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__NOTOC__
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{{Toxic megacolon}}
{{Toxic megacolon}}
{{CMG}}; {{AE}}  
{{CMG}}; {{AE}} {{F.K}}


==Overview==
==Overview==
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
Medical therapy of toxic megacolon include stablizing the patient, decompression and medications. Medications for toxic megacolon include [[corticosteroids]], immunosuppresants and [[antibiotics]].
 
OR
 
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
 
OR
 
The majority of cases of [disease name] are self-limited and require only supportive care.
 
OR
 
[Disease name] is a medical emergency and requires prompt treatment.
 
OR
 
The mainstay of treatment for [disease name] is [therapy].
 
OR
 
The optimal therapy for [malignancy name] depends on the stage at diagnosis.
 
OR
 
[Therapy] is recommended among all patients who develop [disease name].
 
OR
 
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
 
OR
 
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
 
OR
 
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
 
OR
 
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].


==Medical Therapy==
==Medical Therapy==
*Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
Medical therapy of Toxic megacolon include:<ref name="GanBeck2003">{{cite journal|last1=Gan|first1=S. Ian|last2=Beck|first2=P. L.|title=A new look at toxic megacolon: an update and review of incidence, etiology, pathogenesis, and management|journal=The American Journal of Gastroenterology|volume=98|issue=11|year=2003|pages=2363–2371|issn=0002-9270|doi=10.1111/j.1572-0241.2003.07696.x}}</ref><ref name="pmid22009735">{{cite journal |vauthors=Autenrieth DM, Baumgart DC |title=Toxic megacolon |journal=Inflamm. Bowel Dis. |volume=18 |issue=3 |pages=584–91 |year=2012 |pmid=22009735 |doi=10.1002/ibd.21847 |url=}}</ref><ref name="pmid6665937">{{cite journal |vauthors=Farkouh E, Wassef R, Allard M, Atlas H |title=Toxic megacolon in inflammatory colon disease |language=French |journal=Union Med Can |volume=112 |issue=11 |pages=1014–6 |year=1983 |pmid=6665937 |doi= |url=}}</ref><ref name="pmid12918536">{{cite journal |vauthors=Gonzáles Lara V, Pérez Calle JL, Marín Jiménez I |title=Approach to toxic megacolon |journal=Rev Esp Enferm Dig |volume=95 |issue=6 |pages=422–8, 415–21 |year=2003 |pmid=12918536 |doi= |url=}}</ref><ref name="pmid1153934">{{cite journal |vauthors=Koudahl G, Kristensen M |title=Toxic megacolon in ulcerative colitis |journal=Scand. J. Gastroenterol. |volume=10 |issue=4 |pages=417–21 |year=1975 |pmid=1153934 |doi= |url=}}</ref><ref name="pmid213344">{{cite journal |vauthors=Meyers S, Janowitz HD |title=The place of steroids in the therapy of toxic megacolon |journal=Gastroenterology |volume=75 |issue=4 |pages=729–31 |year=1978 |pmid=213344 |doi= |url=}}</ref>
*Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
*'''1. General considerations'''
*Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
**1.1. Complete bowel rest
*Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
**1.2. [[Intravenous fluid]] support 
===Disease Name===
**1.3. Electrocytes monitoring and correction of abnormalities
 
