Toxic megacolon medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

There is no treatment for [disease name]; the mainstay of therapy is supportive care.

OR

Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].

OR

The majority of cases of [disease name] are self-limited and require only supportive care.

OR

[Disease name] is a medical emergency and requires prompt treatment.

OR

The mainstay of treatment for [disease name] is [therapy].

OR   The optimal therapy for [malignancy name] depends on the stage at diagnosis.

OR

[Therapy] is recommended among all patients who develop [disease name].

OR

Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].

OR

Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].

OR

Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].

OR

Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

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 to
    • 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 nasointestinal tube
    Note: Long intestinal tubes are considered to be more effective than nasogastric tubes in colonic decompression but should be placed into the ileum under fluoroscopic guidance.
    • 2.3.Repositioning maneuvers[7][8]
    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
    • 3.2.Toxic megacolon associated with Clostridium difficile [10]
      • Preferred regimen (1): Vancomycin 500 mg PO q6h or via a nasogastric tube AND Metronidazole 500 mg IV q8h

References

  1. 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.
  2. Autenrieth DM, Baumgart DC (2012). "Toxic megacolon". Inflamm. Bowel Dis. 18 (3): 584–91. doi:10.1002/ibd.21847. PMID 22009735.
  3. 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.
  4. 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.
  5. Koudahl G, Kristensen M (1975). "Toxic megacolon in ulcerative colitis". Scand. J. Gastroenterol. 10 (4): 417–21. PMID 1153934.
  6. Meyers S, Janowitz HD (1978). "The place of steroids in the therapy of toxic megacolon". Gastroenterology. 75 (4): 729–31. PMID 213344.
  7. 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.
  8. 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.
  9. 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.
  10. 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.

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