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P389 Low-dose metronidazole is associated with a decreased rate of endoscopic recurrence of Crohn's disease after ileal resection

Glick L.*1, Sossenheimer P.H.1, Hirsch A.1, Hurst R.D.2, Cohen R.D.1, Hyman N.2, Rubin D.T.1

1University of Chicago Medicine, Inflammatory Bowel Disease Center, Chicago, United States 2University of Chicago Medicine, Department of Surgery, Chicago, United States

Background

Recurrence of Crohn's disease (CD) 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 (LD) metronidazole (250 mg three times a day) for three months reduces endoscopic postoperative recurrence rates.

Methods

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 LD metronidazole (primarily from one clinician, DTR) to control patients (DTR and others) 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.

Results

70 Crohn's patients (35 cases) met inclusion criteria. Risk factors for Crohn's recurrence were similar between groups (Table 1).

Table 1. Patient characteristics

Median time to endoscopic follow-up for both groups was similar (cases: 184 days, IQR 178–246; controls: 192 days, IQR 166–250). The number of patients with ≥i2 endoscopic recurrence following ileal resection was significantly lower in the LD metronidazole group (7 of 35 patients; 20%) compared to the control group (19 of 35 patients; 54.3%) (p=0.0058) (Figure 1).

Figure 1. Percent of patients without endoscopic recurrence (Rutgeerts score <i2) and with endoscopic recurrence (Rutgeerts score ≥i2) after ileal resection with primary anastomosis (95% CI: 0.065–0.610; p=0.0058).

Eight participants (22.86%) in the LD metronidazole group experienced adverse events, and 3 of these patients (8.57%) discontinued the therapy.

Conclusion

Low-dose metronidazole for 3 months postoperatively significantly reduces endoscopic recurrence of CD and is safe and well-tolerated. This intervention should be considered as a bridge to other therapies after ileocecetomy.