate the immune response that would typify unremitting disease flares, and perhaps facilitate improved response to medical therapy resulting in an improved disease course," the authors write.

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