They were able to find only a single, small prospective study that identified gastric and small bowel distension as a significant predictor of a poor outcome in TM. Based on this review, we would emphasize the importance of a global assessment, including serial clinical examinations, laboratory tests and abdominal radiographs, when considering a diagnosis of TM. We would further recommend that all patients at risk for TM, even those with signs of only mild toxicity, should undergo a CT scan performed upon admission to identify possible complications.
Supportive measures with or without decompression, steroids, antibiotics and surgery have all been used in the treatment of TM. The authors presented evidence supporting either early surgical intervention or a trial of medical management, but the lack of any prospective data precludes concrete conclusions. The tone of the paper perhaps best reflects the current pattern of practice of most gastroenterologists, who offer medical management, including antibiotics and corticosteroids in IBD-related cases, as long as patients demonstrate improvement. Nevertheless, the reviewers were not able to determine what constitutes a satisfactory trial of medical therapy. This is your opportunity to taking full advantage of the nice options offered to you by most reliable pharmacies on the internet, with free delivery, express shipping and tons of other options you will appreciate.