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Management Considerations for the Older Adult With Inflammatory Bowel Disease

Axenfeld, Ellen; Katz, Seymour; Faye, Adam S.
As the prevalence of older adults with inflammatory bowel disease (IBD) is rising, understanding the unique challenges in both diagnosis and management is becoming increasingly important. Knowledge of phenotypic differences as well as overlapping symptoms with other medical conditions is critical to obtaining a timely diagnosis of IBD in older adults. Although older adults with IBD are at higher risk for adverse events compared with younger adults with IBD, recent data have suggested that ongoing disease activity may be a significant driver of adverse clinical outcomes rather than use of current treatment modalities. Ultimately, earlier and effective treatments can improve outcomes and quality of life for older adults with IBD. However, to help improve medical decision-making, clinicians must move away from the use of chronological age alone and begin to integrate measures of biological age, such as frailty and sarcopenia, into risk stratification tools. This article reviews the management considerations for older adults with IBD and provides the rationale for incorporating measures of biological age into current practice.
ISSN: 1554-7914
CID: 5630682

Risk factors for incomplete telehealth appointments among patients with inflammatory bowel disease

Stone, Katherine L; Kulekofsky, Emma; Hudesman, David; Kozloff, Samuel; Remzi, Feza; Axelrad, Jordan E; Katz, Seymour; Hong, Simon J; Holmer, Ariela; McAdams-DeMarco, Mara A; Segev, Dorry L; Dodson, John; Shaukat, Aasma; Faye, Adam S
BACKGROUND/UNASSIGNED:The COVID-19 pandemic led to the urgent implementation of telehealth visits in inflammatory bowel disease (IBD) care; however, data assessing feasibility remain limited. OBJECTIVES/UNASSIGNED:We looked to determine the completion rate of telehealth appointments for adults with IBD, as well as to evaluate demographic, clinical, and social predictors of incomplete appointments. DESIGN/UNASSIGNED:We conducted a retrospective analysis of all patients with IBD who had at least one scheduled telehealth visit at the NYU IBD Center between 1 March 2020 and 31 August 2021, with only the first scheduled telehealth appointment considered. METHODS/UNASSIGNED:Medical records were parsed for relevant covariables, and multivariable logistic regression was used to estimate the adjusted association between demographic factors and an incomplete telehealth appointment. RESULTS/UNASSIGNED: = 0.22). After adjustment, patients with CD had higher odds of an incomplete appointment as compared to patients with UC [adjusted odds ratio (adjOR): 1.37, 95% confidence interval (CI): 1.10-1.69], as did females (adjOR: 1.26, 95% CI: 1.04-1.54), and patients who had a non-first-degree relative listed as an emergency contact (adjOR: 1.69, 95% CI: 1.16-2.44). While age ⩾60 years was not associated with appointment completion status, we did find that age >80 years was an independent predictor of missed telehealth appointments (adjOR: 2.92, 95% CI: 1.12-7.63) when compared to individuals aged 60-70 years. CONCLUSION/UNASSIGNED:telehealth, particularly those aged 60-80 years, may therefore provide an additional venue to complement in-person care.
PMID: 37124374
ISSN: 1756-283x
CID: 5544752

Crohn's Disease of the Elderly: Unique Biology and Therapeutic Efficacy and Safety

Hong, Simon J; Galati, Jonathan; Katz, Seymour
The incidence and prevalence of inflammatory bowel disease (IBD) is increasing in the elderly population. Compared with patients with onset during younger years, patients with elderly-onset IBD have a distinct clinical presentation, disease phenotype, and natural history. Genetics contribute less to pathogenesis of disease, whereas aging-related biological changes, such as immunosenescence and dysbiosis, are associated with elderly-onset IBD. Frailty is an increasingly recognized predictor of adverse outcomes. As an increasingly wider array of biologic and small molecule therapeutic options becomes available, data regarding efficacy and safety of these agents in patients are paramount given the unique characteristics of this population.
PMID: 35595423
ISSN: 1558-1942
CID: 5235742

Current and Emerging Approaches to the Diagnosis and Treatment of Crohn's Disease Strictures

Lee, Briton; Dane, Bari; Katz, Seymour
The management and understanding of Crohn's disease (CD) continues to evolve quickly. Intestinal strictures were previously thought to be an inevitable result of irreversible fibrosis caused by chronic inflammation. However, increased understanding of the dynamic nature of strictures and of the pathophysiology of this condition has highlighted emerging targets for potential treatment. In the diagnosis of strictures, a distinction must be made between inflammatory and fibrotic types, as the former may respond to medical therapy. Emerging technologies, such as dual-energy computed tomography enterography and iodine density, have allowed more accurate characterization of strictures. Surgical and endoscopic treatment remains the mainstay for fibrotic strictures, but developments in systemic and intralesional biologic therapy have shown efficacy. This article reviews the pathophysiology of this debilitating complication of CD as well as current and emerging diagnostics and treatments.
PMID: 35505943
ISSN: 1554-7914
CID: 5216152

Frailty, Thy Diagnosis Is Uncertain: Impact on IBD Readmission and Mortality [Editorial]

Hong, Simon J; Katz, Seymour
PMID: 33748912
ISSN: 1573-2568
CID: 4875382

Myths and Misconceptions in the Management of Elderly Patients With Inflammatory Bowel Disease

Katz, Seymour; Kane, Sunanda V
PMID: 34602906
ISSN: 1554-7914
CID: 5110762

The elderly IBD patient in the modern era: changing paradigms in risk stratification and therapeutic management

Hong, Simon J; Katz, Seymour
The incidence and prevalence of inflammatory bowel disease (IBD) is rising in the elderly population. Compared with patients with onset during their younger years, patients with elderly onset IBD have a distinct clinical presentation, disease phenotype, and natural history. Genetics contribute less to pathogenesis of disease, whereas biological changes associated with aging including immunosenescence, dysbiosis, and frailty have a greater impact on disease outcomes. With the advent of an increasingly wider array of biologic and small-molecule therapeutic options, data regarding efficacy and safety of these agents in elderly IBD patients specifically are paramount, given the unique characteristics of this population.
PMID: 34276809
ISSN: 1756-283x
CID: 4965892

Challenges in the Management of Inflammatory Bowel Disease

Chapter by: Katz, Seymour; Liu, Yingheng
in: Geriatric gastroenterology by Pitchumoni, CS; Dharmarajan, TS (Eds)
[S.l.] : Springer, 2021
pp. 1675-1690
ISBN: 978-3-030-30193-4
CID: 5325582

Acute Pancreatitis in a Patient With Ulcerative Colitis on Vedolizumab

Lin, Elissa; Katz, Seymour
PMID: 32100867
ISSN: 1536-4844
CID: 4324352

Serious and Opportunistic Infections in Elderly Patients With Inflammatory Bowel Disease

Lin, Elissa; Lin, Kevin; Katz, Seymour
Inflammatory bowel disease (IBD) is often treated with biologics and immunomodulators, which can place elderly IBD patients at risk for serious and opportunistic infections. This article provides an updated account of research on therapies in IBD that are associated with an increased infection risk. Relevant serious and opportunistic infections in the elderly population are discussed along with methods for prevention and treatment. The incidence of infection increases with age and the degree of immunosuppression. Emphasis should be placed on performing vaccinations at the time of IBD diagnosis. Additionally, patients receiving immunosuppressive therapy should avoid live vaccines. Physicians should have a greater awareness of the increased risk of infection in elderly adults and the need for screening for infection prior to initiation of immunosuppressive IBD therapies.
PMID: 31802985
ISSN: 1554-7914
CID: 4297532