Chronic Diarrhea In Dogs Research Articles

Investigating and treating chronic diarrhoea in dogs. Part 2: specific disorders of the small and large intestines

Background: Diarrhoea is a common complaint in dogs and may cause significant patient morbidity and owner distress. Many diseases can lead to chronic diarrhoea (›three weeks) in dogs.Aim of the article: Part one of this series discussed the systematic approach to the diagnosis of chronic diarrhoea in the dog (Walker and McMahon 2019). This second article covers treatment of specific causes of chronic diarrhoea in more detail, focusing on diseases commonly identified in practice. In recognition of the fact that many clients cannot afford extensive investigation, a ‘low‐cost’ treatment approach is suggested at the end of this article.

Investigating and treating chronic diarrhoea in dogs

Background: Diarrhoea is a common complaint in dogs and may cause significant patient morbidity and owner distress. It can be a clinical manifestation of gastrointestinal disorders (primary enteropathy) or non-gastrointestinal...

Evaluation of a structured individualised protocol as a potential cost-effective diagnostic and therapeutic approach to chronic diarrhoea in the dog.

Diagnostic investigation and management of chronic diarrhoea in dogs can be cost‐prohibitive to many owners. The objectives of this study were to evaluate evidence‐based, individualised diagnostic and therapeutic protocols for management of dogs with chronic diarrhoea, where financial constraints dictate a budget‐limited approach and where more expensive approaches are deferred until simple affordable protocols are unsuccessful. Twenty‐two client‐owned dogs with chronic (minimum 2 weeks duration) untreated small, large or mixed small/large bowel diarrhoea were enrolled in a budget‐limited step‐wise management protocol (maximum expenditure $300 over 6 weeks), with diagnostic testing and therapeutic trials managed in an individualised and evidence‐based fashion. Success was defined as complete resolution of diarrhoea for a minimum of 1 month. Dogs that failed to respond to a budget‐limited protocol were then enrolled for complete, referral‐level management. Four dogs exited the project early (one death due to caval syndrome, three lost to follow‐up). Thirteen out of the remaining 18 dogs had complete resolution of diarrhoea utilising a budget‐limited approach (success rate 72.2%, confidence intervals 46.5–90.3%) and five dogs were moved on to a referral‐level investigation, with complete resolution of diarrhoea in four out of five. Seventeen out of the 18 dogs therefore responded to a protocol based on a budget‐limited approach followed by extensive investigation only if needed, for an overall success rate of 94.4% (CI 72.7–99.9%). Comprehensive investigation of chronic diarrhoea can be deferred while simple affordable diagnostics and therapeutic trials are conducted in stable canine patients and, often, an extensive management approach will be unnecessary.

Chronic Diarrhea in Dogs – Retrospective Study in 136 Cases

BackgroundChronic diarrhea (CD) is common in dogs, and information on frequency and distribution of primary and secondary causes is lacking.ObjectivesTo evaluate underlying causes and predictors of outcome in dogs with CD.AnimalsOne hundred and thirty‐six client‐owned dogs with CD (≥3 weeks duration).MethodsRetrospective review of medical records (Small Animal Clinic, Freie Universität Berlin, Germany, 09/2009‐07/2011). Quantification of final diagnoses and comparison of clinical aspects including disease severity and clinicopathological abnormalities among dogs with clinical remission (either complete [gastrointestinal signs absent] or partial [clinical improvement of gastrointestinal signs and reduced episodes with shortened duration]), and those without recovery.ResultsNinety percent of dogs were diagnosed with a primary enteropathy: inflammatory (71%; of those 66% dietary responsive, 23% idiopathic, 11% antibiotic responsive), infectious (13%), neoplastic (4%), and in one dog each mechanical disease or systemic vasculitis. Secondary causes were diagnosed in 10% of dogs: exocrine pancreatic (6%), endocrine (2%), and in one dog each hepatic, renal, and cardiac disease. In total, 87% of dogs had clinical remission, whereas 13% died or did not respond to treatment: Lack of recovery was frequently recorded for dogs with primary inflammatory (idiopathic) or neoplastic disease and was significantly associated with increased disease severity scores (P = .005), anemia (hematocrit < 40%, P < .001), severe hypoalbuminemia (serum albumin <2.0 g/dL, P = .008), and severe hypocobalaminemia (serum cobalamin concentration <200 pg/mL, P = .006).Conclusions and clinical importanceInflammatory enteropathies and particularly those of dietary origin were the most common causes of CD in dogs. Findings support the usefulness of hematocrit, and serum albumin and cobalamin concentration as prognostic markers in dogs with CD.

