By Teresa Garden, DVM
Inflammatory Bowel Disease (IBD) in our dogs and cats is characterized by increased numbers of inflammatory cells such as lymphocytes, plasmacytes, eosinophils, or neutrophils infiltrating the lining of the stomach, small intestines, or colon, or any combination thereof. Similar diseases exist in people such as Irritable Bowel Syndrome, Crohn’s disease, or chronic colitis. There are various causes of IBD in our pets. Food sensitivity, food allergies, parasitism, bacterial toxins, and neoplasia are among them. We do not know the etiology of the disease in some individuals. IBD is considered an immune-mediated disease. The inflammation my range from mild to severe and can progress over time.
Common signs of IBD are lack of appetite, weight loss, vomiting and diarrhea. The diarrhea may contain mucous and/or blood. The signs may be consistent or they may wax and wane. It can be challenging to make a diagnosis of IBD since the symptoms may mimic many other diseases. Pets may have the disease for months or even years before a definitive diagnosis is made. It can be a frustrating time for both the pet owner and the veterinarian. Often, we must rule out a plethora of other diseases before a diagnosis of IBD can be made.
So, how do we go about this daunting diagnostic challenge? Multiple fecal tests should be performed to rule out parasites as a cause of vomiting and diarrhea and weight loss. Your vet may elect to worm your pet with a broad-spectrum wormer since stool checks do not always show worm eggs even though pets may be infected. Another test on stools, a fecal pathogens test, can detect various bacteria, viruses, and protozoa as a cause of symptoms. Blood tests are performed to rule out metabolic diseases and dysfunction of the kidneys or liver. Results of blood tests may make us suspicious of IBD. White blood cells such as neutrophils, monocytes, and eosinophils may be elevated. The protein albumin may be decreased and globulin may be increased. Electrolytes may be imbalanced. B Vitamins such as folate and cobalamin may be decreased with IBD.
Radiographs of the abdomen are often normal. Abdominal ultrasound can be a useful imaging tool. Thickened stomach and/or small intestinal walls can be seen as well as enlarged mesenteric lymph nodes. GI endoscopy with biopsies is the only way to definitively diagnose IBD. This diagnostic procedure is performed under general anesthesia. A scope is passed down the esophagus and then into the stomach and the intestinal tract. Samples for biopsy are obtained from multiple sites (stomach, duodenum, ileum, and colon). Cytology will show inflammatory cells invading the lining of the GI tract in patients with IBD. Once a diagnosis has been established IBD can be treated or managed.
The goals of treatment are to maintain a good appetite, maintain normal body weight and muscle mass, stop vomiting and improve stools. Even with treatment your pet’s stools may not be perfect but we can expect significant clinical improvement. If the pet was having 4-6 stools per day then reducing the number to 2-3 would be a good improvement. If the stools were mushy with blood and mucous then having normal firm stools would be considered a success.
Appropriate dietary therapy alone may result in resolution when dietary hypersensitivity is the cause of the inflammation. Prescription diets such as limited hypoallergenic diets or hydrolyzed protein diets reduce the antigenic stimulation and are advised in all cases. Low-fat diets may be employed to treat patients with diarrhea as their main symptom. Some clients will keep a journal of what is being fed and how the pet responds. This can help to eliminate the foods which may cause allergies or hypersensitivity in that particular pet.
Western medicine will often employ steroids such as prednisone or budesonide to decrease GI inflammations and therefore symptoms of IBD. At Animal Health & Healing we try to avoid using these drugs long-term due to their adverse side effects. We will use Metronidazole both for its antibiotic and anti-inflammatory effects. It can be used short-term for flare ups and some patients may benefit from low dose long-term use. Tylosin can be a second choice of antibiotic if bacterial overgrowth is suspected. Gastriplex, a wonderful product combining western herbs, glucosamine, and B-Vitamins can be used to soothe GI inflammation in flare-ups.
There is much holistic help for IBD patients as well. Proviable is a small capsule containing both prebiotics and probiotics made specifically for the dog and cat. The probiotics will help to re-establish and maintain normal gut flora. This aids the digestive processes and allows the immune system to function at a more optimal level. We encourage our patients to take fish oil products such as Nordic Naturals Omega-3 Pet or Grizzly’s Salmon Oil. The omega-3 fatty acids EPA and DHA can decrease immune-mediated inflammation in the GI tract. The company Standard Process makes the product Enteric Support which can help to repair the damage to the lining of the intestinal tract. It consists of food nutrients and glandular extracts and is available for dogs and cats. Many of these holistic supplements can be used long-term to help our dogs and cats with IBD. It is of paramount importance to pair them with an appropriate diet in order to assure a good quality of life for our pets afflicted with this disease.
Dr Teresa Garden is chief veterinarian/owner of Animal Health & Healing, a full-service holistic and conventional veterinary practice in the Maplewood/Richmond Heights area. Phone: 314-781-1738. www.AnimalHealthandHealing.com.