Ulcerative colitis may occur at any age, though most people receive a diagnosis in young to mid-adulthood, such as in their 30s. However, early or late-onset UC may develop in children, teenagers, or older adults.
This article looks at the age people generally develop UC and the occurrence of early and late-onset UC. We also look at possible differences in causes, risk factors, and treatments for UC across different age groups.
Inflammatory bowel disease (IBD) has two forms: Ulcerative colitis (UC) and Crohn’s. These conditions cause chronic inflammation of all or part of the gastrointestinal tract.
A person can develop UC at any age throughout their life, but doctors diagnose most people in their mid-30s. Further research from 2014 corroborates this age by suggesting that in most populations, people develop UC between their 20s and 30s.
Due to the combination of factors, it is possible that it could occur earlier or later in life. Evidence from older research above shows that it increasingly affects children and older adults.
A note about sex and gender
Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.
People who receive a diagnosis before adulthood — early-onset — account for around 5–10% of all IBD cases.
Meanwhile, approximately 25–35% of people with IBD are under 60. Around 15% had received a late diagnosis, while 20% diagnosed when younger now had transitioned into older age. Specifically with UC, the incidence rate increases from 1.1 per 100,000 people to 16.5 per 100,000 people per year in older people.
The onset of UC and the presentation of the disease varies across the different groups: early-onset and late-onset.
Early-onset
Up to 80,000 children in the United States may have IBD. Early-onset IBD seems to manifest in children differently. Crohn’s disease is twice as frequent as UC, and more boys seem to develop it than girls in childhood.
Doctors diagnose most children after the age of 15. Although, in rare cases, children under 8 have also received a diagnosis.
Generally, early-onset UC causes more extensive inflammation and follows a more severe course than when diagnosed in adulthood.
Some children with IBD may also experience delayed puberty or growth during that period and later in life.
Late-onset
The Crohn’s and Colitis Foundation estimates that 8–16% of people receive an IBD diagnosis when they are 60 or older.
The symptoms are generally the same across age groups. However, diarrhea and bleeding are more likely present in older adults.
The location of UC inflammation appears to remain stable in more than 80% of late-onset patients, compared with the 49% rate of extension reported in the early-onset population.
UC seems to affect males and females equally, but older males are more likely to receive a diagnosis than older females.
Mid vs. late-onset
The clinical manifestations of the disease demonstrated that abdominal pain was less common in late-onset UC compared to mid-late onset.
The risk of developing UC is between 1.6–30% if a person has a first-degree relative with the disease. However, it is not possible to predict who and when a person will be affected, or if at all.
While experts do not understand the exact cause of IBD, it usually occurs as a result of multiple factors:
- genetic predisposition
- environment
- abnormal immune responses
- epithelial barrier defects
While genetics is a key factor in the development of UC, just having genes associated with IBD does not entirely determine if the disease will occur. A person may be more susceptible based on their genetics but also dependent on environmental triggers.
Possible triggers may include:
- smoking
- medication use such as antibiotics or nonsteroidal anti-inflammatory drugs
- diet
- urban areas of the world, and more often in northern climates
In early-onset UC, genetic factors seem to play a greater role. While in late-onset IBD, environmental factors show a more prominent role.
There are still some uncertainties surrounding the treatments according to age at IBD diagnosis.
A 2014 study suggested that the symptoms, location, and frequency of disease activity are more widespread for children early on. Therefore, doctors recommend immunomodulators or biological therapy as the initial lines of treatment. Learn more about UC-approved drugs.
The above research confirmed that, in comparison, people with late-onset IBD received 5 aminosalycte-acid and steroids as treatment for UC. More children and adults required systemic steroids during follow-up compared to the late-onset population.
Moreover,
UC can affect a person at any age, but most people receive a UC diagnosis in their 30s. However, there is also the possibility that doctors diagnose individuals before the age of 15 or after the age of 40–65.
The variation in the onset of the disease causes it to manifest differently across age groups. Children generally have more extensive inflammation and widespread areas affected compared to adults.
Genetics seems to play more of a role in determining early-onset UC, whereas environmental triggers may lead to a late-onset of the disease.
Differences also exist in the treatment guidelines and strategies based on the age of diagnosis.