Cholestyramine treatment in two dogs with presumptive bile acid diarrhoea: a case report

L Toresson,J S Suchodolski,J M Steiner

doi:10.1186/s40575-021-00099-x

L Toresson, J S Suchodolski + Show 1 more

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https://doi.org/10.1186/s40575-021-00099-x

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Abstract

BackgroundIn people, bile acid diarrhoea is a prevalent complication of Crohn’s disease and diarrhoea-associated irritable bowel syndrome. Affected patients typically respond to bile acid sequestrants, such as cholestyramine, but human gastroenterologists often fail to recognize bile acid diarrhoea. Consequently, bile acid diarrhoea is regarded as an underrecognized and undertreated condition in human medicine. Due to lack of diagnostic tools, clinical response to bile acid sequestrants is often used to confirm a diagnosis of bile acid diarrhoea in people.Several recent studies have shown that bile acid dysmetabolism also occurs in dogs with chronic enteropathies. It has further been shown that dogs with chronic enteropathies have significantly decreased expression of a bile acid transport protein in the ileum compared to healthy dogs, which correlates with faecal bile acid dysmetabolism. Consequently, in spite of the lack of reports in the literature, bile acid diarrhoea is likely to exist in dogs as well.Case descriptionsTwo dogs, an 8-year old Rottweiler and a 4.5-year old Siberian Husky were evaluated for chronic watery diarrhoea. Neither dog responded to dietary trials, probiotics, cyclosporine, faecal microbial transplantations or metronidazole. One of the dogs responded to high daily doses of corticosteroids, which were however associated with unacceptable side effects. The other dog was refractory to all standard treatment protocols, including cyclosporine and corticosteroids. Since none of the dogs responded satisfactorily to standard treatment or modulation of the intestinal microbiome, a suspicion of possible bile acid diarrhoea was raised. Treatment with cholestyramine, a bile acid sequestrant was initiated and resulted in marked improvement of faecal consistency, frequency of defecation and activity level in both dogs.ConclusionThis report presents two dogs with presumed bile acid diarrhoea that were successfully treated with cholestyramine. Therefore, bile acid diarrhoea should be considered as a possible diagnosis in dogs with treatment-refractory chronic diarrhoea.

Highlights

In people, bile acid diarrhoea is a prevalent complication of Crohn’s disease and diarrhoeaassociated irritable bowel syndrome
This report presents two dogs with presumed bile acid diarrhoea that were successfully treated with cholestyramine
In people with Crohn’s disease or irritable bowel syndrome associated with diarrhoea, absorption mechanisms fail, and excessive amounts of bile acids reach the large intestine where they can cause what is known as bile acid diarrhoea (BAD)

Summary

Introduction

Bile acid diarrhoea is a prevalent complication of Crohn’s disease and diarrhoeaassociated irritable bowel syndrome. Affected patients typically respond to bile acid sequestrants, such as cholestyramine, but human gastroenterologists often fail to recognize bile acid diarrhoea. Several recent studies have shown that bile acid dysmetabolism occurs in dogs with chronic enteropathies. Various chronic gastrointestinal disorders are associated with increased amounts of BAs in the colon. This stimulates electrolyte and water secretion and increases mucosal permeability and colonic motility [3]. Bile acid dysmetabolism and BA diarrhoea (BAD) have been reported in 40% of patients with Crohn’s disease and 32% of patients with diarrhoea-predominant irritable bowel syndrome (IBS-D) [4]. Despite a high prevalence, BAD is considered an underdiagnosed and undertreated condition in gastroenterology [5]

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