From the Guidelines
The initial treatment for moderate ileus should involve supportive care with intravenous crystalloids, anti-emetics, and bowel rest, as recommended by the most recent guidelines. This approach is based on the latest evidence from a narrative review published in the World Journal of Emergency Surgery in 2019 1. The review emphasizes the importance of starting supportive treatment as soon as possible, including the administration of intravenous crystalloids, such as isotonic dextrose-saline or balanced isotonic crystalloid replacement fluids containing supplemental potassium, to replace lost fluids and maintain hydration and electrolyte balance.
Key components of the initial treatment include:
- Intravenous fluid administration to maintain hydration and electrolyte balance
- Bowel rest to reduce intestinal workload
- Anti-emetics to prevent vomiting
- Nasogastric suction to decompress the proximal bowel and prevent aspiration pneumonia, if necessary
- Insertion of a Foley catheter to monitor urine output
It is also important to address pain management with non-opioid analgesics when possible, as opioids can worsen ileus. Ambulation and early mobilization should be encouraged to stimulate bowel motility. Underlying causes, such as electrolyte abnormalities, should be corrected, and medications that slow intestinal motility should be discontinued. While prokinetic agents like metoclopramide may be considered in some cases, the evidence for their efficacy is limited, and their use should be based on individual patient needs and clinical judgment, as suggested by earlier studies 1.
Overall, the conservative management approach is typically effective for moderate ileus, with most cases resolving within 2-4 days as the bowel's normal peristaltic activity gradually returns, and surgical intervention is rarely needed unless there are complications or the condition fails to improve with conservative measures.
From the Research
Initial Treatment for Moderate Ileus
The initial treatment for moderate ileus typically involves addressing the underlying cause and providing supportive care.
- The treatment may include:
- Nasogastric suction for symptomatic relief 2
- Fluid management to prevent fluid overload 3
- Management of exogenous opioids to minimize their inhibitory effects on gastrointestinal motility 3
- Early enteral nutrition (EEN) to facilitate the return of normal bowel function and reduce hospital length of stay 3
Pharmacological Interventions
Several pharmacological agents have been studied for the treatment of ileus, including:
- Metoclopramide: a prokinetic agent that has shown some effectiveness in reversing decreased gastrointestinal myoelectric and contractile activity in a model of canine postoperative ileus 4. However, its effectiveness in human patients is uncertain, and it is not recommended for or against its use in adult surgical patients 3.
- Erythromycin: a macrolide antibiotic with prokinetic properties, which has not been shown to be effective in shortening the period of postoperative ileus in human patients 5.
- Neostigmine: a cholinesterase inhibitor that has been used to treat postoperative ileus in orthopedic spinal patients, particularly those with acute colonic pseudo-obstruction 6.