Ischemic colitis medical therapy: Difference between revisions
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Revision as of 20:44, 5 January 2018
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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. 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:[1][2][3][4][5][6]
- Treatment is determined by its severity
- Sepsis, hypotension, poor cardiac function, hypovolaemia and hypoxia should be addressed, and precipitating drugs withdrawn.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
- 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
- The following algorithm represents the management of ischemic colitis.
| Abdominal pain, diarrhea, lower GI bleeding | |||||||||||||||||||||||||||||||||||||||||||||||
| Diagnosis by CT scan or colonscopy | |||||||||||||||||||||||||||||||||||||||||||||||
| Stable or improving | Peritonitis signs or gangrenous bowel | Continuation of symptoms | |||||||||||||||||||||||||||||||||||||||||||||
| Repeat colonoscopy after 2 weeks | Emergency laparatomy | Resection of diseased bowel | |||||||||||||||||||||||||||||||||||||||||||||
| {{{ ! }}} | {{{ }}} | ||||||||||||||||||||||||||||||||||||||||||||||
| {{{ C01 }}} | {{{ C02 }}} | ||||||||||||||||||||||||||||||||||||||||||||||
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.
- ↑ Nikolic, Amanda L.; Keck, James O. (2017). "Ischaemic colitis: uncertainty in diagnosis, pathophysiology and management". ANZ Journal of Surgery. doi:10.1111/ans.14237. ISSN 1445-1433.