Controlled trial of metronidazole treatment for prevention of crohn's recurrence after ileal resection
Abstract
Background/aims New lesions recur within weeks to months after ileal resection and ileocolonic anastomosis for Crohn's ileitis. A double-blind controlled trial was performed using metronidazole to prevent recurrence after ileal resection.Methods Sixty patients who underwent curative ileal resection and primary anastomosis were included within 1 week after surgery. Thirty patients received metronidazole (20 mg/kg body wt) daily for 3 months, and 30 patients received placebo. Treatment was then discontinued. Nine patients dropped out during treatment, 7 in the metronidazole group and 2 in the placebo arm.Results At 12 weeks, 21 of 28 patients (75%) in the placebo group had recurrent lesions in the neoterminal ileum as compared with 12 of 23 patients (52%) in the metronidazole group (P = 0.09). The incidence of severe endoscopic recurrence was significantly reduced by metronidazole (3 of 23; 13%) as compared with placebo (12 of 28; 43%; P = 0.02). Patients in the metronidazole arm had more frequent side effects. Metronidazole therapy statistically reduced the clinical recurrence rates at 1 year (4% vs. 25%). Reductions at 2 years (26% vs. 43%) and 3 years (30% vs. 50%) were not significant.Conclusions Metronidazole therapy for 3 months decreases the severity of early recurrence of Crohn's disease in the neoterminal ileum after resection and seems to delay symptomatic recurrence.
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Patients who have had a resection for Crohn's disease have a decreased rate of endoscopic and clinical recurrence when metronidazole or ornidazole are used as prophylactic therapies.
“Patients who have had a resection for CD have a decreased rate of endoscopic and clinical recurrence when metronidazole or ornidazole are used as prophylactic therapies.78”
From The gut microbiota and host health: a new clinical frontier (2016) · cites this paper as [78]
Antibiotics demonstrate efficacy in particular groups of patients with Crohn's disease.
“Antibiotics demonstrate efficacy in particular groups of patients with CD”
From The gut microbiota and host health: a new clinical frontier (2016) · cites this paper as [78]
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Neut, C., Bulois, P., Desreumaux, P., Membré, J., Lederman, E., Gambiez, L. P., Cortot, A., Quandalle, P. A., Kruiningen, H. J. V., & Colombel, J. (2002) · The American Journal of Gastroenterology · doi:10.1111/j.1572-0241.2002.05613.x · Cited by 274 · see citing works
“Metronidazole delays endoscopic recurrence after ileocecal resection”
Treatment of inflammatory bowel disease: A review of medical therapy
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“…against strictly anaerobic bacteria and it is reported that treatment of active disease in IBD patients with metronidazole results in complete or partial clinical remission and also prevents recurrence after ileal resection (Greenbloom et al., 1998; Prantera et al., 1998; Rutgeerts et al., 1995).”
BackgroundManagement of Crohn's disease in adults
Hanauer, S. B., & Sandborn, W. J. (2001) · The American Journal of Gastroenterology · doi:10.1111/j.1572-0241.2001.03671.x · Cited by 261 · see citing works
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Interleukin 10 (Tenovil) in the prevention of postoperative recurrence of Crohn's disease
Colombel, J.-F., Rutgeerts, P., Malchow, H., Jacyna, M., Nielsen, O. H., Rask-Madsen, J., van Deventer, S. J. H., Ferguson, A., Desreumaux, P., Forbes, A., et al. (2001) · Gut · doi:10.1136/gut.49.1.42 · Cited by 241 · see citing works
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The Immune Response in Inflammatory Bowel Disease
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Waidmann, M., Bechtold, O., Frick, J.-S., Lehr, H.-A., Schubert, S., Dobrindt, U., Loeffler, J., Bohn, E., & Autenrieth, I. B. (2003) · Gastroenterology · doi:10.1016/s0016-5085(03)00672-3 · Cited by 234 · see citing works
Treatment of IBD: Where We Are and Where We Are Going
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Linskens, R. K., Huijsdens, X. W., Savelkoul, P. H. M., Vandenbroucke-Grauls, C. M. J. E., & Meuwissen, S. G. M. (2001) · Scandinavian Journal of Gastroenterology · doi:10.1080/003655201753265082 · Cited by 233 · see citing works
“Furthermore, in a single report, metronidazole reduced endoscopic and clinical recurrence of CD after ileal resection (142).”
