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Outlook:
Several studies are ongoing on the use of FMT in dogs and cats, and publication of results can be expected with 1 to 2 years. If their outcome is positive, it is likely that FMT will gain popularity in the treatment of acute and chronic GI disorders. In the future, it is possible that FMT will be recommended in small animals as part of the treatment of diseases primarily affecting organs outside the GI tract. Examples could include hepatic encephalopathy, obesity, behavioral disorders, etc.
Additional reading (selection):
· Al Shawaqfeh MK, Wajid B, Minamoto Y, et al. A dysbiosis index to assess microbial changes in fecal samples of dogs with chronic inflammatory enteropa- thy. FEMS Microbiol Ecol 2017;93 (11). [Open Access]
· Barko PC, McMichael MA, Swanson KS, and Williams DA. The Gastrointestinal Microbiome: A Review. J Vet Intern Med 2018;32 (1): 9-25. [Open Access]
· Chaitman J, Jergens A, Gaschen FP, et al. Commen- tary on key aspects of fecal microbiota transplanta- tion in small animal practice. Veterinary Medicine: Research and Reports 2016;7: 71-74 [Open Access]
· Perereira GQ, Gomes LA, Santos IA, et al. Fecal microbiota transplantation in puppies with canine parvovirus infection. J Vet Intern Med 2018;32 (2): 707-11. [Open Access]
Your Singapore, the Tropical Garden City
WSV18-0213
SVA FELINE
FELINE FEEDING TUBES: O/E-TUBE OR PEG-TUBE?
E. Robertson1
1American Board Certified Diplomate Feline Practice,
Feline Vet and Endoscopy Vet Referrals, Brighton, East Sussex, United Kingdom
Introduction:
The cardinal rule of feeding a malnourished or anorectic patient is ‘if the gut works, use it’! This is a tricky proposition in cats who seem more prone to anorexia than dogs as a result of stress (at home or in hospital), finicky eating behaviours and dietary pref- erences. When these factors are added to an ill cat experiencing gastrointestinal signs, malaise, pain or lethargy, it becomes in- creasingly challenging to keep these patients at an appropriate plane of nutrition. Yet studies have shown that nutrition plays a key role in the full recovery of critically-ill patients1. Enteral feed- ing techniques preserve the mucosal barrier, prevent villus atro- phy, help maintain the immunologic function of the GI tract, and can allow owners to treat their pets at home. While pharmaco- logical appetite stimulants and naso-oesophageal feeding tubes are ideal for short term usage, neither generally allow adequate caloric feeding in severely sick patients and feeding may even be impossible in cats with anatomical or functional problems of the oral cavity or oesophagus.
This lecture will outline basic information for clinicians to con- sider using feeding methods intended for more long-term use (e.g oesophagostomy tube vs gastrostomy tube). It should be emphasised early on that with suitable training, these solutions are achievable for those in the general practice setting.
1) Oesophagostomy Tube
Oesophagostomy tubes are often favoured for intermediate to long-term use (>1-2 weeks). Examples of cases which could ben- efit from this method would include: nutritional support for severe orofacial injuries, cases of hepatic lipidosis/cholangitis/acute pan- creatitis and for those non-compliant patients requiring long-term oral medications to manage their condition (e.g. mycobacteria in- fection).
It should be noted that if a patient is anaesthetised for an inves- tigative procedure (e.g. exploratory laparotomy for full-thickness biopsies for suspected gastrointestinal disease), the placement of an oesophagostomy tube should be strongly considered as they can be easily removed if not required.
Oesophagostomy tubes are generally well tolerated by most pa- tients. Because of its large bore (16-18F), it can often accommodate most blenderised diets (cf. naso-oesophageal feeding tubes).
Contraindications:
· Primary or secondary oesophageal disorders such as oesophageal stricture, oesophagitis and mega-oe- sophagus
· Persistent vomiting
· Absent gag reflex
Serious complications seem to be exceptionally rare.2 The only minor complication occasionally seen with oesophagostomy tubes is stoma-site infection/granulation tissue1,2 and (in the author’s experience) continued anorexia due to oesophageal irritation. Prevention of stoma-site infection is usually achieved by daily cleaning of the tube site.
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