Toxic megacolon medical therapy: Difference between revisions
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==Medical Therapy== | ==Medical Therapy== | ||
Medical therapy of Toxic megacolon include:<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="pmid22009735">{{cite journal |vauthors=Autenrieth DM, Baumgart DC |title=Toxic megacolon |journal=Inflamm. Bowel Dis. |volume=18 |issue=3 |pages=584–91 |year=2012 |pmid=22009735 |doi=10.1002/ibd.21847 |url=}}</ref> | Medical therapy of Toxic megacolon include:<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="pmid22009735">{{cite journal |vauthors=Autenrieth DM, Baumgart DC |title=Toxic megacolon |journal=Inflamm. Bowel Dis. |volume=18 |issue=3 |pages=584–91 |year=2012 |pmid=22009735 |doi=10.1002/ibd.21847 |url=}}</ref> | ||
*1.General considerations | *'''1.General considerations''' | ||
**1.1.Complete bowel rest | **1.1.Complete bowel rest | ||
**1.2.Intravenous fluid support to | **1.2.Intravenous fluid support to | ||
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**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 or long nasointestinal tube | ||
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*:'''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 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 | *:'''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 | ||
Revision as of 19:15, 8 November 2017
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Toxic megacolon medical therapy On the Web |
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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
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
OR
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
OR
The majority of cases of [disease name] are self-limited and require only supportive care.
OR
[Disease name] is a medical emergency and requires prompt treatment.
OR
The mainstay of treatment for [disease name] is [therapy].
OR The optimal therapy for [malignancy name] depends on the stage at diagnosis.
OR
[Therapy] is recommended among all patients who develop [disease name].
OR
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
OR
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
OR
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
OR
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
Medical Therapy
Medical therapy of Toxic megacolon include:[1][2]
- 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][5]
- 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 [6]
- 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][5]
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.
- ↑ 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.