Toxic megacolon medical therapy: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Toxic megacolon}} | {{Toxic megacolon}} | ||
{{CMG}}; {{AE}} | {{CMG}}; {{AE}} {{F.K}} | ||
==Overview== | ==Overview== | ||
Medical therapy of toxic megacolon include stablizing the patient, decompression and medications. Medications for toxic megacolon include [[corticosteroids]], immunosuppresants and [[antibiotics]]. | |||
==Medical Therapy== | ==Medical Therapy== | ||
Medical therapy of Toxic megacolon include: | Medical therapy of Toxic megacolon include:<ref name="GanBeck2003">{{cite journal|last1=Gan|first1=S. Ian|last2=Beck|first2=P. L.|title=A new look at toxic megacolon: an update and review of incidence, etiology, pathogenesis, and management|journal=The American Journal of Gastroenterology|volume=98|issue=11|year=2003|pages=2363–2371|issn=0002-9270|doi=10.1111/j.1572-0241.2003.07696.x}}</ref><ref name="pmid22009735">{{cite journal |vauthors=Autenrieth DM, Baumgart DC |title=Toxic megacolon |journal=Inflamm. Bowel Dis. |volume=18 |issue=3 |pages=584–91 |year=2012 |pmid=22009735 |doi=10.1002/ibd.21847 |url=}}</ref><ref name="pmid6665937">{{cite journal |vauthors=Farkouh E, Wassef R, Allard M, Atlas H |title=Toxic megacolon in inflammatory colon disease |language=French |journal=Union Med Can |volume=112 |issue=11 |pages=1014–6 |year=1983 |pmid=6665937 |doi= |url=}}</ref><ref name="pmid12918536">{{cite journal |vauthors=Gonzáles Lara V, Pérez Calle JL, Marín Jiménez I |title=Approach to toxic megacolon |journal=Rev Esp Enferm Dig |volume=95 |issue=6 |pages=422–8, 415–21 |year=2003 |pmid=12918536 |doi= |url=}}</ref><ref name="pmid1153934">{{cite journal |vauthors=Koudahl G, Kristensen M |title=Toxic megacolon in ulcerative colitis |journal=Scand. J. Gastroenterol. |volume=10 |issue=4 |pages=417–21 |year=1975 |pmid=1153934 |doi= |url=}}</ref><ref name="pmid213344">{{cite journal |vauthors=Meyers S, Janowitz HD |title=The place of steroids in the therapy of toxic megacolon |journal=Gastroenterology |volume=75 |issue=4 |pages=729–31 |year=1978 |pmid=213344 |doi= |url=}}</ref> | ||
*1.General considerations | *'''1. General considerations''' | ||
**1.1.Complete bowel rest | **1.1. Complete bowel rest | ||
**1.2.Intravenous fluid support | **1.2. [[Intravenous fluid]] support | ||
**1.3.Electrocytes monitoring and correction of abnormalities | **1.3. Electrocytes monitoring and correction of abnormalities | ||
**1.4.Withdrawal of all anticholinergics, antidiarrheal and narcotics | **1.4. Withdrawal of all [[anticholinergics]], [[antidiarrheal]] and [[narcotics]] | ||
**1.5.Rule out infectious etiology | **1.5. Rule out infectious etiology | ||
*2.Decompression | *'''2. Decompression''' | ||
**2.1.Rectal tube | **2.1. Rectal tube | ||
**2.2.Nasogastric or long | **2.2. [[Nasogastric tube|Nasogastric]] or long naso-intestinal tube | ||
*:'''Note:''' Long intestinal tubes are considered to be more effective than | *:'''Note:''' Long intestinal tubes are considered to be more effective than naso-gastric tubes in colonic decompression but should be placed into the [[ileum]] under [[Fluoroscopy|fluoroscopic]] guidance. | ||
**2.3.Repositioning maneuvers | **2.3. Repositioning maneuvers<ref name="pmid3183326">{{cite journal |vauthors=Present DH, Wolfson D, Gelernt IM, Rubin PH, Bauer J, Chapman ML |title=Medical decompression of toxic megacolon by "rolling". A new technique of decompression with favorable long-term follow-up |journal=J. Clin. Gastroenterol. |volume=10 |issue=5 |pages=485–90 |year=1988 |pmid=3183326 |doi= |url=}}</ref><ref name="pmid8282262">{{cite journal |vauthors=Panos MZ, Wood MJ, Asquith P |title=Toxic megacolon: the knee-elbow position relieves bowel distension |journal=Gut |volume=34 |issue=12 |pages=1726–7 |year=1993 |pmid=8282262 |pmc=1374472 |doi= |url=}}</ref> | ||
*:'''Note:''' Maneuver 1: Asking patients to roll into the prone position for | *:'''Note:''' Maneuver 1: Asking patients to roll into the prone position for 10-15 minutes every 2-3 hours and encourage them to pass gas. | ||
