Lower gastrointestinal bleeding medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

Pharmacotherapy is only used as an adjuvant therapy for all patients with LGIB. Epinephrine is used alone or in conjunction with other surgical techniques to treat a variety of causes of LGIB.

Medical Therapy

Pharmacotherapy is only used as an adjuvant therapy for all patients with LGIB. Epinephrine is used alone or in conjunction with other surgical techniques to treat a variety of causes of LGIB. Local injection of epinephrine stops bleeding by both pressure tamponade and the vasoconstrictor effect. In patients with rebleeding, surgery should be considered.

Dosage

• Preferred regimen (1): Local injection of 1:10,000 to 20,000 solution (Intra-arterial vasopressin infusions begin at a rate of 0.2 U/min. If the bleeding persists, the rate of the infusion is increased to 0.4-0.6 U/min).
• Note:- The bleeding stops in about 91% of patients receiving intra-arterial vasopressin but recurs in up to 50% of patients when the infusion is stopped.

Major contraindications

• Closed-angle glaucoma
• Labor
• Shock
• Sulfite hypersensitivity
• CAD, PAD

Complications

During vasopressin infusion, patients must be monitored for:

• Recurrent hemorrhage
• Myocardial ischemia (Nitroglycerine drip can be used to overcome cardiac complications).
• Arrhythmias
• Hypertension
• Volume overload with hyponatremia.