**1.4. Withdrawal of all [[anticholinergics]], [[antidiarrheal]] and [[narcotics]]
* '''1 Stage 1 - Name of stage'''
**1.5. Rule out infectious etiology
** 1.1 '''Specific Organ system involved 1'''
*'''2. Decompression'''
*** 1.1.1 '''Adult'''
**2.1. Rectal tube
**** Preferred regimen (1): [[drug name]] 100 mg PO q12h for 10-21 days '''(Contraindications/specific instructions)''' 
**2.2. [[Nasogastric tube|Nasogastric]] or long naso-intestinal tube
**** Preferred regimen (2): [[drug name]] 500 mg PO q8h for 14-21 days
*:'''Note:''' Long intestinal tubes are considered to be more effective than naso-gastric tubes in colonic decompression but should be placed into the [[ileum]] under [[Fluoroscopy|fluoroscopic]] guidance.
**** Preferred regimen (3): [[drug name]] 500 mg q12h for 14-21 days
**2.3. Repositioning maneuvers<ref name="pmid3183326">{{cite journal |vauthors=Present DH, Wolfson D, Gelernt IM, Rubin PH, Bauer J, Chapman ML |title=Medical decompression of toxic megacolon by "rolling". A new technique of decompression with favorable long-term follow-up |journal=J. Clin. Gastroenterol. |volume=10 |issue=5 |pages=485–90 |year=1988 |pmid=3183326 |doi= |url=}}</ref><ref name="pmid8282262">{{cite journal |vauthors=Panos MZ, Wood MJ, Asquith P |title=Toxic megacolon: the knee-elbow position relieves bowel distension |journal=Gut |volume=34 |issue=12 |pages=1726–7 |year=1993 |pmid=8282262 |pmc=1374472 |doi= |url=}}</ref>
**** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
*:'''Note:''' Maneuver 1: Asking patients to roll into the prone position for 10-15 minutes every 2-3 hours and encourage them to pass gas.  
**** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
*:'''Note:''' Maneuver 2: Turning to the prone knee-elbow position, which moves the rectum to the highest point in the body.
**** Alternative regimen (3): [[drug name]] 500 mg PO q6h for 14–21 days
*'''3. Medical management'''
*** 1.1.2 '''Pediatric'''
**3.1. Toxic megacolon associated with [[inflammatory bowel disease]](IBD):<ref name="GanBeck2003">{{cite journal|last1=Gan|first1=S. Ian|last2=Beck|first2=P. L.|title=A new look at toxic megacolon: an update and review of incidence, etiology, pathogenesis, and management|journal=The American Journal of Gastroenterology|volume=98|issue=11|year=2003|pages=2363–2371|issn=0002-9270|doi=10.1111/j.1572-0241.2003.07696.x}}</ref><ref name="pmid22131898">{{cite journal |vauthors=Strong SA |title=Management of acute colitis and toxic megacolon |journal=Clin Colon Rectal Surg |volume=23 |issue=4 |pages=274–84 |year=2010 |pmid=22131898 |pmc=3134807 |doi=10.1055/s-0030-1268254 |url=}}</ref>
**** 1.1.2.1 (Specific population e.g. '''children < 8 years of age''')
***3.1.1. [[Corticosteroids]]:
***** Preferred regimen (1): [[drug name]] 50 mg/kg PO per day q8h (maximum, 500 mg per dose) 
****Preferred regimen (1): [[Hydrocortisone]] 100 mg IV q6h
***** Preferred regimen (2): [[drug name]] 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
****Preferred regimen (2): [[Methylprednisolone]] 60 mg IV q24h
***** Alternative regimen (1): [[drug name]]10 mg/kg PO q6h (maximum, 500 mg per day)
***3.1.2. Immunosuppresants:
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
****Preferred regimen (1): [[Cyclosporine|Cyclosporin]] 2 mg/kg q24h for 7 days
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
***:'''Note:''' Maintain serum levels between 150 to 250 ng/mL
****1.1.2.2 (Specific population e.g. ''''''children < 8 years of age'''''')
****Preferred regimen (2): [[Infliximab]] 5 mg/kg for 3 to 7 days  
***** Preferred regimen (1): [[drug name]] 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
**3.2. Toxic megacolon associated with [[Clostridium difficile|''Clostridium difficile'']] <ref name="pmid3781329">{{cite journal |vauthors=Bolton RP, Culshaw MA |title=Faecal metronidazole concentrations during oral and intravenous therapy for antibiotic associated colitis due to Clostridium difficile |journal=Gut |volume=27 |issue=10 |pages=1169–72 |year=1986 |pmid=3781329 |pmc=1433873 |doi= |url=}}</ref>
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h (maximum, 500 mg per day)
***Preferred regimen (1): [[Vancomycin]] 500 mg PO q6h or via a naso-gastric tube '''AND''' [[Metronidazole]] 500 mg IV q8h
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose) 
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
** 1.2 '''Specific Organ system involved 2'''
*** 1.2.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 500 mg PO q8h
*** 1.2.2  '''Pediatric'''
**** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h (maximum, 500 mg per dose)
 
