IBD in the elderly

The prevalence of Crohn's disease and ulcerative colitis is increasing worldwide and the aging of the population makes elderly-onset IBD, as well as IBD in elderly patients with disease starting at a younger age, a rising problem. IBD in the elderly poses challenges in terms of its diagnosis, as it can be confused with complicated diverticular disease and with infectious, ischemic, or drug-related colitis. There are many uncertainties regarding therapeutic strategies in the elderly, given the lack of data from clinical trials in this population, the increased risk of side-effects, and the high rate of comorbidities and polypharmacy. Challenging previous observations mostly coming from referral centers or small series, recent evidence has outlined that the disease course of elderly-onset IBD is less aggressive than that in the younger population. This distinction should be considered when discussing therapeutic management in this complex population.