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When I'm 64

As I approach my 43rd birthday this December, I've been thinking about what life might be like in a couple of decades.  Not a mid-life crisis, there's no new convertible in my garage.  My kids will hopefully be functioning adults. I'll be contemplating retirement.  The usual stuff most people face as they age.

I'm thinking about what the hell is my digestive system going to look like when I'm 64?

(For the young readers, "When I'm 64" is a Beatles song.  The Beatles are a pioneering rock-n-roll band from the 1960s.  They're on Spotify.)

If you haven't read my blog before, I have 2 chronic digestive diseases - Crohn's disease and eosinophilic esophagitis.  Neither are great things to have, but I am fortunate to have what I'd consider relatively mild to moderate disease.  For some people these diseases are a complete shit show.  I've had 1 surgery and 1 hospital stay.

But CD and EoE are somewhat progressive.  When I'm 64, I'll have had CD for almost 40 years and EoE for about 30 years.  At 42, the EoE has caused my esophagus to produce "normal" swallows 20% of the time.  Twen-ty percent.  WTF is that?  My esophagus is already retired for all intents and purposes.  If the EoE isn't controlled, it'll continue to screw everything up until my esophagus is about as useful as a barbecue at a vegan convention.

A screen door on a submarine.

A one-legged man in an ass kicking contest.

The Kardashians.

You get the idea.

So because I'm a research nerd I fired up PubMed and looked for longitudinal (meaning, over a long period of time) study on IBD as people age.  The great news is I came up with exactly ZERO results.

There are some studies on elderly onset IBD, but I could find nothing about how IBD progresses over the lifespan.  If someone knows of anything, PLEASE @ me on the Twitter (@OPBMed).

A 2018 review (Link: https://www.ncbi.nlm.nih.gov/pubmed/29563038) noted several interesting, and somewhat concerning, points. But, again, these are in people who developed IBD after age 60 who:
  • Tend to have more colonic disease
  • Overall have milder disease with rare disease progression
  • Can't tolerate the inflammation they have as well as younger patients
  • Are at high risk for adverse events from both the disease and its treatments
  • Frequently develop colon cancer within 8 years of diagnosis
  • Are wholly underrepresented in clinical trials
  • Have more infection risks when taking anti-TNF medications
  • Have more hospital-related complications when taking steroids
I also saw the mantra for treatment is "start low and go slow" in elderly onset IBD.  So what does that mean for those diagnosed at a younger age, already on biologic medications?  Generally it's not advised to go backwards in terms of treatment, but would it be once I'm 64?  One review on deescalation of IBD therapy says it is important to consider the risks of serious complications versus continuing a biologic medication in the elderly with IBD (Link: https://www.ncbi.nlm.nih.gov/pubmed/24957164).

Then I went on to search PubMed for studies on EoE in the elderly and this showed up on my screen:


So I'm left wondering about what things will be when I'm 64 without much guidance from the medical world. I'm sure I'm not alone in this, and gastroenterologists are mindful of how diseases go across the lifespan.  But often disease management is very present focused, put out the fire today, get them in remission. Without this, we're less likely to age in the first place. 

There's not much worrying about this can do for me, so I'll put it on the shelf, maybe a bit in my line of sight as I work to keep my digestive system healthy. But focusing on what's enjoyable today.

--T2

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