Ischemic colitis medical therapy

Colitis Main Page
Ischemic colitis Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Ischemic colitis from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Abdominal X Ray
CT
MRI
Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Ischemic colitis medical therapy On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Ischemic colitis medical therapy All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA onIschemic colitis medical therapy
CDC on Ischemic colitis medical therapy
Ischemic colitis medical therapy in the news
Blogs on Ischemic colitis medical therapy
Directions to Hospitals Treating Ischemic colitis
Risk calculators and risk factors for Ischemic colitis medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hamid Qazi, MD, BSc [2]

Overview

Ischemic colitis is usually treated with supportive care. Treatment is determined by its severity and include intravenous fluids, bowel rest, nasogastric tube, and total parenteral nutrition. Patients with colonic dilatation are managed with insertion of a rectal tube or endoscopic decompression. There is no evidence about the role of anticoagulation or antiplatelet therapy. Steroids have not been shown to improve outcomes.

Medical Therapy

The medical therapy for ischemic colitis is as follows:

• Treatment is determined by its severity
  • Sepsis, hypotension, poor cardiac function, hypovolemia and hypoxia should be addressed, and precipitating drugs withdrawn.
• Patients with colonic dilatation are managed with insertion of a rectal tube or endoscopic decompression.
• There is no evidence about the role of anticoagulation or antiplatelet therapy.
• Steroids have not been shown to improve outcomes.

Intravenous Fluids

• Fluid resuscitation with:
  • Intravenous fluids
  • Bowel rest
  • Nasogastric tube
  • Total parenteral nutrition if prolonged bowel rest

Optimize Cardiac Output

• If possible, cardiac function and oxygenation should be optimized to improve oxygen delivery to the ischemic bowel.

Nasogastric Tube

• A nasogastric tube may be inserted if an ileus is present.

Antibiotics

• Antibiotic use in animal studies has demonstrated reduced duration and severity of ischemic colitis, and prevention of bacterial translocation through damaged mucosa.
  • A study involving dogs demonstrated reduction in vessel thrombosis and increased survival.
• The role of antibiotic therapy in humans requires further research.

Contraindicated medications

• Alosetron

Algorithm of management of ischemic colitis

• The following algorithm represents the management of ischemic colitis.

Abdominal pain, diarrhea, lower GI bleeding

Diagnosis by CT scan or colonoscopy

Stable or improving

Peritonitis signs or gangrenous bowel

Continuation of symptoms

Repeat colonoscopy after 2 weeks

Emergency laparatomy

Resection of diseased bowel

Normal

Segmental colitis

Segment colectomy