Ischemic colitis medical therapy: Difference between revisions
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==Medical Therapy== | ==Medical Therapy== | ||
The medical therapy for ischemic colitis is as follows:<ref>PATH, EJ, McCLURE, JN Jr. Intestinal obstruction; the protective action of sulfasuxidine and sulfathalidine to the ileum following vascular damage. Ann Surg 1950; 131:159.</ref><ref>{{cite journal | author = Plonka A, Schentag J, Messinger S, Adelman M, Francis K, Williams J | title = Effects of enteral and intravenous antimicrobial treatment on survival following intestinal ischemia in rats. | journal = J Surg Res | volume = 46 | issue = 3 | pages = 216-20 | year = 1989 | id = PMID 2921861}}</ref><ref>{{cite journal | author = Bennion R, Wilson S, Williams R | title = Early portal anaerobic bacteremia in mesenteric ischemia. | journal = Arch Surg | volume = 119 | issue = 2 | pages = 151-5 | year = 1984 | id = PMID 6696611}}</ref><ref>{{cite journal | author = Redan J, Rush B, Lysz T, Smith S, Machiedo G | title = Organ distribution of gut-derived bacteria caused by bowel manipulation or ischemia. | journal = Am J Surg | volume = 159 | issue = 1 | pages = 85-9; discussion 89-90 | year = 1990 | id = PMID 2403765}}</ref><ref>Feldman: Sleisenger & Fordtran's Gastrointestinal and Liver Disease, 7th ed., 2002 Saunders, p. 2334.</ref> | The medical therapy for ischemic colitis is as follows:<ref>PATH, EJ, McCLURE, JN Jr. Intestinal obstruction; the protective action of sulfasuxidine and sulfathalidine to the ileum following vascular damage. Ann Surg 1950; 131:159.</ref><ref>{{cite journal | author = Plonka A, Schentag J, Messinger S, Adelman M, Francis K, Williams J | title = Effects of enteral and intravenous antimicrobial treatment on survival following intestinal ischemia in rats. | journal = J Surg Res | volume = 46 | issue = 3 | pages = 216-20 | year = 1989 | id = PMID 2921861}}</ref><ref>{{cite journal | author = Bennion R, Wilson S, Williams R | title = Early portal anaerobic bacteremia in mesenteric ischemia. | journal = Arch Surg | volume = 119 | issue = 2 | pages = 151-5 | year = 1984 | id = PMID 6696611}}</ref><ref>{{cite journal | author = Redan J, Rush B, Lysz T, Smith S, Machiedo G | title = Organ distribution of gut-derived bacteria caused by bowel manipulation or ischemia. | journal = Am J Surg | volume = 159 | issue = 1 | pages = 85-9; discussion 89-90 | year = 1990 | id = PMID 2403765}}</ref><ref>Feldman: Sleisenger & Fordtran's Gastrointestinal and Liver Disease, 7th ed., 2002 Saunders, p. 2334.</ref> | ||
* Treatment is determined by its severity | |||
** Precipitating factors such as sepsis, hypotension, poor cardiac function, hypovolaemia and hypoxia should be addressed, and precipitating drugs withdrawn. | |||
* Fluid resuscitation | |||
** intravenous fluids | |||
** bowel rest | |||
** nasogastric tube | |||
** total parenteral nutrition if prolonged bowel rest | |||
* Patients with colonic dilatation are managed with insertion of a rectal tube or endoscopic decompression. | |||
* Antibiotic use in animal studies has demonstrated reduced duration and severity of IC, 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 limiting the duration and severity of IC in humans requires further research. | |||
* There is no evidence available about the role of anticoagulation or antiplatelet therapy in acute presentations of IC, prevention of recurrence or in mitigating death from vascular causes. | |||
** Antiplatelets have an established role in limiting tissue injury in ischemia and ischemia-reperfusion events, such as stroke and acute myocardial infarction. | |||
** Further research into potential benefits of antiplatelets may be warranted. | |||
* Steroids have not been shown to improve outcomes. | |||
===Intravenous Fluids=== | ===Intravenous Fluids=== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hamid Qazi, MD, BSc [2]
Overview
Except in the most severe cases, ischemic colitis is treated with supportive care.
Medical Therapy
The medical therapy for ischemic colitis is as follows:[1][2][3][4][5]
- Treatment is determined by its severity
- Precipitating factors such as sepsis, hypotension, poor cardiac function, hypovolaemia and hypoxia should be addressed, and precipitating drugs withdrawn.
- Fluid resuscitation
- intravenous fluids
- bowel rest
- nasogastric tube
- total parenteral nutrition if prolonged bowel rest
- Patients with colonic dilatation are managed with insertion of a rectal tube or endoscopic decompression.
- Antibiotic use in animal studies has demonstrated reduced duration and severity of IC, 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 limiting the duration and severity of IC in humans requires further research.
- There is no evidence available about the role of anticoagulation or antiplatelet therapy in acute presentations of IC, prevention of recurrence or in mitigating death from vascular causes.
- Antiplatelets have an established role in limiting tissue injury in ischemia and ischemia-reperfusion events, such as stroke and acute myocardial infarction.
- Further research into potential benefits of antiplatelets may be warranted.
- Steroids have not been shown to improve outcomes.
Intravenous Fluids
- IV fluids are given to treat dehydration, and the patient is placed on bowel rest (meaning nothing to eat or drink) until the symptoms resolve.
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
- Antibiotics are sometimes given in moderate to severe cases. The data supporting this practice dates to the 1950s. More recent animal data suggests that antibiotics may increase survival and prevent bacteria from crossing the damaged lining of the colon into the bloodstream.
- The use of prophylactic antibiotics in ischemic colitis has not been prospectively evaluated in humans, but many authorities recommend their use based on the animal data.
Contraindicated medications
Ischemic colitis is considered an absolute contraindication to the use of the following medications:
References
- ↑ PATH, EJ, McCLURE, JN Jr. Intestinal obstruction; the protective action of sulfasuxidine and sulfathalidine to the ileum following vascular damage. Ann Surg 1950; 131:159.
- ↑ Plonka A, Schentag J, Messinger S, Adelman M, Francis K, Williams J (1989). "Effects of enteral and intravenous antimicrobial treatment on survival following intestinal ischemia in rats". J Surg Res. 46 (3): 216–20. PMID 2921861.
- ↑ Bennion R, Wilson S, Williams R (1984). "Early portal anaerobic bacteremia in mesenteric ischemia". Arch Surg. 119 (2): 151–5. PMID 6696611.
- ↑ Redan J, Rush B, Lysz T, Smith S, Machiedo G (1990). "Organ distribution of gut-derived bacteria caused by bowel manipulation or ischemia". Am J Surg. 159 (1): 85–9, discussion 89-90. PMID 2403765.
- ↑ Feldman: Sleisenger & Fordtran's Gastrointestinal and Liver Disease, 7th ed., 2002 Saunders, p. 2334.