Inflammatory%20bowel%20disease Treatment
Supportive Therapy
Severe Ulcerative Colitis
- IV fluid and electrolyte replacement to correct and prevent dehydration or electrolyte imbalance, with blood transfusion to maintain a hemoglobin of >10 g/dL
- Withdrawal of anticholinergics, antidiarrheal agents, NSAIDs and opioid drugs which can precipitate colonic dilatation
- Controlled trials failed to demonstrate therapeutic benefit of administering antibiotics especially in the absence of infections; however, there are protocols that recommend administration of broad-spectrum antibiotics in patients with severe UC who have signs of toxicity or with worsening condition despite maximal medical therapy
- SC Heparin may be given to reduce the risk of thromboembolism
- Total parenteral nutrition is needed if patient is significantly malnourished
Severe to Fulminant Crohn's Disease
- If patient is unable to maintain nutritional requirements for 5-7 days, nutritional support via elemental feeding or parenteral hyperalimentation is indicated
- Dehydrated patients should receive fluid and electrolytes as necessary
- Transfusions may be necessary for anemia and active hemorrhage
- Use of opiates and anticholinergics should be limited and antidiarrheal agents avoided
- Prophylaxis for venous thromboembolism is recommended
- Oral feeding should continue as tolerated in patients without evidence of intestinal obstruction
- Severely ill patients or those with obstruction should have bowel rest and parenteral support