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Inflammatory Bowel Disease

Inflammatory Bowel Disease: An Overview

Inflammatory bowel disease (IBD) is a gastrointestinal disorder where a dog's intestine remains irritated for long periods of time. IBD occurs when cells involved in inflammation and immune response are called into the lining of the GI tract. This causes the bowel lining to thicken and interferes with absorption and motility, or the ability of the bowel to contract and move food. IBD is usually seen in middle-aged to older dogs; however, some forms of IBD are seen in dogs less than 5 years old. Several breeds may be at increased risk for developing IBD, including the German Shepherd, Boxer, Shar-Pei, Soft Coated Wheaton Terrier and Rottweiler.

The term IBD is often used interchangeably with other conditions including: Chronic Colitis/Colitis, Lymphocytic-plasmacytic Inflammatory Bowel Disease, Regional Enteritis, Granulomatous Enteritis, Spastic Bowel Syndrome. To further confuse matters, Irritable Bowel Syndrome (IBS) is often confused with IBD. Treatment for IBS is aimed at stress reduction; it is a completely different condition from IBD.

Causes of Inflammatory Bowel Disease

The causes of inflammatory bowel disease are not well understood. The basic theory is that IBD is an immunologic reaction to some kind of stimulation. This could include an allergy, parasites, bacteria or an immune system problem. However, usually an extensive search for the cause is not made because of expense.

A bacterium called Helicobacter is associated with inflammatory bowel disease. While it is not known which is the cause and which is the effect, Helicobacter infection can lead to ulceration and inflammation, compounding the problems of the IBD. Special treatment is necessary for this type of infection.

Symptoms of Inflammatory Bowel Disease

The most common symptoms include:

  • Persistent loose stools
  • Frequent, smaller stools
  • Straining and diarrhea
  • Weight loss
  • Vomiting
  • Low grade fevers
  • Lethargy

Diagnosing Inflammatory Bowel Disease

There are several non-invasive tests that are usually performed to diagnose IBD:

  • Blood Panel and Urinalysis: Used to rule out other problems, such as liver or kidney disease. These tests are usually normal, but they may show a general inflammatory response in the blood, or a loss of blood proteins albumin (an important blood protein) may leak from the intestine into the bowel.
  • Broad Spectrum Deworming: This and more extensive parasite testing are done if the dog is under one year old or lives with other animals. Typical parasites to rule out include: Giardia, Crytospoidium, and Tritrichomona. Younger dogs are also tested for Salmonella and Campylobacter.
  • Trial of a simple medication: Metaclopramide (Reglan) or metronidazol (Flagyl) is often used to see if there is symptomatic relief.
  • Radiographs (X-rays): To rule out growths in the abdomen or tumors.

If non-invasive testing is not revealing, then a biopsy is performed. This can be done via endoscopy or surgery. Tissue samples obtained via endoscopy or surgery are analyzed by a special laboratory. The infiltration of inflammatory cells is graded as mild, moderate, or severe and the type of cells involved are identified. These procedures are expense and often require referral to a specialist.

Treating Inflammatory Bowel Disease

Treatments for IBD are aimed at decreasing inflammation in the intestines and preventing symptoms through a combination of the following:

  • Suppressing the immune system
  • Slowing down intestinal motility
  • Coating and protecting the lining of the intestine
  • Killing bacteria
  • Limiting specific diet ingredients that may be irritating

Medications that Suppress the Immune System:
Corticosteroids: Prednisone, dexamethasone, and prednisolone are used to decrease inflammation and are very effective in lessening or eliminating the signs of IBD. However, they can have a number of serious side effects, including weight gain, fluid retention, liver changes, and suppressed immune system. A newer corticosteroid showing promise is budesonide (Entocort? EC). This drug is marketed to treat Crohn's disease in people. Budesonide may cause less of the systemic side effects associated with corticosteroid use.

Cyclosporine and azathioprine: These are powerful anti-cancer medications that have been known to cause pancreatitis, bone marrow and liver problems, and should be managed carefully through frequent laboratory tests.

Sulfasalazine (5-ASA, Salazoprin, Azulfidine) a sulfa antibiotic is also used as an immune suppressant. While it has anti-inflammatory effects, it is poorly absorbed so it does not have the level of side effects that steroids have and thus is often tried before resorting to cortiocosteroids. Sulfasalazine can affect the glands of the eyes causing permanent dry eye or keratoconjunctivis sicca (KCS). Similar drugs that may be less likely to cause KCS include Olsalazine and Mesalamine.

Medications for Diarrhea and Vomiting:
Loperamide (Imodium): During flairs loperamide (Imodium) or diphenoxylate (Lomotil) sometimes help. However, if given continuously over long periods of time they may lose their effectiveness or cause constipation. They are quite safe when the correct dose is given.

Medications That Protect the Lining of the Digestive Tract:
Bismuth subsalicylate (Pepto Bismol): This is helpful when vomiting is part of the problem or during diarrhea flare-ups.

Mistoprostol, cimetidine,and ranitidine: If the dog has bleeding ulcers, drugs that decrease stomach acidity or medications that from a barrier against acidity, such as sucralfate, may help.

Medications That Attack Bacteria:
Metronidazole (Flagyl): This is an antibiotic. Even when harmful bacteria are not the apparent root cause, metronidazole is sometimes effective. Another antibiotic, tylosin, sometimes helps control IBD when it is added to food.

Nutritional Changes
Dietary changes may be helpful and may limit the amount of medication you need to give your dog. Omega 3 Fatty acids may help decrease intestinal inflammation. There are many highly digestible, hypoallergenic and bland diets available. These diets are free of preservatives, additives and coloring agents, and contain protein sources such as cheese, rabbit, venison, cottage cheese, or duck, or contain proteins that are hydrolyzed into small non-antigenic component molecules. It can take several months to see improvement. Some dogs with IBD see improvement with high fiber diets. Others do better when fiber is reduced. In addition, some dogs have less diarrhea when the fat content in their diet is reduced. It can be hard to tell which is beneficial since high fiber diets (typically designed for pet to lose weight) are also lower in fat.

Caring for Dogs with Inflammatory Bowel Disease

Caring for a dog with IBD requires a great deal of patience and dedication. And, finding the right medication and diet will also require time and money. Over time, it may become harder for your dog to get the nutrients he needs and, perhaps to keep weight on. You can compensate for this with and extra-nutritious diet and supplemental vitamins. Because there is often an underlying genetic element, you should refrain from breeding your dog.

The AKC Canine Health Foundation and Inflammatory Bowel Disease

CHF has funded three grants to study IBD in the dog. These studies have looked to determine the pathogenesis, genes that are linked to predisposition, and treatments.

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