From the Guidelines
Management of an ileus involves supportive care, including bowel rest, nasogastric tube decompression, and intravenous fluids, as the cornerstone of treatment, as recommended by the most recent guidelines 1. The goal of treatment is to relieve symptoms, prevent complications, and address the underlying cause of the ileus. Key components of supportive care include:
- Bowel rest, which involves stopping oral intake to reduce the workload on the bowel
- Nasogastric tube decompression to relieve abdominal distension and prevent vomiting, as noted in the guidelines 1
- Intravenous fluids to maintain hydration and electrolyte balance, with isotonic dextrose-saline crystalloid and balanced isotonic crystalloid replacement fluids containing supplemental potassium recommended 1
- Pain management with medications like hydromorphone or morphine, used cautiously due to their potential to worsen ileus
- Early mobilization to stimulate bowel function, with patients encouraged to walk when possible
- Monitoring for signs of resolution, such as passing flatus, bowel movements, or decreased abdominal distension Surgical intervention may be necessary if the ileus is caused by mechanical obstruction or if conservative management fails after several days, with the decision to operate guided by the patient's overall clinical status and the presence of risk factors for poor surgical outcome, as discussed in the guidelines 1. Prokinetic agents, such as metoclopramide or erythromycin, may be used in select cases, but their use should be carefully considered due to potential side effects and interactions, as noted in the guidelines 1. Overall, the management of ileus requires a comprehensive approach that addresses the underlying cause, relieves symptoms, and prevents complications, with the goal of improving patient outcomes and quality of life.
From the FDA Drug Label
INDICATIONS & USAGE Diabetic Gastroparesis (Diabetic Gastric Stasis) Metoclopramide Injection (metoclopramide hydrochloride, USP) is indicated for the relief of symptoms associated with acute and recurrent diabetic gastric stasis The answer to what to do in an ileus is not directly addressed in the provided drug label.
- The label discusses diabetic gastroparesis, which is a related but distinct condition.
- Ileus management is not explicitly mentioned. 2
From the Research
Management of Ileus
- The management of ileus includes addressing the underlying cause and supportive care 3, 4.
- Supportive measures, such as nasogastric suction and management of fluid and electrolyte imbalances, are crucial in the treatment of ileus 5, 4.
- 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 with ileus 3.
Role of Prokinetic Agents
- The use of prokinetic agents, such as metoclopramide and erythromycin, is not recommended for the treatment of ileus due to lack of evidence supporting their effectiveness 3, 5, 6.
- Metoclopramide has been shown to be ineffective in reducing the length of ileus after colorectal surgery 6.
- Erythromycin has limited data supporting its use in the treatment of ileus, and its effectiveness is uncertain 3, 5.
Recent Advances in Treatment
- Enhanced Recovery After Surgery (ERAS) protocols and minimally invasive surgical approaches have been shown to be effective in reducing patient morbidity and promoting early return of gut function 7.
- The use of specific pharmaceutical therapies, such as alvimopan, has shown promising results in reducing the duration of postoperative ileus, but its clinical use is limited due to potential complications and cost 7.