Análise do perfil clínico, epidemiológico e da qualidade de vida da doença inflamatória intestinal no paciente idoso, em centro de referência brasileiro

Abstract

Introduction: Inflammatory bowel diseases (IBD), mainly represented by Crohn's Disease (CD) and Ulcerative Colitis (UC), are diseases characterized by a chronic and recurrent inflammatory process of the gastrointestinal mucosa, of partially known etiology, with a peak incidence in younger age groups. However, the elderly population is growing and the incidence and prevalence of IBD is also in this age group. Objectives: To evaluate the epidemiological, clinical, evolutionary profile and quality of life of patients aged 60 years or over. Both for those who were diagnosed after this age, and for those who aged with IBD. Methods: This is a two-pronged study, a historical cohort with an evaluation of the medical records of patients aged 60 years or older, registered at the Ambulatory of Inflammatory Bowel Diseases at the Alfa Institute of Gastroenterology, Hospital das Clínicas, Federal University of Minas Gerais (HC) / UFMG) and the University Hospital of the Federal University of Juiz de Fora (HU / UFJF). The other consists of assessing quality of life through the application of two questionnaires (IBDQ and WHOQOL-bref). Demographic aspects, diagnoses, phenotype at diagnosis and location of the disease were analyzed (Montreal classification for CD and UC) at diagnosis and every 5 years, evolution of CD as to the appearance of complications (strictures and fistulas), clinical and surgical therapy. Results: Of the 173 patients analyzed, there was balance in terms of CD, 90 cases (52%) and UC, 83 (48%). The female sex predominated (63.6%). There were no differences in clinical presentation, regarding intestinal and extraintestinal manifestations between groups. The elderly patient <60 years old at diagnosis, seems to have a more aggressive course initially, penetrating behavior was observed at diagnosis in 30 (33.8%) patients, but at 20 years of illness, only in 3 (11%). Predominant stricturing behavior (B2), 42.7% in CD at diagnosis. In the UC, there was a predominance of left colitis and pancolitis (75%) and the time between diagnosis and hospitalization was shorter. The evolution of the elderly was less aggressive, 85.6% of the cases had comorbidities. Polypharmacy predominated in the group aged ≥ 60 years (74.4%). Aminosalicylates was the most used medication (91.5%). The rate of surgery was similar in both groups, but surgery at diagnosis was more common in the elderly (80%). There was a predominance of complications in the group with diagnosis aged <60 years (56.9%), but 51.8% aged ≥60 years required admission to the diagnosis. As for the quality of life, in the 126 respondents, it was considered good, in the two scores applied. Good coexistence with IBD was observed in 78.6% of the patients evaluated by the IBDQ and the factors with the greatest impact on quality of life were disease activity and the presence of symptoms such as fatigue, asthenia and insomnia. Conclusions: Research in this age group is scarce and the management of IBD in this population is complex. This work contributed to a better understanding of the profile of IBD in the elderly population. New studies are necessary to allow the approach with more specific protocols for this population.