What is the treatment for ileus?

From the Guidelines

Treatment for ileus involves a multifaceted approach. The most effective strategy includes minimally invasive surgery, optimized fluid management, opioid-sparing analgesia, early mobilization, early postoperative food intake, laxative administration, and omission or early removal of nasogastric intubation 1.

Key Interventions

• Laparoscopic-assisted surgery leads to faster return of bowel function and resumption of oral diet compared to open surgery 1
• Mid-thoracic epidural analgesia is highly effective in preventing postoperative ileus 1
• Avoidance of fluid overloading and nasogastric decompression may reduce the duration of postoperative ileus 1
• Oral magnesium oxide and bisacodyl may promote postoperative bowel function 1
• Alvimopan, a μ-opioid receptor antagonist, accelerates gastrointestinal recovery and reduces length of stay in patients undergoing open colonic resection with postoperative opioid analgesia 1
• Perioperative use of chewing gum has a positive effect on postoperative duration of ileus 1

Postoperative Care

• Early tube feeding should be initiated in patients who cannot start oral nutrition early and will have inadequate oral intake for more than 7 days 1
• Early parenteral nutrition may be indicated if enteral feeding is contraindicated 1
• Early mobilization should be assisted as soon as possible after surgery 1

From the Research

Treatment Options for Ileus

The treatment for ileus can vary depending on the underlying cause and severity of the condition. Some key points to consider include:

• The treatment of ileus depends on the timely determination of the pathogenesis (mechanical versus functional) and on close interdisciplinary collaboration 2.
• Mechanical ileus, particularly of the small bowel, can often be successfully treated conservatively, and functional ileus only rarely requires surgery 2.
• Supportive measures, depending on the etiology, usually suffice for functional ileus 2.
• Early enteral nutrition (EEN) has been shown to facilitate the return of normal bowel function, achieve enteral nutrition goals, and reduce hospital length of stay in adult surgical patients with ileus 3.
• Neither metoclopramide nor erythromycin were found to be effective in expediting the resolution of ileus in adult surgical patients 3.
• A multimodal concept is required for the successful treatment of postoperative ileus, which is multifactorial in its genesis 4.
• The use of prokinetic agents such as metoclopramide, cisapride, and erythromycin has been evaluated, but their efficacy in shortening the duration of postoperative ileus is unclear 5.
• Alvimopan, a μ-opioid receptor antagonist, has been shown to significantly shorten the duration of ileus, and its use can be recommended in major gastrointestinal surgery to reduce postoperative ileus 6.

Pharmacological Management

Pharmacological management can play a role in preventing ileus in major abdominal surgery, with certain compounds showing promise in reducing bowel recovery time. These include:

• Opioid receptor antagonists, such as alvimopan, which have been shown to significantly shorten the duration of ileus 6.
• Serotonin receptor agonists, which may also be of use in reducing postoperative ileus, although further randomized trials are required to establish their efficacy 6.
• Ghrelin receptor agonists, which did not appear to have any effect in preventing postoperative ileus in five trials 6.