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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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Yang, Z., Wu, Q., Wu, K., & Fan, D. (2014) · Expert Review of Gastroenterology & Hepatology · doi:10.1586/17474124.2014.917958 · Cited by 1
“Nitroimidazole antibiotics can reduce the early relapse following surgery, but the side effects of long-term use are intolerable to patients [40,44,45].”
BackgroundMethodStandard Therapeutic Approach and New Therapies
Mendolaro, M., Viola, A., & Cappello, M. (2015) · Springer eBooks · doi:10.1007/978-3-319-23066-5_7 · Cited by 1
Medical Therapy for Crohn’s Disease: The Present
Fausel, R. A., & Zisman, T. L. (2015) · Springer eBooks · doi:10.1007/978-3-319-14181-7_3 · Cited by 1
Insufficiency of ileocolic anastomosis in Crohn’s disease patients – prevention and treatment
Cwaliński, J., Stawczyk‐Eder, K., Cwalińska, A., Zasada, W., Cholerzyńska, H., Banasiewicz, T., & Paszkowski, J. (2025) · World Journal of Gastrointestinal Surgery · doi:10.4240/wjgs.v17.i5.102064 · Cited by 1
“Another suggestion proposed by Rutgeerts et al [43] is the simultaneous use of metronidazole and ornidazole as a curative treatment for limiting inflammation.”
Kelsen, J. R., & Wu, G. D. (2012) · Springer eBooks · doi:10.1007/978-1-4614-5061-0_4 · Cited by 1
Zadravec, P., Štrukelj, B., & Berlec, A. (2012) · InTech eBooks · doi:10.5772/27804 · Cited by 1
“Rutgeerts and coworkers published two double-blind randomized studies of the efficacy of nitroimidazole antibiotics in the prevention of postoperative CD (Rutgeerts et al., 2005; Rutgeerts et al., 1995).”
BackgroundActualización del diagnóstico y tratamiento de la enfermedad de Crohn
Chaparro, M., & Gisbert, J. P. (2016) · Medicine - Programa de Formación Médica Continuada Acreditado · doi:10.1016/j.med.2016.02.018 · Cited by 1
Probiotics, Prebiotics, and Antibiotics in IBD
Gionchetti, P., Calabrese, C., Calafiore, A., & Rizzello, F. (2017) · Springer eBooks · doi:10.1007/978-3-319-33703-6_46 · Cited by 1
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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