Toxic megacolon medical therapy: Difference between revisions
Jump to navigation
Jump to search
Farima Kahe (talk | contribs) |
Farima Kahe (talk | contribs) No edit summary |
||
| Line 4: | Line 4: | ||
==Overview== | ==Overview== | ||
Pharmacologic medical therapies for toxic megacolon include corticosteroids, | Pharmacologic medical therapies for toxic megacolon include [[corticosteroids]], immunosuppresants and [[antibiotics]]. | ||
==Medical Therapy== | ==Medical Therapy== | ||
| Line 12: | Line 12: | ||
**1.2.Intravenous fluid support to | **1.2.Intravenous fluid support to | ||
**1.3.Electrocytes monitoring and correction of abnormalities | **1.3.Electrocytes monitoring and correction of abnormalities | ||
**1.4.Withdrawal of all anticholinergics, antidiarrheal and narcotics | **1.4.Withdrawal of all [[anticholinergics]], [[antidiarrheal]] and [[narcotics]] | ||
**1.5.Rule out infectious etiology | **1.5.Rule out infectious etiology | ||
*'''2.Decompression''' | *'''2.Decompression''' | ||
**2.1.Rectal tube | **2.1.Rectal tube | ||
**2.2.Nasogastric or long nasointestinal tube | **2.2.[[Nasogastric tube|Nasogastric]] or long nasointestinal tube | ||
*:'''Note:''' Long intestinal tubes are considered to be more effective than nasogastric tubes in colonic decompression but should be placed into the ileum under fluoroscopic guidance. | *:'''Note:''' Long intestinal tubes are considered to be more effective than nasogastric tubes in colonic decompression but should be placed into the ileum under fluoroscopic guidance. | ||
**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> | **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> | ||
| Line 22: | Line 22: | ||
*:'''Note:''' Maneuver 2: Turning to the prone knee-elbow position, which moves the rectum to the highest point in the body | *:'''Note:''' Maneuver 2: Turning to the prone knee-elbow position, which moves the rectum to the highest point in the body | ||
*'''3.Medical management''' | *'''3.Medical management''' | ||
**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> | **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> | ||
***3.1.1.Corticosteroids | ***3.1.1.[[Corticosteroids]] | ||
****Preferred regimen(1): Hydrocortisone 100 mg IV q6h | ****Preferred regimen(1): [[Hydrocortisone]] 100 mg IV q6h | ||
****Preferred regimen(2): Methylprednisolone 60 mg IV q24h | ****Preferred regimen(2): [[Methylprednisolone]] 60 mg IV q24h | ||
***3.1.2.Immunosuppresants | ***3.1.2.Immunosuppresants | ||
****Preferred regimen(1): Cyclosporin 2 mg/kg q24h for 7 days | ****Preferred regimen(1): [[Cyclosporine|Cyclosporin]] 2 mg/kg q24h for 7 days | ||
***:'''Note:''' Maintain serum levels between 150 to 250 ng/mL | ***:'''Note:''' Maintain serum levels between 150 to 250 ng/mL | ||
****Preferred regimen(2): Infliximab 5 mg/kg for 3 to 7 days | ****Preferred regimen(2): [[Infliximab]] 5 mg/kg for 3 to 7 days | ||
**3.2.Toxic megacolon associated with 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> | **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> | ||
***Preferred regimen (1): Vancomycin 500 mg PO q6h or via a nasogastric tube '''AND''' Metronidazole 500 mg IV q8h | ***Preferred regimen (1): [[Vancomycin]] 500 mg PO q6h or via a nasogastric tube '''AND''' [[Metronidazole]] 500 mg IV q8h | ||
==References== | ==References== | ||
Revision as of 19:09, 17 November 2017
|
Toxic Megacolon Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Toxic megacolon medical therapy On the Web |
|
American Roentgen Ray Society Images of Toxic megacolon medical therapy |
|
Risk calculators and risk factors for Toxic megacolon medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Pharmacologic medical therapies 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
- 1.1.Complete bowel rest
- 1.2.Intravenous fluid support to
- 1.3.Electrocytes monitoring and correction of abnormalities
- 1.4.Withdrawal of all anticholinergics, antidiarrheal and narcotics
- 1.5.Rule out infectious etiology
- 2.Decompression
- 2.1.Rectal tube
- 2.2.Nasogastric or long nasointestinal tube
- Note: Long intestinal tubes are considered to be more effective than nasogastric tubes in colonic decompression but should be placed into the ileum under fluoroscopic guidance.
- 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
- 3.1.Toxic megacolon associated with inflammatory bowel disease(IBD)[1][9]
- 3.1.1.Corticosteroids
- Preferred regimen(1): Hydrocortisone 100 mg IV q6h
- Preferred regimen(2): Methylprednisolone 60 mg IV q24h
- 3.1.2.Immunosuppresants
- Preferred regimen(1): Cyclosporin 2 mg/kg q24h for 7 days
- Note: Maintain serum levels between 150 to 250 ng/mL
- Preferred regimen(2): Infliximab 5 mg/kg for 3 to 7 days
- 3.1.1.Corticosteroids
- 3.2.Toxic megacolon associated with Clostridium difficile [10]
- Preferred regimen (1): Vancomycin 500 mg PO q6h or via a nasogastric tube AND Metronidazole 500 mg IV q8h
- 3.1.Toxic megacolon associated with inflammatory bowel disease(IBD)[1][9]
References
- ↑ 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.
- ↑ Autenrieth DM, Baumgart DC (2012). "Toxic megacolon". Inflamm. Bowel Dis. 18 (3): 584–91. doi:10.1002/ibd.21847. PMID 22009735.
- ↑ 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.
- ↑ 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.
- ↑ Koudahl G, Kristensen M (1975). "Toxic megacolon in ulcerative colitis". Scand. J. Gastroenterol. 10 (4): 417–21. PMID 1153934.
- ↑ Meyers S, Janowitz HD (1978). "The place of steroids in the therapy of toxic megacolon". Gastroenterology. 75 (4): 729–31. PMID 213344.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.