Is Crohn's disease different in the elderly?

We reviewed the records of 22 patients hospitalized at onset or first presentation of Crohn's disease after age 50. There were 12 females and 10 males, and the mean age was 64.5 years. The most common presenting symptoms were: abdominal pain, fever, diarrhea and weight loss. The disease was located in the small bowel in 14, in the ileo-colic region in 3 and in the colon in 5. The median interval from onset of symptoms until diagnosis was 42 months. 12 (54%) underwent surgery. All 5 patients with colonic disease were operated. 6 patients underwent small bowel resections, mostly terminal ileum, while 1 had resection of both terminal ileum and left colon. The recurrence rate was 70% in the medically treated and 50% in those operated. 1 patient died after surgery for Crohn's disease (4.5%), and 3 others died of unrelated causes. Compared to younger patients, the symptomatology, clinical course, need for and response to surgery, and its complications, did not differ in these older patients, but the recurrence rate seemed to be higher.