Ileus medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Nil per os (NPO or Nothing by Mouth) is mandatory in all cases. Nasogastric suction and parenteral feeds may be required until passage is restored. There are several options in the case of paralytic ileus. Most treatment is supportive. If caused by medication, the offending agent is discontinued or reduced. Bowel movements may be stimulated by prescribing lactulose, erythromycin or in severe cases, (Ogilvie's syndrome) neostigmine. If possible the underlying cause is corrected (e.g. replace electrolytes).
Medical Therapy
Medical therapy for ileus includes correcting the underlying condition and supportive therapy.
- Patients of ileus from electrolyte abnormalities should be treated with appropriate supplementation.
- Antimotility drugs and other medications (narcotics) which may alter intestinal motility should be stopped.
- Nasogastric decompression can relieve recurrent vomiting or abdominal distention associated with pain.
- Prokinetic agents such as erythromycin are not routinely recommended.
- Patients should receive intravenous hydration.
Contraindicated medications
Paralytic ileus is considered an absolute contraindication to the use of the following medications: