Chronic Enteropathies

The goal of this retrospective study was to compare the severity of clinical signs, age at diagnosis, serum albumin, cobalamin and folate concentrations, and outcomes among dogs with chronic enteropathies. Dogs were separated into the following treatment groups: those that responded to treatment with dietary management alone (FRD), with diet and antimicrobials (ARD), and with diet and immunosuppressive therapy (SRD). Diagnosis was confirmed via exclusion of other causes of chronic diarrhea and via endoscopy with biopsies. 

FRD group dogs (n = 131) responded to an elimination, hydrolysed, or home-cooked diet within 2 weeks, were strictly kept on the diet for 12 weeks, and were then switched back to their original diets. Dogs in the ARD group (n = 33) had a failed response to a dietary trial but responded to metronidazole within 2 weeks. Dogs in the SRD group (n = 39) had failed dietary and antimicrobial trials and required immunosuppressive therapy to control clinical signs. Clinical severity scores were lowest in the FRD group. There was no difference between groups for serum folate and cobalamin levels. Albumin concentration was significantly decreased in the SRD group as compared with the FRD group. The FRD group had significantly better outcomes than the ARD group at 2 to 4 weeks and 6 to 12 months postdischarge; it had significantly better outcomes than the SRD group at 2 to 4 weeks and 6 to 12 months postdischarge. 

The authors concluded that good outcomes can be expected in FRD dogs that follow strict dietary regimens for at least 12 weeks. They encourage further study of dogs with other causes of chronic enteropathies to improve treatment outcomes.

Global Commentary

Diarrhea caused by enteropathies is a common complaint in dogs. Dogs treated at English primary care veterinary practices had a 17.5% prevalence of enteropathies.¹ Clinicians have often given antibiotics as a first treatment; however, we are becoming more aware of the potential for causing antimicrobial resistance. Another common treatment for inflammatory bowel disease is corticosteroids, a class of medications rife with undesirable side effects. 

In this study, 64% of dogs were in the food-responsive group; this confirms previous findings^2,3 and the clinical experience of many gastroenterologists. This reinforces starting treatment with a dietary trial, especially in dogs with milder clinical and clinicopathologic signs. Clinicians should also be aware that cases that require use of antibiotics and then immunosuppressive drugs may have a worse prognosis than food-responsive dogs do.—Marge Chandler, DVM, MS, MANZCVSc, DACVN, DACVIM, DECVIM-CA, MRCVS