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:[1][2][3][4][5][6]

Intravenous Fluids

Optimize Cardiac Output

Nasogastric Tube

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

Algorithm of management of ischemic colitis

  • The following algorithm represents the management of ischemic colitis.
 
 
 
 
 
 
 
 
Abdominal pain, diarrhea, lower GI bleeding
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Diagnosis by CT scan or colonoscopy
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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
 

References

  1. PATH, EJ, McCLURE, JN Jr. Intestinal obstruction; the protective action of sulfasuxidine and sulfathalidine to the ileum following vascular damage. Ann Surg 1950; 131:159.
  2. Plonka A, Schentag J, Messinger S, Adelman M, Francis K, Williams J (1989). "Effects of enteral and intravenous antimicrobial treatment on survival following intestinal ischemia in rats.". J Surg Res. 46 (3): 216–20. PMID 2921861. 
  3. Bennion R, Wilson S, Williams R (1984). "Early portal anaerobic bacteremia in mesenteric ischemia.". Arch Surg. 119 (2): 151–5. PMID 6696611. 
  4. Redan J, Rush B, Lysz T, Smith S, Machiedo G (1990). "Organ distribution of gut-derived bacteria caused by bowel manipulation or ischemia.". Am J Surg. 159 (1): 85–9; discussion 89–90. PMID 2403765. 
  5. Feldman: Sleisenger & Fordtran's Gastrointestinal and Liver Disease, 7th ed., 2002 Saunders, p. 2334.
  6. Nikolic, Amanda L.; Keck, James O. (2017). "Ischaemic colitis: uncertainty in diagnosis, pathophysiology and management". ANZ Journal of Surgery. ISSN 1445-1433. doi:10.1111/ans.14237. 

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