Lower gastrointestinal bleeding medical therapy

Lower gastrointestinal bleeding Microchapters
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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]

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, monitor patients for:

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