Immunosuppressant-Responsive Enteropathy and Non-Responsive Enteropathy in Dogs: Prognostic Factors, Short- and Long-Term Follow Up.

Elena Benvenuti,Enrico Bottero,Alessio Pierini,Marco Pietra,Veronica Marchetti,Stefano Salvadori,Eleonora Gori

doi:10.3390/ani11092637

Abstract

Simple SummaryChronic intestinal inflammation in dogs is a challenging disease to manage. Most studies about prognostic factors and follow-up data are only available for small populations or with short-term follow-up. The aim of this study of 165 dogs with chronic intestinal inflammation was to identify clinical and haematological factors associated with mortality, clinical response and relapse, with long-term follow-up. Nine per cent of dogs did not respond to therapy at 1 month follow-up. Most dogs with chronic intestinal inflammation had a good clinical course in most cases, and the non-response or relapse rate was 9–11%. A reduction of body condition (loss of weight), lower serum albumin concentration and presence of lacteal dilatation on intestinal histology at diagnosis were identified as factors associated with a decreased response rate, higher mortality and lower chance of achieving long-term remission.A multicentre prospective study was performed to assess whether clinical, hematobiochemical, endoscopic and histopathological parameters were associated with mortality, clinical response and relapse of disease in short- and long-term follow-up of a total of 165 dogs with chronic inflammatory enteropathy, of which 150 had immunosuppressant responsive enteropathy (IRE), and 15 had non-responsive enteropathy (NRE) dogs. Clinical severity (CCECAI) was evaluated from presentation (T0) to 18 months (T18) from diagnosis. T0 body condition score (BCS), selected haematological parameters and endoscopic and histopathological scores were evaluated. Presence/absence of histopathological duodenal lesions was recorded. Responders were evaluated using CCECAI at T1. Relapse was evaluated from T3 to T18. Long-term responders included dogs who responded at T1 and showed no relapse. Dogs were divided into responders/non-responders, survivors/non-survivors and relapsed/non-relapsed. At T1, 15/165 dogs (9%) were considered NRE. Sixteen dogs (11%) were considered relapsed at T3, 8% at T6 and 10% at T12, and none of 96 dogs relapsed at T18. NREs showed significantly lower BCS than IREs. Non-survivors showed a significantly lower serum albumin concentration and BCS than survivors. Non-responders, relapsed or non-survivors had higher presence of lacteal dilatation compared to long-term responders. Dogs with IRE showed a good clinical course with a low relapse rate, with only a few dogs in the NRE group. Reduction of BCS, albumin and lacteal dilatation at diagnosis may be considered negative prognostic factors for response, mortality and long-term disease remission.

Highlights

Chronic enteropathy (CE) in dogs is defined as a complex interaction among host genetics, the intestinal microenvironment and the immune system [1]
Protein-losing enteropathy (PLE) is a particular subtype of enteropathy with worse prognosis, which is classified based on the presence of low levels of albumin and the absence of other proteinlosing disease
Blood samples required for haematological tests were taken after obtaining the owners’ informed consent, and the study received the official approval of the animal welfare committee of the University of Pisa (OPBA number 31834/2017)

Summary

Introduction

Chronic enteropathy (CE) in dogs is defined as a complex interaction among host genetics, the intestinal microenvironment and the immune system [1]. Cerquetella et al [2] proposed novel inclusion criteria in the diagnosis of IRE without the use of antibiotic trials after diet trials [2]. The final diagnosis is based on the response to treatment, histopathological evaluation of intestinal biopsy or all the above. Immunosuppressant-responsive enteropathy (IRE) is defined as an idiopathic, multifactorial intestinal inflammation in which diet and antibiotic trials have failed [3]. In IRE, intestinal inflammation must be demonstrated on histopathology, and response to an immunosuppressant therapy is needed [3,4]. Dogs not responding to immunosuppressant treatment are categorized as having non-responsive enteropathy (NRE) [3,4]. IRE, NRE and intestinal lymphangiectasia are considered the most common causes of PLE in dogs [5,6]

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