Nutritional management of alimentary disease in dogs and cats (Proceedings)

There is little evidence based medicine concerning the best dietary or nutritional management of alimentary disease in dogs and cats.  Most information is anecdotal.

Regurgitation and dysphagia

Dysphagia is the most important sign of a problem affecting the oral cavity.  Patients frequently present with signs of decreased tongue movement, difficulty with prehension and bolus accumulation.  Pytalism may also be present and some animals are hesitant to eat, despite an apparent interest in food.

Treatment

Treat primary cause

Symptomatic - feeding in elevated position may significantly reduce swallowing difficulties   It is important to vary the consistency of the diet to determine which works best for patient.  Consider placement of an esophageal or gastric feeding tube.  Since liquids are often easier for dysphagic patients to swallow, a calorically dense food, such as Hill's A/D, blenderized with a small amount of water, may be best tolerated.  Some patients do best with canned food formed into ‘meatballs'.  In these cases, a more solid food, such as Hill's P/D may be most beneficial

Esophageal disease and regurgitation may be caused by

In addition to treating the underlying problem, it is often beneficial for the patient to be fed in an upright position.  This may involve using a step stool or a chair specifically designed for this purpose (http://petprojectblog.com/archives/dogs/megaesophagus-and-the-bailey-chair/).  As with dysphagia, feeding a calorically dense food is often the best option.  Having owners experiment with various textures is also recommended.  In patients that do not tolerate oral feeding, regardless of specific food and consistency, an esophageal or gastric feeding tube may be the best option.

Small intestinal diarrhea

The primary three categories of foods used to treat idiopathic small intestinal diarrhea (suspect IBD, food allergy, food intolerance )   include 1) hypoallergenic diets   2)  limited or novel antigen diets  and 3) intestinal diets.  Some studies have shown that > 50% of cats with chronic  diarrhea improved.

Examples of hypoallergenic diets include Hill's Z/D ultra, Purina HA and Royal Canin HP.  These foods contain a protein source that is hydrolyzed.  Theoretically the protein is broken down into particles that are too small to evoke an allergic response.  Limited  or novel antigen foods are simply diets that include a protein (meat) and carbohydrate (vegetable) source that the patient has not been exposed to previously.  It is ESSENTIAL to collect a thorough diet history prior to prescribing such a food.  Options include products from Hill's, Purina, Iams, and Royal Canin.  Meat sources available include rabbit, venison, duck, fish, lamb and kangaroo.  Other protein sources to consider include pork, bison, salmon (as opposed to white fish) and unusual meats found at specialty pet stores (including beaver).  It is not uncommon for pets with a diarrhea that responds to a limited antigen food to come out of remission and need a new antigen source after 6-18 months. 

Intestinal diets are routinely highly digestible and restricted in insoluble fiber.  Examples include Hill's I/D, Iams low residue, Purina EN, Royal Canin digestive low fat. They may contain prebiotics and altered levels of omega-3 fatty ac ids.  One clinical trial assessing the affects of two intestinal foods in dogs and cats with idiopathic chronic diarrhea, found that both led to improvement in fecal score (unpublished data from J. Stokes).         

In a study of 16 cats with chronic diarrhea, they were fed two intestinal diets (Hill's I/D and Purina EN) for 4 weeks.  Fecal scores improved with both foods, although they improved more in cats fed the Purina product.  Normal stools developed in 34.8% of cats fed Purina EN compared to 14.7% of cats fed Hill's I/D food.   (2010 ACVIM forum Comparison of Two Canned Diets Designed for the Management of Feline Diarrhea, H. Xu; D. Laflamme; C. Cupp; Z. Ramadan; G. Long)

Feline hepatic lipidosis

Unless a cat has hepatic encephalopathy or renal azotemia, avoid feeding protein-restricted foods.  A highly digestible food that is calorically dense should be fed.  Examples include Hill's A/D, Iams maximum calorie, Royal Canin Recovery RS.

Pancreatitis

It has been recognized that pancreatitis is a highly catabolic condition and that nutritional support is very important.  Although parenteral nutrition is necessary to use in vomiting animals that are unable to keep any food down, enteral nutrition is preferred.  In one study assessing nutrition in people with pancreatitis, enteral enteral nutrition was associated with a significantly lower risk of infections, pancreatitis-related complications, single organ failure, multi-organ failure, and mortality.  Recently, a study in dogs with pancreatitis compared intravenous total parenteral nutrition and esophagostomy tube in dogs. There was no difference in mortality, but the severity of clinical signs decreased significantly more rapidly in the esophagostomy tube fed group. (ACVIM 2010 forum, Highlights From Digestive Diseases Week & Veterinary Correlates: Pancreatitis Jörg M. Steiner)

Feeding a fat restricted food is recommended.  Examples include:

¯         Royal Canin Digestive Low fat

¯         Hill's W/D

¯         Purina OM

Exocrine pancreatic insufficiency

¯         Fat restriction, highly digestible, low fiber

¯         Royal Canin Digestive Low fat

¯         Hill's W/D

¯         Purina O