Ready, fire, aim: Putting diagnosis before treatment (Proceedings)

Inflammatory bowel disease (IBD)

Gastrointestinal signs over 3 weeks duration with incomplete response to dietary trials and anthelminthics, histologic lesions of mucosal inflammation on biopsy and clinical response to immunomodulatory therapies. www.wsava.org/StandardizationGroup.htm.

Only dogs in which histologic evidence of inflammation is found without an apparent underlying cause can be diagnosed as chronic idiopathic enteropathy. German et al. JVIM vol. 17, 2003

Food responsive diarrhea (FRD)

Schreiner NM et al. JVIM vol. 22, 2008

CC: daily or intermittent diarrhea, vomiting (or both), and/or weight-loss

Rule-out 2nd GI: CBC, biochemical profile, urinalysis, fecal analysis, folate/cobalamin, abd U/S

Responded to Elimination Diet alone within 10 days.

Probiotics in FRD Dogs?

Sauter et al. J Anim Physiol Nutr vol. 90, 2006

Elimination Diet + 4 weeks of Probiotic cocktail (Lactobacillus spp.) supplementation improved clinical signs – attitude, appetite, activity, fecal frequency and consistency.

Steroid responsive diarrhea (idiopathic IBD)

Schreiner NM et al. JVIM vol. 22, 2008

CC: daily or intermittent diarrhea, vomiting (or both), and/or weight-loss

Rule-out 2nd GI: CBC, biochemical profile, urinalysis, fecal analysis, folate/cobalamin, abd U/S

No clinical improvement within 1 week trial of Elimination Diet alone

Rx: Prednisolone

1 mg/kg PO BID for 10 days

0.5 mg/kg PO BID for 10 days

0.5 mg/kg PO SID for 10 days

0.5 mg/kg PO q48hrs for remainder of study

Antibiotic responsive diarrhea

Tylosin-responsive diarrhea

Westermarck et al. JVIM vol. 19, 2005

Sig: middle-aged, large breed dogs

CC: Chronic or intermittent diarrhea > 1 year

Rule-out: Parasites, EPI, IBD, SIBO, Salmonella, Campylobacter, Yersinia, Lawsoni, Clostridium perfringens and Clostridium difficile.

Rx: Tylosin eliminated diarrhea within 3 days

Discontinue Tylosin = return of diarrhea within 30 days

Minimally responsive to Prednisone or Probiotic alone

Enrofloxacin, metronidazole, amoxicillin-responsive diarrhea

Sig: Boxers and English Bulldogs

CC: Chronic large bowel diarrhea, tenesmus, weight-loss

Minimally responsive to prednisone, azathioprine, sulfasalazine, metronidazole alone

Histopathology = histiocytic ulcerative colitis (HUC)

Rx = enrofloxacin alone or in combination with metronidazole + amoxicillin

Resolution of clinical signs and weight gain within 2-12 days, some dogs tapered off medication completely.

Tritrichomonas foetus

Gookin et al. JVIM vol. 20, 2006; Kather et al. JVIM vol. 21, 2007

Sig: Purebred kittens/cats (Bengal) from shelters/catteries

CC: Chronic or recurrent large intestinal diarrhea, mucus, tenesmus, increased frequency

Minimally responsive to metronidazole, fenbendazole, furazolidone, paromomycin

Diagnosis: PCR

Rx: Ronidazole 30-50mg/kg PO BID, 14 days (lower dose led to relapse in 2-20 weeks)