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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 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]
In the citing paper
“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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Predictors of recurrence of Crohn’s disease after ileocolectomy: A review
Connelly, T. M. (2014) · World Journal of Gastroenterology · doi:10.3748/wjg.v20.i39.14393 · Cited by 41
State-of-the-art medical prevention of postoperative recurrence of Crohn's disease
Sorrentino, D. R. (2013) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/nrgastro.2013.69 · Cited by 41
Luminal microbiota related to Crohn’s disease recurrence after surgery
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BackgroundReview article: can post‐operative recurrence in Crohn's disease be prevented?
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“Literature data on mesalazine (5-ASA) are conflicting [13–16], while the benefit of nitroimidazole antibiotics, especially metronidazole (MZ), seems to decrease over time [17, 18].”
BackgroundPostoperative Therapy for Crohnʼs Disease
Blum, E. B., & Katz, J. (2008) · Inflammatory Bowel Diseases · doi:10.1002/ibd.20741 · Cited by 41
“, 1999 83 (43, 40) Budesonide 3 mg daily 1 year 1 year Endoscopic (or clinical, when endo refused) (3 months, 1 year) 3 months Placebo: 53% Drug: 38% (P NS)”
Risk of postoperative recurrence and postoperative management of Crohn's disease.
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Medical Therapy for Inflammatory Bowel Disease
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Diagnosis and management of inflammatory bowel disease in children
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New Insights into IBD Epidemiology: Are There Any Lessons for Treatment?
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“Most clinicians feel that antibiotics have an adjunctive role at best in treating active disease, but there are fairly robust data that nitroimidazole therapy can reduce recurrence rates postoperatively [”
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Do probiotics have a therapeutic role in gastroenterology
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Antibiotics and probiotics in inflammatory bowel disease: when to use them?
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“Rutgeerts et al. [ 20 ] conducted a 3-month doubleblind, placebo-controlled trial comparing metronidazole (20 mg/kg) and placebo in patients who had undergone ileal resection and anastomosis.”
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Early-Life Gut Microbiota Governs Susceptibility to Colitis via Microbial-Derived Ether Lipids
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Negative Interactions with the Microbiota: IBD
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Early symptomatic recurrence after intestinal resection in Crohn's disease is unpredictable
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Antibiotics Should Be Used as First-line Therapy for Crohnʼs Disease
Greenberg, G. R. (2004) · Inflammatory Bowel Diseases · doi:10.1097/00054725-200405000-00021 · Cited by 38
Current Therapeutic Approaches in Inflammatory Bowel Disease
Sohrabpour, A. A., Malekzadeh, R., & Keshavarzian, A. (2010) · Current Pharmaceutical Design · doi:10.2174/138161210794079155 · Cited by 37
“In a randomized, placebo-controlled trial, metronidazole (20 mg/kg/day), started within 7 days postoperatively and continued for 12 weeks, was associated with significant reductions in severe endoscopic CD recurrence [205].”
BackgroundUse and Safety of Rifaximin in Children With Inflammatory Bowel Disease
Muniyappa, P., Gulati, R., Mohr, F., & Hupertz, V. F. (2009) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/mpg.0b013e3181a0d269 · Cited by 37
Interventions for prevention of post-operative recurrence of Crohn's disease
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Antibiotics, Probiotics and Prebiotics in IBD
Bernstein, C. N. (2014) · Nestlé Nutrition Institute Workshop series · doi:10.1159/000360713 · Cited by 39
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Evolving Treatment Strategies for Inflammatory Bowel Disease
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Metadata
- 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
- Health Sciences › Medicine › Gastroenterology › 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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