*:'''Note:''' Maneuver 2: Turning to the prone knee-elbow position, which moves the rectum to the highest point in the body | *:'''Note:''' Maneuver 2: Turning to the prone knee-elbow position, which moves the rectum to the highest point in the body. | ||
*3.Medical management | *'''3. Medical management''' | ||
**3.1.Toxic megacolon associated with inflammatory bowel disease(IBD) | **3.1. Toxic megacolon associated with [[inflammatory bowel disease]](IBD):<ref name="GanBeck2003">{{cite journal|last1=Gan|first1=S. Ian|last2=Beck|first2=P. L.|title=A new look at toxic megacolon: an update and review of incidence, etiology, pathogenesis, and management|journal=The American Journal of Gastroenterology|volume=98|issue=11|year=2003|pages=2363–2371|issn=0002-9270|doi=10.1111/j.1572-0241.2003.07696.x}}</ref><ref name="pmid22131898">{{cite journal |vauthors=Strong SA |title=Management of acute colitis and toxic megacolon |journal=Clin Colon Rectal Surg |volume=23 |issue=4 |pages=274–84 |year=2010 |pmid=22131898 |pmc=3134807 |doi=10.1055/s-0030-1268254 |url=}}</ref> | ||
***3.1.1.Corticosteroids | ***3.1.1. [[Corticosteroids]]: | ||
****Preferred regimen(1): Hydrocortisone 100 mg IV q6h | ****Preferred regimen (1): [[Hydrocortisone]] 100 mg IV q6h | ||
****Preferred regimen(2): Methylprednisolone 60 mg IV q24h | ****Preferred regimen (2): [[Methylprednisolone]] 60 mg IV q24h | ||
***3.1.2.Immunosuppresants | ***3.1.2. Immunosuppresants: | ||
****Preferred regimen(1): Cyclosporin 2 mg/kg q24h for 7 days | ****Preferred regimen (1): [[Cyclosporine|Cyclosporin]] 2 mg/kg q24h for 7 days | ||
***:'''Note:''' Maintain serum levels between 150 to 250 ng/mL | ***:'''Note:''' Maintain serum levels between 150 to 250 ng/mL | ||
****Preferred regimen(2): Infliximab 5 mg/kg for 3 to 7 days | ****Preferred regimen (2): [[Infliximab]] 5 mg/kg for 3 to 7 days | ||
**3.2.Toxic megacolon associated with Clostridium difficile <ref name="pmid3781329">{{cite journal |vauthors=Bolton RP, Culshaw MA |title=Faecal metronidazole concentrations during oral and intravenous therapy for antibiotic associated colitis due to Clostridium difficile |journal=Gut |volume=27 |issue=10 |pages=1169–72 |year=1986 |pmid=3781329 |pmc=1433873 |doi= |url=}}</ref> | **3.2. Toxic megacolon associated with [[Clostridium difficile|''Clostridium difficile'']] <ref name="pmid3781329">{{cite journal |vauthors=Bolton RP, Culshaw MA |title=Faecal metronidazole concentrations during oral and intravenous therapy for antibiotic associated colitis due to Clostridium difficile |journal=Gut |volume=27 |issue=10 |pages=1169–72 |year=1986 |pmid=3781329 |pmc=1433873 |doi= |url=}}</ref> | ||
***Preferred regimen: Vancomycin 500 mg PO q6h or via a | ***Preferred regimen (1): [[Vancomycin]] 500 mg PO q6h or via a naso-gastric tube '''AND''' [[Metronidazole]] 500 mg IV q8h | ||
==References== | ==References== | ||
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{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[Category: | [[Category:Surgery]] | ||
[[Category:Gastroenterology]] | |||
[[Category:Emergency medicine]] | |||
[[Category:Disease]] | |||
Latest revision as of 18:50, 8 December 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Farima Kahe M.D. [2]
Overview
Medical therapy of toxic megacolon include stablizing the patient, decompression and medications. Medications for toxic megacolon include corticosteroids, immunosuppresants and antibiotics.
