Lower gastrointestinal bleeding medical therapy
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Differentiating Lower gastrointestinal bleeding from other Diseases |
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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 re-bleeding, surgery should be considered.[1][2][3][4]
Dosage
- Preferred regimen (1): Local injection of 1:10,000 to 20,000 solution (Intra-arterial epinephrine 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 epinephrine but recurs in up to 50% of patients when the infusion is stopped.
Major contraindications
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.
References
- ↑ Liou TC, Lin SC, Wang HY, Chang WH (2006). "Optimal injection volume of epinephrine for endoscopic treatment of peptic ulcer bleeding". World J. Gastroenterol. 12 (19): 3108–13. PMC 4124392. PMID 16718798.
- ↑ Ghassemi KA, Jensen DM (2013). "Lower GI bleeding: epidemiology and management". Curr Gastroenterol Rep. 15 (7): 333. doi:10.1007/s11894-013-0333-5. PMC 3857214. PMID 23737154.
- ↑ Beck DE, Margolin DA, Whitlow CB, Hammond KL (2007). "Evaluation and management of gastrointestinal bleeding". Ochsner J. 7 (3): 107–13. PMC 3096402. PMID 21603524.
- ↑ Triadafilopoulos G (2012). "Management of lower gastrointestinal bleeding in older adults". Drugs Aging. 29 (9): 707–15. doi:10.1007/s40266-012-0008-1. PMID 23018607.