VET TALK:What will happen if your pet is diagnosed with inflammatory bowel disease
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“Bear” was a fun loving, bouncy, five-year-old Wheaten Terrier. He was brought into the surgery as he had yet another acute episode of vomiting and diarrhoea, and he was clearly in some abdominal discomfort. Bear had had a number of these acute episodes over the past year, so investigative tests were now advised. His tests included an endoscopic examination of his gastrointestinal tract, and tissue samples taken for histology during this procedure revealed that unfortunately Bear had inflammatory bowel disease.
Inflammatory bowel disease, IBD, is a syndrome rather than a disease. The syndrome is caused by a specific reaction to chronic irritation of the gastrointestinal tract. Most dogs with IBD have a history of abdominal discomfort, recurrent or chronic vomiting or diarrhoea and may have a poor appetite.
The cause of IBD is poorly understood. In fact, it appears there are several causes. Whatever the cause, the result is that the stomach and the lining of the intestines is invaded by inflammatory cells, and an allergic-type response then occurs within the intestinal tract. This on-going inflammation causes abdominal discomfort, vomiting and diarrhoea and can interfere with the ability to digest and absorb nutrients. Some possible causes include parasitic or bacterial infection (e.g., Salmonella, E. coli, or Giardia), or a reaction to specific proteins in their diet. However, in most instances, an exact underlying cause cannot be identified.
IBD is a disease that can cause inflammation in any part of the digestive tract. Some breeds of dog, such as Soft Coated Wheaten Terriers do have a genetic predisposition to this disease. In other breeds of dogs, it can be triggered by certain gut bacteria, or parasites, or by a food intolerance. More commonly though, no specific underlying cause is found, and the disease is thought to be caused by an over-activity of the patient’s own immune system reacting to what it sees as ‘foreign’ proteins, such as in certain foods, resulting in chronic gut inflammation.
The clinical signs of IBD are weight loss, vomiting, diarrhoea, increased or decreased appetite, blood or mucus in the faeces, episodes of abdominal pain.
IBD is diagnosed by a combination of tests, as several other disease processes can cause similar symptoms and signs. Blood tests can be performed to rule out other underlying diseases such as liver, pancreatic or kidney disease, and a full faecal examination is often checked to look for any unusual bacteria or parasites. Some patients with IBD can also have low vitamin B12 levels, so this is also measured. X-rays and Ultrasound scans are often done, as foreign body obstructions or tumours, can also cause symptoms of weight loss and vomiting. A definitive diagnosis of IBD is usually made by an Endoscopic examination: by taking small tissue biopsies from the stomach and intestines for accurate diagnosis. This is performed under a general anaesthetic using a flexible Endoscope camera. In some cases, abdominal surgery is required to obtain adequate gut tissue samples in certain areas of the intestine.
How is IBD treated? Many dogs and cats will improve following an advised dietary trial. Often this involves prescribing a new diet that is hypoallergenic. This a diet low in potential allergens and unlikely to cause a reaction, containing a unique protein source that your pet has not eaten before e.g., venison or salmon. This diet is fed as the pet's sole diet for about two months, and it is very important that no other food type is given alongside this diet. A true food trial requires that the test diet be fed exclusively, and for the advised time. Often this can be trial and error, as some pets won’t respond to one diet, but will respond well to another.
Pets that don’t respond to diet alone may be prescribed certain gut protectant treatments and healthy flora probiotic supplements, and there are also certain oral antibiotics that help restore the balance of the normal bacteria found in the gastrointestinal tract and can also act as an anti-inflammatory treatment for the gut.
Dogs that are severely affected, or that don’t respond to the treatments mentioned above alone, may also be prescribed an oral steroid treatment. A high dose is prescribed initially, and this is then carefully decreased every few weeks over several months to the lowest effective dosage. Some pets don’t tolerate steroids or don’t respond to steroids alone, in these cases other drugs which can suppress the patient’s immune system are prescribed. Supplementation with B12 (cobalamin) is often given, as most dogs with inflammatory bowel disease are unable to absorb this important vitamin.
IBD has a broad spectrum of severity, ranging from a mild occasional vomiting and diarrhoea symptoms to severe weight loss and fluid build-up in the abdomen. It is not generally a life-threatening disease, but it can be in extremely debilitating in the severely affected patients. IBD is not a curable disease and does require lifelong therapy, therefore the aim of treatment is to try to manage the bowel inflammation, and so minimise the frequency of vomiting and diarrhoea. It is rare to be able to stop all the clinical signs altogether, and flare-ups are common. Once the appropriate drugs or diet is determined, many dogs remain on these for life, although it may be possible to decrease the drug dosages over time. Most patients can live a good quality of life following a diagnosis and advised treatments.
Thankfully, lovely Bear responded well to his dietary trial, and he was much more comfortable on his new food and advised on-going gut protectant treatments.
Do contact your Vet if you are concerned about any of these IBD symptoms in your pet.
Alison Laurie-Chalmers is a senior consultant at Crown Vets.
