Ischemic colitis medical therapy

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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

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  • Sepsis, hypotension, poor cardiac function, hypovolemia and hypoxia should be addressed, and precipitating drugs withdrawn.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

• 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

Normal

Segmental colitis

Segment colectomy