2930 Does Triple Antibiotic Therapy Reduce Faecal Calprotectin Levels and Gastrointestinal Symptoms in Patients With Ulcerative Colitis? A Retrospective Study

Abstract

INTRODUCTION: Ulcerative colitis (UC) is characterised by inflammation in the colon and the rectum. The primary symptoms include abdominal pain, diarrhoea, fever, weight loss and anaemia. Fusobacterium varium (F. varium) is present in the colonic mucosa of approximately 80% of patients with UC. Butyric acid, a derivative of F. varium culture supernatants has shown to cause UC-like lesions in mice. F. varium shows susceptibility to a combination of antibiotics whose efficacy in inhibiting inflammation was investigated in this study. Aims To assess the efficacy of triple antibiotic therapy in reducing faecal calprotectin in patients with UC at 6 and 12 weeks. METHODS: A retrospective analysis of patients with UC, who were treated with triple antibiotic therapy between July 2014 and December 2018 was conducted. Patients were treated with three antibiotics tinidazole, rifaximin and nitazoxanide for 12 weeks. Gastrointestinal symptoms and faecal calprotectin were recorded pre-treatment and at 6 and 12 weeks on the treatment. Elevated faecal calprotectin in the stool indicates intestinal inflammation (Normal range ≤ 50 µg/g). Wilcoxon matched-pairs signed rank test was used to compare the differences between data sets, and a P value < 0.05 was considered statistically significant. RESULTS: A total of N = 63 patients (32 M, average age 42 years) with UC treated with the antibiotics were identified. Baseline calprotectin was available for 22 patients, follow-up values at 6 weeks in 8 patients and in 15 patients at 12 weeks of treatment. A significant reduction in faecal calprotectin was observed at 12 weeks on the treatment (median: 64 µg/g) (P = 0.003) but not at 6 weeks (P = 0.382) compared to baseline (median: 252.5 µg/g) (Figure 1). Baseline symptoms were reported for 57 patients, of which 31 patients at 6 weeks and 39 patients reported symptoms at 12 weeks. Diarrhoea and blood in the stool resolved significantly at 6 and 12 weeks on the treatment (P ≤ 0.006) (Figure 2). No changes were seen in constipation, pain, nausea, vomiting, mucus in the stool or weight loss at 6 or 12 week on the treatment versus pre-treatment (P ≥ 0.077). CONCLUSION: A significant improvement in gastrointestinal symptoms and a fall in faecal calprotectin were observed in patients with UC who were treated with a triple antibiotic regimen. Future prospective studies are required to evaluate the efficacy of this therapy in inducing endoscopic remission.