Medical Therapy
Medical therapy of Toxic megacolon include:[1][2][3][4][5][6]
- 1. General considerations
- 1.1. Complete bowel rest
- 1.2. Intravenous fluid support
- 1.3. Electrocytes monitoring and correction of abnormalities
- 1.4. Withdrawal of all anticholinergics, antidiarrheal and narcotics
- 1.5. Rule out infectious etiology
- 2. Decompression
- 2.1. Rectal tube
- 2.2. Nasogastric or long naso-intestinal tube
- Note: Long intestinal tubes are considered to be more effective than naso-gastric tubes in colonic decompression but should be placed into the ileum under fluoroscopic guidance.
- Note: Maneuver 1: Asking patients to roll into the prone position for 10-15 minutes every 2-3 hours and encourage them to pass gas.
- Note: Maneuver 2: Turning to the prone knee-elbow position, which moves the rectum to the highest point in the body.
- 3. Medical management
- 3.1. Toxic megacolon associated with inflammatory bowel disease(IBD):[1][9]
- 3.1.1. Corticosteroids:
- Preferred regimen (1): Hydrocortisone 100 mg IV q6h
- Preferred regimen (2): Methylprednisolone 60 mg IV q24h
- 3.1.2. Immunosuppresants:
- Preferred regimen (1): Cyclosporin 2 mg/kg q24h for 7 days
- Note: Maintain serum levels between 150 to 250 ng/mL
- Preferred regimen (2): Infliximab 5 mg/kg for 3 to 7 days
- 3.1.1. Corticosteroids:
- 3.2. Toxic megacolon associated with Clostridium difficile [10]
- Preferred regimen (1): Vancomycin 500 mg PO q6h or via a naso-gastric tube AND Metronidazole 500 mg IV q8h
- 3.1. Toxic megacolon associated with inflammatory bowel disease(IBD):[1][9]
References
- ↑ 1.0 1.1 Gan, S. Ian; Beck, P. L. (2003). "A new look at toxic megacolon: an update and review of incidence, etiology, pathogenesis, and management". The American Journal of Gastroenterology. 98 (11): 2363–2371. doi:10.1111/j.1572-0241.2003.07696.x. ISSN 0002-9270.
- ↑ Autenrieth DM, Baumgart DC (2012). "Toxic megacolon". Inflamm. Bowel Dis. 18 (3): 584–91. doi:10.1002/ibd.21847. PMID 22009735.
- ↑ Farkouh E, Wassef R, Allard M, Atlas H (1983). "Toxic megacolon in inflammatory colon disease". Union Med Can (in French). 112 (11): 1014–6. PMID 6665937.
- ↑ Gonzáles Lara V, Pérez Calle JL, Marín Jiménez I (2003). "Approach to toxic megacolon". Rev Esp Enferm Dig. 95 (6): 422–8, 415–21. PMID 12918536.
- ↑ Koudahl G, Kristensen M (1975). "Toxic megacolon in ulcerative colitis". Scand. J. Gastroenterol. 10 (4): 417–21. PMID 1153934.
- ↑ Meyers S, Janowitz HD (1978). "The place of steroids in the therapy of toxic megacolon". Gastroenterology. 75 (4): 729–31. PMID 213344.
- ↑ Present DH, Wolfson D, Gelernt IM, Rubin PH, Bauer J, Chapman ML (1988). "Medical decompression of toxic megacolon by "rolling". A new technique of decompression with favorable long-term follow-up". J. Clin. Gastroenterol. 10 (5): 485–90. PMID 3183326.
- ↑ Panos MZ, Wood MJ, Asquith P (1993). "Toxic megacolon: the knee-elbow position relieves bowel distension". Gut. 34 (12): 1726–7. PMC 1374472. PMID 8282262.
- ↑ Strong SA (2010). "Management of acute colitis and toxic megacolon". Clin Colon Rectal Surg. 23 (4): 274–84. doi:10.1055/s-0030-1268254. PMC 3134807. PMID 22131898.
- ↑ Bolton RP, Culshaw MA (1986). "Faecal metronidazole concentrations during oral and intravenous therapy for antibiotic associated colitis due to Clostridium difficile". Gut. 27 (10): 1169–72. PMC 1433873. PMID 3781329.