What is the treatment for ileus (intestinal obstruction)?

From the Guidelines

The treatment of ileus primarily involves supportive care while addressing the underlying cause, with initial management including bowel rest, intravenous fluid resuscitation, and nasogastric tube decompression, as recommended by the most recent study 1.

Key Components of Treatment

• Bowel rest with nothing by mouth (NPO) to reduce bowel workload
• Intravenous fluid resuscitation to correct electrolyte imbalances and prevent dehydration, with isotonic dextrose-saline crystalloid and balanced isotonic crystalloid replacement fluids containing supplemental potassium 1
• Nasogastric tube decompression to relieve abdominal distension and vomiting, which can be diagnostically useful and therapeutically important to prevent aspiration pneumonia 1

Additional Considerations

• Pain management is important, preferably using non-opioid analgesics as opioids can worsen ileus
• Early ambulation should be encouraged as mobility helps stimulate bowel function
• Prokinetic agents such as metoclopramide or erythromycin may be used in select cases, though evidence for their efficacy is limited
• Nutritional support via parenteral nutrition may be necessary if ileus persists beyond 5-7 days
• Surgery is reserved for cases with mechanical obstruction, perforation, or ischemia, and should be decided in a multidisciplinary setting taking into account the characteristics of the obstruction, patient’s expectations, prognosis, expected subsequent therapies, and functional status 1

Decision-Making

• The decision about specific interventions should be made in a multidisciplinary setting including oncologists, surgeons, and endoscopists 1
• Improved quality of life should be the primary goal of surgical treatment, with risks and benefits discussed with the patient and family 1

From the FDA Drug Label

INDICATIONS & USAGE Metoclopramide Injection (metoclopramide hydrochloride, USP) is indicated for the relief of symptoms associated with acute and recurrent diabetic gastric stasis The Prevention of Nausea and Vomiting Associated with Emetogenic Cancer Chemotherapy Metoclopramide Injection is indicated for the prophylaxis of vomiting associated with emetogenic cancer chemotherapy The Prevention of Postoperative Nausea and Vomiting Metoclopramide Injection is indicated for the prophylaxis of postoperative nausea and vomiting in those circumstances where nasogastric suction is undesirable Small Bowel Intubation Metoclopramide Injection may be used to facilitate small bowel intubation in adults and pediatric patients in whom the tube does not pass the pylorus with conventional maneuvers Radiological Examination Metoclopramide Injection may be used to stimulate gastric emptying and intestinal transit of barium in cases where delayed emptying interferes with radiological examination of the stomach and/or small intestine.

The treatment for ileus (intestinal obstruction) is not explicitly stated in the provided drug label for metoclopramide (IV) 2. The label discusses various indications, including diabetic gastroparesis, prevention of nausea and vomiting, and facilitation of small bowel intubation, but does not directly address the treatment of ileus.

• Key points:
  • Metoclopramide is used for several gastrointestinal-related conditions
  • Ileus treatment is not mentioned in the label Therefore, metoclopramide (IV) may not be the appropriate treatment for ileus based on the provided information.

From the Research

Treatment for Ileus

The treatment for ileus, also known as intestinal obstruction, involves addressing the underlying cause and providing supportive care. Some key aspects of treatment include:

• Addressing fluid overload, exogenous opioids, neurohormonal dysfunction, gastrointestinal stretch, and inflammation, which are the main mechanisms of postoperative ileus pathophysiology 3
• 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 patients who have undergone abdominal surgery 3
• The use of metoclopramide and erythromycin has been found to be ineffective in expediting the resolution of ileus in adult surgical patients 3, 4, 5
• Administration of an oral hydration solution can prevent electrolyte and fluid disturbances and reduce readmissions in patients with a diverting ileostomy after colorectal surgery 6

Medical Interventions

Some medical interventions that have been proposed for the treatment of ileus include:

• Prokinetic agents such as metoclopramide, cisapride, and erythromycin, although their efficacy is uncertain and they may have potential adverse effects 5
• Cholinesterase inhibitors, which may be safe and effective in treating constipation, but are poorly prescribed 7
• Enteral opioid antagonists, which may be a promising strategy for patients treated with high doses of opioids during sedation 7
• Osmotic laxatives, which may be used as part of a bowel management protocol to prevent ileus, but their effectiveness has not been demonstrated 7

Supportive Care

Supportive care is a crucial aspect of treating ileus, and includes:

• Management of fluid and electrolyte imbalances 3, 5
• Nasogastric suction, which is the mainstay of therapy 5
• Bowel management protocols, which may include the use of osmotic laxatives and other measures to prevent ileus 7