As the inflammatory bowel disease (IBD) population ages and the incidence of elderly-onset IBD increases, the prevalence of elderly IBD will continue to increase.1 In North America, the increase in prevalence of IBD was higher in the elderly population than any other age group.2 This shift in demographics introduces new considerations in medical decision making as the risk profile of medical therapy also fluctuates with age. Malignancies are the leading cause of death in elderly and middle-aged IBD patients.