Rethinking chronic enteropathy management in canine patients

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Patients coming into the clinic with chronic enteropathy (CE) are characterized by persistent gastrointestinal (GI) symptoms, including diarrhea, inappetence, vomiting, and weight loss, that last for over 2 to 3 weeks. Traditionally, CE is classified as food-responsive, antimicrobial-responsive enteropathy, and immunosuppressant-responsive enteropathy, with other classifications like fiber-responsive and nonresponsive enteropathy. According to Laura Gaylord, DVM, DACVIM (Nutrition), because these classifications may overlap or represent a continuum of the state of the disease, nutritional management remains the cornerstone of CE treatments.

During her lecture at the 2025 Fetch Charlotte Conference, Gaylord shared with attendees how they can manage CE in their patients with a multimodal approach to nutrition and how recent advancements in research have the role of gut dysbiosis in CE.

Management and diagnostics

Patient history, dietary review, diagnostic workup, and physical examination are required when it comes to creating an appropriate treatment plan for CE and veterinary teams should assess clinical signs.

“The first sign, I think, is often inappetence, picky eaters, or variable appetites. So if you get these younger dogs that...your owners are saying, 'well, he's picky and he won't eat,' and it's a puppy that makes no sense, right? Their body is growing and should have a higher, longer drive so they're not eating. I always say, I give the dogs credit. I assume it's a medical reason, not a behavioral one until I ruled everything else out,” explained Gaylord.

“Yes, you do have those special owners that say behavior problems, but don't jump to that. Give the owner credit. Give the pet credit. Make sure you're doing your work like you would any other sick pet, even if it is just picky eating,” she continued.

Along with eating clinical signs, patients with CE can present to the clinic with vomiting, diarrhea, weight loss, with the possibility of additional systems such as regurgitation, flatulence, hematemesis, hematochezia, melena, and constipation, which can help professionals with disease localization within the GI tract.

The diagnostics could include complete blood count, urinalysis, blood chemistry, thyroid testing, imaging, pancreatic enzyme testing, vitamin B status, and ACTH stimulation testing. In cases where there is inflammatory bowel disease or neoplastic conditions such as lymphoma are suspected, an endoscopic or surgical biopsy may be necessary.

Diet trials

Diagnosing and managing all lies within diet trials. When conducting a diet trial with patients, the chosen diet needs to be strictly fed and all noncompliant foods eliminated. A clinical response to the trials can be assessed within 2-3 weeks, and some cases could require multiple trials before finding the right diet for the patient. Gaylord said that hydrolyzed protein and novel protein diets are common, but upcoming evidence is suggesting individualized diet formulated based on microbiome profiling could enhance diet trial outcomes.

“Diet trials can be both diagnostic and therapeutic, so we're going to choose foods, and we're testing to see that they're better, but it also, in hindsight, kind of gives you information. We want to make logical diet changes. So we're looking at the diets that were already fed, already tried. We could gather information from that, or the diets you are trying each step of the way, that's going to help you make the next diet selection. More than one diet trial is needed often,” said Gaylord.

“So second best tip I have for you, tell your clients from the start, you need to be prepared, we're going to have to do a few diet trials. We may not pick the best diet on the first trial. So 2 trial, 3 trials, have their mindset already ready for the fact that we might have to do more than one diet trial,” she concluded.

Gaylord also explained that these trials could take up to 12 weeks, but usually last for 8, it just depends on how spread out the patient’s symptoms are. When it comes to selecting the nutrient profile for the trial, previous diets can be used as a guide to pick the appropriate therapeutic diet. Veterinary professionals should consider highly digestible/gastroenteric diets, novel/hydrolyzed protein, or high-fiber diets, but some cases call for a combination of these if needed. Diet trials for patients must also consider the individual patient’s needs, disease localization, and clinical history.

Gaylord also explained the impact of dietary fiber on gut microbiota and the potential benefits of prebiotic and probiotic supplementations for stabilizing or supporting gut balance—an area that is currently in active research.

In conclusion

Owners should be informed that CE is not primarily caused by pathogenic bacteria, and antibiotics are rarely indicated. Adherence to diet trials is crucial, and multiple may be needed to determine an effective nutritional plan. A complete resolution is uncommon, so diet trials will remain a key diagnostic and therapeutic tool to help manage CE.

Reference

Gaylord L. Gut check: A fresh look at managing chronic enteropathy in dogs. Presented at: Fetch Charlotte; Charlotte, North Carolina. March 14-16, 2025.