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 25-28 September, 2018 | Singapore
categories, which may be due to small bowel disorders affecting the large bowel function or disease which involves both the small and large bowel. Up to 30% of dogs with chronic diarrhoea have diffuse disease of the gastrointestinal tract. The classic signs of large vs small intestinal diarrhoea are presented here.
appears to be effective regardless of the fat content7.
Anorexia and poor appetite as a GI sign
There are many reasons for decreased appetite or anorexia. Food responsive enteropathy can cause nausea and vomiting and, subsequently, lead to learned food aversion (LFA). Especially in young dogs that show intermittent GI signs and reduced appetite, or are “finicky eaters”, LFA secondary to CE should be suspected.
An important differential diagnosis for poor appetite is hypoadrenocorticism, which should be ruled out either by basal cortisol measurement or ACTH stimulation test8(Bovens et al 2014).
Diet trial
Adverse reactions to food are diagnosed using elimination-challenge trials. Dietary trials confirm or
rule out adverse reactions to food but do not establish an immune mediated basis for the reaction, although that does not affect the case management. Ingredients previously fed should be avoided or a hydrolyzed protein diet can be fed. Hydrolysed proteins are generally less antigenic than whole proteins. Absolutely no other foods or ingredients should be fed during the diet trial as this makes it impossible to confirm that diet is part of the problem. Counselling the owner on feeding management, including the feeding of treats or snacks, is key to the success. Dogs with antibiotic responsive enteropathy often respond better if the antimicrobial therapy is combined with an elimination diet. Animals that respond to elimination diets usually do so within 2 weeks, although rare patients may require 4-6 weeks.
To confirm an adverse reaction to food a rechallenge or provocation is necessary. The initial food in reintroduced or individual ingredients from the initial diet are
added to the elimination diet one by one. Cases with gastrointestinal disease usually react within several days. Many clients do not want to rechallenge and the pet can be kept on the test diet if it is complete and balanced or another novel protein complete diet can be tried 10.
If an elimination diet trial does not resolve the CE signs, additional diagnostics and therapies are warranted. Dogs with idiopathic antibiotic-responsive diarrhoea respond well to antibacterials (e.g. metronidazole or tylosin). Some chronic inflammatory enteropathy (CIE) patients
fail to respond to diet or antibiotics. Definitive diagnosis of CIE is based on histology; therefore, endoscopy
and histopathological evaluation of mucosal biopsies are needed before initiating the immunosuppressive medication (e.g corticosteroids, cyclosporine or chlorambucil).
   Faecal volume
   Faecal frequency
Increased 4x
  Increased 8x
 None or digested blood (melaena)
   None or fresh blood.
   Faecal mucus
   Often present
   Weight loss
    Relatively rare
 Inflammatory bowel disease (IBD) or Chronic Enteropathy (CE)
Canine and feline IBD or CE is a heterogeneous
group of disorders characterized by persistent or recurrent gastrointestinal signs and in the case of
IBD also an inflammatory infiltrate within the GIT. It
may affect the stomach, small intestine, colon or any combination of these organs. The infiltration is most often lymphoplasmacytic but may include eosinophilic and neutrophilic infiltrates and may be associated with crypt abscessation and/or lacteal dilation with protein-losing enteropathy (PLE). The underlying cause is not fully understood and is likely to be multifactorial. “ When the disorder affects the small intestine “chronic enteropathy” is probably a better term than “inflammatory bowel disease” in dogs and cats, because the treatment and outcome of the disease is very different from that of inflammatory bowel disease in humans1.
About two-thirds of canine CE cases respond to an elimination diet trial with a hydrolysed protein diet
or novel ingredient diet 2,3 (see below). Hydrolysed
diets may improve nutrient absorption and decrease antigenic exposure. In dogs which don’t respond to dietary therapy, about 16% will respond to antibiotics (e.g. metronidazole or tylosin) and about another fifth may require immunosuppressive medications (prednisolone, cyclosporine). Food responsive dogs have a better outcome than the other groups2. In a study comparing
a highly digestible “intestinal” diet and a hydrolysed diet in dogs with chronic small intestinal disease, both diets improved clinical signs initially; however, longterm remission at one year was better using the hydrolysed diet4. Thirty-one of 39 dogs with food responsive chronic diarrhoea did not have a recurrence of clinical signs when switched back to their original diet after 14 weeks of elimination diet trial5. A diet with high protein, low carbohydrate, and moderate fat was effective in resolving diarrhoea in 7/15 cats6. A highly digestible diet

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