Navigating Complex Gastrointestinal Pathologies in the Aging Population: Therapeutic Paradigms for Inflammatory Bowel Disease and Hepatocellular Carcinoma

Abstract

Background: The global demographic shift towards an aging population has precipitated a rise in geriatric gastrointestinal disorders. Specifically, the management of Inflammatory Bowel Disease (IBD) and Hepatocellular Carcinoma (HCC) in the elderly presents unique clinical challenges due to immunosenescence, comorbidities, and polypharmacy.

Methods: We conducted a comprehensive review of current literature regarding therapeutic safety and efficacy in elderly patients (>60 years) with IBD and HCC. The analysis focused on the transition from conventional thiopurines to biological agents in IBD, and the evolution of systemic therapies in HCC, alongside surveillance strategies.

Results: In late-onset IBD, phenotypes often present with less extensive disease but higher mortality risk due to complications. Evidence suggests that while thiopurines remain in use, their safety profile in the elderly is compromised by increased risks of lymphoproliferative disorders and bone marrow suppression. Conversely, biological therapies and newer small molecules show promise but are frequently underprescribed due to infection fears. Regarding HCC, the epidemiological landscape is shifting towards non-viral etiologies. Systemic therapies have evolved, yet elderly patients often receive suboptimal surveillance.

Conclusion: Management of GI pathologies in the elderly requires a paradigm shift from standard protocols to personalized, geriatric-focused care. There is a critical need to include older adults in clinical trials to establish robust safety data for biologics and novel HCC treatments.

Keywords:

Geriatric Gastroenterology, Inflammatory Bowel Disease, Hepatocellular Carcinoma

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