PROGNOSIS AND MANAGEMENT OF CROHNS-DISEASE IN THE OVER-55 AGE GROUP

The course, prognosis and management of 62 patients with Crohn's disea se aged 55 years or over at diagnosis has been reviewed. The distal il eus was the commonest site of disease in the older patient, where the characteristic presentation was acute after initially mild symptoms. E arly local resection was often required, particularly where there was diagnostic doubt or suspicion of caecal malignancy. Recurrence rates w ere much lower in the older patient than after resection in younger pa tients. Medical treatment played a minor role in the management of pat ients with distal ileal disease, in part because stricture formation w as present at diagnosis and the acute nature of symptoms at presentati on led to early surgical treatment. Colonic Crohn's disease was usuall y confined to the distal or left side of the colon and initially could be difficult to distinguish from diverticular disease. Extensive colo nic Crohn's disease was rare. The apparently limited disease was not n ecessarily associated with a good prognosis, since disease at this sit e sometimes progressed rapidly, necessitating urgent surgical resectio n. Medical treatment (corticosteriod therapy, with or without azathiop rine) was usually effective initially for treatment of symptomatic col onic Crohn's disease, but sustained remission was rare. Those patients with persistent symptoms were restored to good health with surgical t reatment but at a price, in that nearly half eventually required a per manent stoma.