BackgroundTherapy of inflammatory bowel disease
Sands, B. E. (2000) · Gastroenterology · doi:10.1016/s0016-5085(00)70007-2 · Cited by 235 · see citing works
Environmental risk factors for inflammatory bowel diseases: Evidence based literature review
Abegunde, A. T., Muhammad, B. H., Bhatti, O. I., & Ali, T. (2016) · World Journal of Gastroenterology · doi:10.3748/wjg.v22.i27.6296 · Cited by 232 · see citing works
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Fedorak, R. N., Feagan, B. G., Hotte, N., Leddin, D., Dieleman, L. A., Petrunia, D. M., Enns, R. A., Bitton, A., Chiba, N., Paré, P., et al. (2014) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2014.10.031 · Cited by 230 · see citing works
Distinct cytokine patterns in early and chronic ileal lesions of Crohn's disease
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Savarino, E. V., Bodini, G., Dulbecco, P., Assandri, L., Bruzzone, L., Mazza, F., Frigo, A. C., Fazio, V., Marabotto, E., & Savarino, V. (2013) · The American Journal of Gastroenterology · doi:10.1038/ajg.2013.287 · Cited by 214 · see citing works
Candida albicans Colonization and ASCA in Familial Crohn's Disease
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Recent Advances in Characterizing the Gastrointestinal Microbiome in Crohnʼs Disease
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Recent Developments in the Immunology of Inflammatory Bowel Disease
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IOIBD technical review on endoscopic indices for Crohn's disease clinical trials
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Postoperative recurrent luminal Crohnʼs Disease: A systematic review
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“57, NNT 1⁄4 4) relative to placebo.(221,222) However, both these agents were associated with higher risk of adverse events (RR 2.”
BackgroundLinks Between Inflammatory Bowel Disease and Chronic Obstructive Pulmonary Disease
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“Patients who had undergone ileal resection and were treated with metronidazole, an antibiotic that is usually ineffective in patients with ileitis (180), exhibited a delay in symptomatic recurrence (181).”
BackgroundBritish Society of Gastroenterology guidelines on inflammatory bowel disease in adults: 2025
Moran, G. W., Gordon, M. A., Sinopoulou, V., Radford, S. J., Darie, A.-M., Vuyyuru, S. K., Alrubaiy, L., Arebi, N., Blackwell, J., Butler, T. D., et al. (2025) · Gut · doi:10.1136/gutjnl-2024-334395 · Cited by 178 · see citing works
Failure of Synbiotic 2000 to Prevent Postoperative Recurrence of Crohn’s Disease
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“. Typhimurium as well as marked signs of infectious colitis. We also showed that metronidazole induces distinct caecal pathologies and inflammatory responses in 129S1/SvImJ and C57BL/6 mice, which coincided with differences in microbiota populations. This indicates that differences in host microbiota might explain the…”
Probiotics and the Management of Inflammatory Bowel Disease
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“Interestingly, these endoscopic remission rates at 1 year with an antibiotic followed by VSL#3 are similar to those that have previously been described with metronidazole alone.(44)”
ResultThe Value of Myenteric Plexitis to Predict Early Postoperative Crohn’s Disease Recurrence
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Self-citationCombination Ciprofloxacin and Metronidazole for Active Crohn’s Disease
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“Metronidazole is the only antibiotic that has been shown to provide clinical benefit for patients with ileocolonic (3-5) and perianal Crohn’s disease (6) and to delay the recurrence rate after ileal resection (7).”
Comparative Tolerability of Treatments for Inflammatory Bowel Disease
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ACG Clinical Guideline: Management of Crohn's Disease in Adults
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Adherent-invasive Escherichia coli: a putative new E. coli pathotype associated with Crohn's disease
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Cruz, P. P. D., Kang, S., Wagner, J., Buckley, M. J., Sim, W. H., Prideaux, L., Lockett, T. J., McSweeney, C. S., Morrison, M., Kirkwood, C. D., et al. (2014) · Journal of Gastroenterology and Hepatology · doi:10.1111/jgh.12694 · Cited by 157 · see citing works
- Authors
- Rutgeerts, P., Hiele, M., Geboes, K., Peeters, M., Penninckx, F., Aerts, R., & Kerremans, R.
- Affiliations
- Universitair Ziekenhuis Leuven (BE)
- Venue
- Gastroenterology
- Publisher
- Elsevier BV
- Published
- 1995-06
- Volume
- 108
- Issue
- 6
- Pages
- 1617-1621
- ISSN
- 0016-5085 (ISSN-L)
- OpenAlex
- W1980212383
- Cited by
- 743
- References
- 24
- Citations by year
- 2026: 3 · 2025: 11 · 2024: 14 · 2023: 14 · 2022: 6 · 2021: 13 · 2020: 18 · 2019: 17 · 2018: 13 · 2017: 26 · 2016: 27 · 2015: 28 · 2014: 28 · 2013: 25 · 2012: 28
- FWCI
- 10.61
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Inflammatory Bowel Disease
- Health Sciences › Medicine › Surgery › Diverticular Disease and Complications
- Health Sciences › Medicine › Ophthalmology › Ocular Diseases and Behçet’s Syndrome
- Keywords
- metronidazole, Crohn's disease, ileal resection, ileocolic anastomosis, postoperative recurrence, recurrence prevention, endoscopic recurrence
- MeSH terms
- Adult, Crohn Disease, Double-Blind Method, Follow-Up Studies, Humans, Ileum, Metronidazole, Middle Aged, Recurrence
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