Contributors: Julien Bazelle, Ed Hall, Ken Harkin
Species: Canine | Classification: Miscellaneous
- Most common cause of chronic vomiting Vomiting and diarrhea Diarrhea: overview.
- Cause: any idiopathic inflammatory condition of the small or large intestine:
- Signs: chronic gastroenteritis (diarrhea and vomiting), weight loss.
- Characterized by infiltration of gastrointestinal tract with inflammatory cells including:
- Plasma cells.
- Neutrophils (rarely).
- Diagnosis: idiopathic nature makes it a diagnosis of exclusion.
- Treatment: dietary change, immunosuppressive therapy (prednisolone/cyclosporine/chlorambucil).
- Prognosis: good with appropriate treatment.
Print off the owner factsheet on Inflammatory bowel disease Inflammatory bowel disease to give to your client.
- Breed predisposition: Shar-Pei Chinese Shar Pei , Yorkshire terrier Yorkshire Terrier , German Shepherd dog German Shepherd Dog.
- Underlying cause unknown but immune mechanisms involving the response of the gut-associated lymphoid tissue (GALT) implicated:
- Genetic factors, eg major histocompatibility type.
- Specific defects in the immune system, eg decreased IgA (Maeda et al, 2013).
- Mucosal and/or systemic infection (viral, bacterial or parasitic).
- Abnormal or inappropriate antigen presentation, eg mutation of Toll-like receptors.
- Complement activation, mast cell degranulation and T-cell and macrophage activation → active inflammation.
- Location and relative amount of inflammatory mediators depend on inciting factors and immune response → variable clinical and pathological presentations.
- Hypersensitivity to luminal dietary or microbial antigens implicated.
- Chronic/recurrent vomiting.
- Chronic/recurrent diarrhea (small or large intestinal).
- Tenesmus, hematochezia, flatulence, mucoid stools.
- Abdominal pain, borborygms.
- Anorexia or ravenous appetite.
- Weight loss.
- Signs of hyproteinemia Hypoproteinemia : subcutaneous edema, ascites.
- Clinical activity index Canine Chronic Enteropathy Activity Index Score (CCECAI) Canine Inflammatory Bowel Disease Activity Index Score (CIBDAI): based on attitude, appetite, vomiting, stool consistency, stool frequency, weight loss +/- albumin, ascites and pruritus.
- Baseline information is necessary to exclude other causes.
- Routine parameters Hematology: complete blood count (CBC) may be normal, but occasionally see mild anemia (anemia of chronic disease, GI blood loss).
- Leucocytosis (mature neutrophilia) may also be seen. Eosinophilia Hematology: eosinophil occasionally seen with eosinophilic gastroenteritis.
- Routine parameters Blood biochemistry: overview may be normal.
- Hypoproteinemia Urinalysis: protein may occur in severe cases.
- Hypocholesterolemia Blood biochemistry: cholesterol , ionized hypocalcemia Blood biochemistry: ionized calcium , hypovitaminosis D Blood biochemistry: vitamin B12 (Gow et al (2011).
- Canine pancreatic lipase (prognostic value) Canine pancreatic lipase immunoreactivity (cPLI) test.
- Folates Blood biochemistry: folate and cobamain.
- Urinalysis Urinalysis: dipstick analysis to rule out protein losing nephropathy Glomerulonephritis , diabetes mellitus Diabetes mellitus as causes of weight loss.
- Fecal analysis Fecal analysis: overview for parasitic Fecal analysis: parasites and bacterial infections Fecal analysis: bacteriology , eg Giardia Giardiasis , salmonellosis Salmonellosis.
- For diet-responsive conditions.
- For antibiotic responsive conditions.
- See abdominal radiography Radiography: abdomen.
- Plain and contrast films.
- Usually unremarkable or non-specific findings (mucosal irregularities or thickened bowel segments).
- Thickening of intestinal wall, lymphadenopathy Ultrasonography: GI system.
- Diffuse vs localized lesions.
- Rule out other conditions.
- Allow US-guided FNAs Fine needle aspirate: ultrasound-guided.
- To examine intestinal mucosa Enteroscopy.
- Gastric ulcerations Gastroscopy - particularly in pyloric region (cf normal).
- May be normal - lesions often microscopic.
- Intestinal biopsy is the only method of definitive diagnosis. Endoscopic biopsy safest, surgical biopsy more representative.
- Biopsy several sites (6-15 depending on quality of biopsies) because signs do not always correlate with site of pathology. Biopsy of both duodenum and ileum increases likelihood to reach diagnosis.
- Lymph node biopsy should be taken if lymphadenopathy Lymphadenopathy is detected.
- Usually lymphocytic or eosinophilic infiltrate predominates.
- Possible signs of secondary lymphangiectasia.
- In chronic cases mucosal villus atrophy and fibrosis may be severe.
- Giardiasis Giardiasis , and other infectious gastrointestinal diseases.
- Lymphoma Lymphoma.
- Colitis Colitis: overview.
- Food intolerance.
- Food hypersensitivity Skin: food hypersensitivity.
- Exocrine pancreatic insufficiency Exocrine pancreatic insufficiency.
- Small intestinal bacterial overgrowth Antibiotic-responsive diarrhea (ARD)
- Reduce antigenic load, increase fiber.
- Highly digestible, gluten-free diet.
- Moderate fat restriction.
- Supplementation with medium chain triglycerides Fat may help.
- Feeding prescription hypoallergenic diets may help.
- Supplementation with folates and cobalamin may be required.
- Prednisolone Prednisolone 0.5-2.0 mg/kg (in severe cases) BID PO for 2 weeks, then tapering dose. Budesonide Budesonide (Dye et al, 2013).
- In refractory cases,it may be helpful to use prednisolone in combination withcyclosporine Ciclosporin (5-10 mg/kg SID-BID) or chlorambucil Chlorambucil (1.5 mg/m2 EOD).This is considered more efficient than prednisolone andazathioprine Azathioprine 1-2 mg/kg SID. Treat for 14 days then alternate days PO for 3-4 months (Dandrieux J R et al, 2013).
- Antibiotics - to reduce antigenic load, eg metronidazole Metronidazole 10-15 mg/kg PO BID, oxytetracycline Oxytetracycline tylosin Tylosin.
Metronidazole may suppress cell-mediated cellular responses in addition to its antiprotozoal and antibacterial effects. May not improve outcome when combined with steroid therapy.
- May be possible to wean patient off therapy after 3-4 months and maintain by dietary manipulation alone.