Protein-losing enteropathy in a dog with lymphangiectasia, lymphoplasmacytic enteritis and pancreatic exocrine insufficiency

This is a report of seven-year-old male Akita mixed dog, with protein-losing enteropathy (PLE). He had a history of chronic vomiting and diarrhea with anorexia/hyporexia. Previously he suffered acute abdomen about eight months prior to this visit. Our dog showed uncommon combination of diseases that could cause PLE since it was affected by inflammatory bowel disease (IBD), intestinal lymphangiectasia (IL), and exocrine pancreatic insufficiency (EPI). The dog had most of the abnormalities found in IL, as well as hypoalbuminemia, hyperglobulinemia, lymphopenia, hypocalcemia, and hypercholesterolemia. During endoscopy exam, we found changes characteristic of IL such as irregular small white spots. We took biopsies from stomach, duodenum, and cecum. These biopsies showed infiltration by lymphocytes and plasmatic cells in the lamina propria also, the duodenal biopsies showed moderate dilation of the lymphatic vessels. The patient had 2.1 µg/mL of TLI, this result was compatible with EPI. We assume that the first pathology in this animal was IBD, which caused chronic pancreatitis (CP) that in turn progressed to EPI. It is also possible that IL was secondary to IBD. We have reported for the first time the correlation of IBD and EPI in dogs. This should change our approach to treating chronic diarrhea in dogs. Therefore, we propose that dogs diagnosed with EPI should also be subjected to endoscopy and intestinal biopsy. Similarly, to rule out secondary EPI, TLI should be measured routinely in dogs with IBD.

Gene expression of selected signature cytokines of T cell subsets in duodenal tissues of dogs with and without inflammatory bowel disease

Inflammatory bowel disease (IBD) is a common cause of chronic diarrhoea in dogs. In people, specific cytokine patterns attributed to T cell subsets, especially T helper cell [Th]1, Th17 and regulatory T(reg) cells have emerged in IBD. In contrast, no specific involvement of a distinct T cell subset has been described so far in canine IBD. Thus, the aim of the present study was to assess gene expression of signature cytokines in duodenal tissues from 18 German shepherd dogs with IBD (group 1), 33 dogs of other breeds with IBD (group 2) and 15 control dogs (group 3). Relative quantification of IL-17A, IL-22, IL-10, IFNy and TGFβ was performed. Expression of IL-17A was significantly lower in groups 1 and 2 compared to group 3 (p=0.014), but no difference in the expression of IL-22 (p=0.839), IFNγ (p=0.359), IL-10 (p=0.085) or TGFβ (p=0.551) across groups was detected. Thus, no clear evidence for the involvement of Th-17 signature cytokines in canine IBD at the mRNA level could be shown. The contribution of specific T cell subsets to the pathogenesis of canine IBD warrants further investigation.

What Is the Evidence?

