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J Crohns Colitis. 2019 Feb 27. pii: jjz047. doi: 10.1093/ecco-jcc/jjz047. [Epub ahead of print]

Low-dose metronidazole is associated with a decreased rate of endoscopic recurrence of Crohn's disease after ileal resection: a retrospective cohort study.

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Pritzker School of Medicine, University of Chicago.
Inflammatory Bowel Disease Center, University of Chicago Medicine.
Department of Medicine, University of Chicago Medicine.
Department of Surgery, University of Chicago Medicine.



Recurrence of Crohn's disease after surgical resection and primary anastomosis is an important clinical challenge. Previous studies have demonstrated the benefit of imidazole antibiotics, but have been limited by adverse events and medication intolerance. We evaluated whether administration of low-dose metronidazole (250mg TID) for three months reduces endoscopic postoperative recurrence rates.


We performed a retrospective cohort study of patients with Crohn's disease who underwent ileal resection with a primary anastomosis and subsequently received care at our center. We compared the cases who received low-dose metronidazole for three months to control patients who did not receive this therapy. Data collected included demographics, risk factors for recurrence, and medications before and after surgery. The primary endpoint was the number of patients with ≥i2 (Rutgeerts) endoscopic recurrence by 12 months. Variables found to be predictive in univariate analysis at p<0.10 were introduced in the Cox model for multivariate analysis.


70 Crohn's disease patients (35 cases) met inclusion criteria. Risk factors for Crohn's recurrence were similar between groups. The number of patients with ≥i2 endoscopic recurrence within 12 months following ileal resection was significantly lower in the metronidazole group (7 of 35 patients; 20%) compared to the control group (19 of 35 patients; 54.3%) (p=0.0058). Eight participants (22.9%) in the metronidazole group experienced adverse events, and 3 of these patients (8.6%) discontinued the therapy.


Low-dose metronidazole reduces endoscopic recurrence of Crohn's disease postoperatively and is well tolerated. This intervention should be considered as a therapy option following ileocolonic resection.


Crohn’s disease; endoscopic recurrence; metronidazole


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