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

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. Pharmacotherapy is only used as an adjuvant therapy for all patients with LGIB.

• 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.