Abstracts identified through the keyword search were reviewed and evaluated for their relevance to the clinical question. A total of 27 abstracts were identi-fied; however, abstracts containing information not concerned with the clinical aspects of treatment or in-volving another species (ie, rat) were excluded. Once relevant abstracts were identified, the articles were reviewed to evaluate the quality of evidence provided by each through use of a published grading system for studies in veterinary clinical nutrition, 1 with I repre-senting the highest grade (ie, a properly designed ran-domized, controlled clinical trial involving the target species) and IV representing the lowest (ie, opinion based on clinical experience). Factors such as study de -sign, results obtained, and relevance to the canine spe-cies were also evaluated.Two studies 2,3 were identified in which the use of tylosin for treatment of chronic diarrhea in dogs was evaluated. The first study 2 was a prospective case se-ries involving 7 colony Beagles with chronic diarrhea. Those with persistent diarrhea (of at least 1 month’s duration) and fecal consistency scores of 3.5 to 4.5 (median, 4.0), based on a 5-point scale with 1 being hard, dry, and crumbly feces and 5 being very watery diarrhea, were treated with tylosin and had firmer feces 2 to 3 days afterward, with a median consistency score of 2.75, which was significantly (

The effect of the macrolide antibiotic tylosin on microbial diversity in the canine small intestine as demonstrated by massive parallel 16S rRNA gene sequencing

BackgroundRecent studies have shown that the fecal microbiota is generally resilient to short-term antibiotic administration, but some bacterial taxa may remain depressed for several months. Limited information is available about the effect of antimicrobials on small intestinal microbiota, an important contributor to gastrointestinal health. The antibiotic tylosin is often successfully used for the treatment of chronic diarrhea in dogs, but its exact mode of action and its effect on the intestinal microbiota remain unknown. The aim of this study was to evaluate the effect of tylosin on canine jejunal microbiota. Tylosin was administered at 20 to 22 mg/kg q 24 hr for 14 days to five healthy dogs, each with a pre-existing jejunal fistula. Jejunal brush samples were collected through the fistula on days 0, 14, and 28 (14 days after withdrawal of tylosin). Bacterial diversity was characterized using massive parallel 16S rRNA gene pyrosequencing.ResultsPyrosequencing revealed a previously unrecognized species richness in the canine small intestine. Ten bacterial phyla were identified. Microbial populations were phylogenetically more similar during tylosin treatment. However, a remarkable inter-individual response was observed for specific taxa. Fusobacteria, Bacteroidales, and Moraxella tended to decrease. The proportions of Enterococcus-like organisms, Pasteurella spp., and Dietzia spp. increased significantly during tylosin administration (p < 0.05). The proportion of Escherichia coli-like organisms increased by day 28 (p = 0.04). These changes were not accompanied by any obvious clinical effects. On day 28, the phylogenetic composition of the microbiota was similar to day 0 in only 2 of 5 dogs. Bacterial diversity resembled the pre-treatment state in 3 of 5 dogs. Several bacterial taxa such as Spirochaetes, Streptomycetaceae, and Prevotellaceae failed to recover at day 28 (p < 0.05). Several bacterial groups considered to be sensitive to tylosin increased in their proportions.ConclusionTylosin may lead to prolonged effects on the composition and diversity of jejunal microbiota. However, these changes were not associated with any short-term clinical signs of gastrointestinal disease in healthy dogs. Our results illustrate the complexity of the intestinal microbiota and the challenges associated with evaluating the effect of antibiotic administration on the various bacterial groups and their potential interactions.

Tylosin-Responsive Chronic Diarrhea in Dogs

Fourteen dogs had shown chronic or intermittent diarrhea for more than 1 year. Diarrhea had been successfully treated with tylosin for at least 6 months but recurred when treatment was withdrawn on at least 2 occasions. Tylosin-responsive diarrhea (TRD) affects typically middle-aged, large-breed dogs and clinical signs indicate that TRD affects both the small and large intestine. Treatment with tylosin eliminated diarrhea in all dogs within 3 days and in most dogs within 24 hours. Tylosin administration controlled diarrhea in all dogs, but after it was discontinued, diarrhea reappeared in 12 (85.7%) of 14 dogs within 30 days. Prednisone given for 3 days did not completely resolve diarrhea. Probiotic Lactobacillus rhamnosus GG did not prevent the relapse of diarrhea in any of 9 dogs so treated. The etiology of TRD, a likely form of antibiotic-responsive diarrhea (ARD) is unclear. The following reasons for chronic diarrhea were excluded or found to be unlikely: parasites, exocrine pancreatic insufficiency, inflammatory bowel disease, small intestinal bacterial overgrowth, enteropathogenic bacteria (Salmonella spp., Campylobacter spp., Yersinia spp., or Lawsoni intracellularis), and Clostridium perfringens enterotoxin and Clostridium difficile A toxin. A possible etiologic factor is a specific enteropathogenic organism that is a common resident in the canine gastrointestinal tract and is sensitive to tylosin but difficult to eradicate. Additional studies are required to identify the specific cause of TRD.