* 2 '''Stage 2 - Name of stage'''
** 2.1 '''Specific Organ system involved 1 '''
**: '''Note (1):'''
**: '''Note (2)''':  
**: '''Note (3):'''  
*** 2.1.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.1.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) ''''''(Contraindications/specific instructions)''''''
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days (maximum,500 mg per dose)
** 2.2 '''Other Organ system involved 2'''
**: '''Note (1):'''
**: '''Note (2):'''
**: '''Note (3):'''
*** 2.2.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.2.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)


==References==
==References==
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{{WH}}
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[[Category: (name of the system)]]
[[Category:Surgery]]
[[Category:Gastroenterology]]
[[Category:Emergency medicine]]
[[Category:Disease]]

Latest revision as of 18:50, 8 December 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Farima Kahe M.D. [2]

Overview

Medical therapy of toxic megacolon include stablizing the patient, decompression and medications. Medications for toxic megacolon include corticosteroids, immunosuppresants and antibiotics.

Medical Therapy

Medical therapy of Toxic megacolon include:[1][2][3][4][5][6]

  • 1. General considerations
  • 2. Decompression
    • 2.1. Rectal tube
    • 2.2. Nasogastric or long naso-intestinal tube
    Note: Long intestinal tubes are considered to be more effective than naso-gastric tubes in colonic decompression but should be placed into the ileum under fluoroscopic guidance.
    • 2.3. Repositioning maneuvers[7][8]
    Note: Maneuver 1: Asking patients to roll into the prone position for 10-15 minutes every 2-3 hours and encourage them to pass gas.
    Note: Maneuver 2: Turning to the prone knee-elbow position, which moves the rectum to the highest point in the body.
  • 3. Medical management

References

  1. ↑ 1.0 1.1 Gan, S. Ian; Beck, P. L. (2003). "A new look at toxic megacolon: an update and review of incidence, etiology, pathogenesis, and management". The American Journal of Gastroenterology. 98 (11): 2363–2371. doi:10.1111/j.1572-0241.2003.07696.x. ISSN 0002-9270.
  2. ↑ Autenrieth DM, Baumgart DC (2012). "Toxic megacolon". Inflamm. Bowel Dis. 18 (3): 584–91. doi:10.1002/ibd.21847. PMID 22009735.
  3. ↑ Farkouh E, Wassef R, Allard M, Atlas H (1983). "Toxic megacolon in inflammatory colon disease". Union Med Can (in French). 112 (11): 1014–6. PMID 6665937.
  4. ↑ Gonzáles Lara V, Pérez Calle JL, Marín Jiménez I (2003). "Approach to toxic megacolon". Rev Esp Enferm Dig. 95 (6): 422–8, 415–21. PMID 12918536.
  5. ↑ Koudahl G, Kristensen M (1975). "Toxic megacolon in ulcerative colitis". Scand. J. Gastroenterol. 10 (4): 417–21. PMID 1153934.
  6. ↑ Meyers S, Janowitz HD (1978). "The place of steroids in the therapy of toxic megacolon". Gastroenterology. 75 (4): 729–31. PMID 213344.
  7. ↑ Present DH, Wolfson D, Gelernt IM, Rubin PH, Bauer J, Chapman ML (1988). "Medical decompression of toxic megacolon by "rolling". A new technique of decompression with favorable long-term follow-up". J. Clin. Gastroenterol. 10 (5): 485–90. PMID 3183326.
  8. ↑ Panos MZ, Wood MJ, Asquith P (1993). "Toxic megacolon: the knee-elbow position relieves bowel distension". Gut. 34 (12): 1726–7. PMC 1374472. PMID 8282262.
  9. ↑ Strong SA (2010). "Management of acute colitis and toxic megacolon". Clin Colon Rectal Surg. 23 (4): 274–84. doi:10.1055/s-0030-1268254. PMC 3134807. PMID 22131898.
  10. ↑ Bolton RP, Culshaw MA (1986). "Faecal metronidazole concentrations during oral and intravenous therapy for antibiotic associated colitis due to Clostridium difficile". Gut. 27 (10): 1169–72. PMC 1433873. PMID 3781329.

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