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Background The natural history of patients with Montreal classification A2 group is well studied. Available studies on disease characteristics at extreme ages, which form 10%-25% of patients with IBD, focused on pediatric or elderly population, but not all age groups together.1 We aimed to compare the disease characteristics of pediatric- (≤16 years, P) and elderly- (≥60 years, E) onset IBD with 17-59Y middle aged group (M). Methods 266 consecutive patients with IBD were divided into 3 groups according to age of onset. Information about disease location, extent, behavior and need for immunosuppressants / biologics and surgery was entered in pro-forma. Results The table shows details of 258 (P 46, M 170, E 42) patients. 8 IBD-unclassified patients were not included in the analysis as numbers were too small to compare the differences. Among UC patients, pancolitis was more common in the pediatric population (p=0.018) and indolent behavior was more common in elderly population (p=0.005). Almost all UC patients requiring colectomy had extensive colitis(p=0.008). While among CD patients, elderly had more of ileal (p=0.04) and pediatric group had more colonic involvement (p=0.02). Perianal disease was least common in elderly CD group (p=0.03). There were no treatment differences in UC patient subgroups while elderly CD patients less frequently required steroids, biologics, immunosuppressants and surgery(p&amp;lt;0.05) and younger CD patients needed biologics much more frequently (p=0.005). Conclusion Pediatric UC had more pancolitis(E3) while elderly UC had milder disease with EIM less frequently. Significant co-relation was noted between colectomy and extensive colitis. Pediatric CD patients had more colonic (L2) disease with more requirement of biologics, while elderly CD group had more common ileal (L1) disease, least common perianal disease and less requirement of all treatment modalities when compared to adults. This study highlights possible different Indian IBD disease spectrum in contrast to Western literature. 1. Nimmons D, Limdi JK. Elderly patients and inflammatory bowel disease. World J Gastrointest Pharmacol Ther. 2016;7:51–65.

P542 Clinical presentation, disease behavior and management of inflammatory bowel disease at extremes of age