Tylosin-Responsive Chronic Diarrhea in Dogs

Fourteen dogs had shown chronic or intermittent diarrhea for more than 1 year. Diarrhea had been successfully treated with tylosin for at least 6 months but recurred when treatment was withdrawn on at least 2 occasions. Tylosin-responsive diarrhea (TRD) affects typically middle-aged, large-breed dogs and clinical signs indicate that TRD affects both the small and large intestine. Treatment with tylosin eliminated diarrhea in all dogs within 3 days and in most dogs within 24 hours. Tylosin administration controlled diarrhea in all dogs, but after it was discontinued, diarrhea reappeared in 12 (85.7%) of 14 dogs within 30 days. Prednisone given for 3 days did not completely resolve diarrhea. Probiotic Lactobacillus rhamnosus GG did not prevent the relapse of diarrhea in any of 9 dogs so treated. The etiology of TRD, a likely form of antibiotic-responsive diarrhea (ARD) is unclear. The following reasons for chronic diarrhea were excluded or found to be unlikely: parasites, exocrine pancreatic insufficiency, inflammatory bowel disease, small intestinal bacterial overgrowth, enteropathogenic bacteria (Salmonella spp., Campylobacter spp., Yersinia spp., or Lawsoni intracellularis), and Clostridium perfringens enterotoxin and Clostridium difficile A toxin. A possible etiologic factor is a specific enteropathogenic organism that is a common resident in the canine gastrointestinal tract and is sensitive to tylosin but difficult to eradicate. Additional studies are required to identify the specific cause of TRD.

Diagnosis of Exocrine Pancreatic Insufficiency in the Dog Using Radial Enzyme Diffusion

Vondrakova K., J. Klime‰: Diagnosis of Exocrine Pancreatic Insufficiency in the Dog Using Radial Enzyme Diffusion.Acta Vet. Brno 2002, 71: 223‐228. Exocrine pancreatic insufficiency (EPI) is an important cause of chronic diarrhoea in dogs, which should be reliably excluded before proceeding to the more invasive diagnostic methods like endoscopy. The aim of the present study was to validate the radial enzyme diffusion (RED) as one of the diagnostic techniques for canine EPI based on measurement of faecal proteolytic activity. The modification of RED is described where a water solution of skim milk is used instead of Caparacaseinate as a substrate for pancreatic proteases. Serum trypsin-like immunoreactivity (TLI) with 100% specificity and sensitivity was used as a reference technique. The RED was validated in 24 dogs mostly with chronic diarrhoea. Dogs of various breeds were examined with German shepherds over-represented. Ten clinically healthy dogs were used as controls. In each dog, 3 consecutive faecal samples were examined. In all dogs, serum samples were examined for TLI. Sensitivity of 100 % and specificity of 75 % were calculated for RED. Possible causes of falsely positive and falsely negative results of RED and TLI are discussed. The RED has proven to be a quick, cheap and easy-to-perform method suitable for reliable exclusion of those cases where the diarrhoea is not caused by EPI. However, regarding its lower specificity, positive results should be confirmed by TLI assay.

Giardiasis

Giardia spp. are common, yet frequently overlooked, parasites of small animals. These parasites may cause chronic diarrhea in dogs and cats. This article discusses the clinical signs of giardiasis, and its diagnosis, treatment, and control.