Vet360 Vol 3 Issue 04 August 2016 - Page 23

GASTROENTEROLOGY Pythiosis may only be diagnosed cytologically or on histopathology if the work up is pursued. 2. Rule out Food Responsive Enteropathy (FRE) Before conducting a diet trial the severity of the disease should be established. A canine inflammatory bowel disease activity index (CIBDAI) or a canine chronic enteropathy clinical activity index (CCECAI) index in the dog and a feline inflammatory bowel disease activity index (FIBDAI) in the cat is established. Some authors advocate the addition of an albumin value and histological score to the CIBDAI activity in- dex. Whilst this may be necessary in individual cases, and in research, the practicality of repeat endoscopic procedures in clinical practice is limited. Interpretation of index score The FIBDAI is not graded as it is in the dog and does not differentiate food responsive enteropathy (FRE) from idiopathic IBD cases. The numeric number is simply used as a reference for evaluating post treatment success which is set 75% of the original pretreatment score. A good response to a therapeutic trial is seen as a CCECAI score reduction from mild Table 1: The CIBDAI & CCECAI Indices Parameter Attitude/Activity Appetite Vomiting Stool consistency Stool (or mucus/ blood) Frequency Weight loss Albumin levels Ascites and peripheral oedema Pruritis Clinical Inflammatory Bowel Disease Activity Canine Chronic Enteropathy Clinical Activity Index (CIBDAI) Index (CCECAI) 0 – normal 0 – normal 1 – slightly decreased 1 – slightly decreased 2 – moderately decreased 2 – moderately decreased 3 – severely decreased 3 – severely decreased 0 – normal 0 – normal 1 – slightly decreased 1 – slightly decreased 2 – moderately decreased 2 – moderately decreased 3 – severely decreased 3 – severely decreased 0 – normal 0 – normal 1 – mild (1x/wk) 1 – mild (1x/wk) 2 – moderate (2-3x/wk) 2 – moderate (2-3x/wk) 3 – severe (>3x/wk) 3 – severe (>3x/wk) 0 – normal 0 – normal 1 – slightly soft 1 – slightly soft 2 – very soft 2 – very soft 3 – watery diarrhoea 3 – watery diarrhoea 0 – normal 0 – normal 1 – slightly increased (2-3x/d) 1 – slightly increased (2-3x/d) 2 –moderately increased (4-5x/d) 2 –moderately increased (4-5x/d) 3 – severely increased (>5x/d) 3 – severely increased (>5x/d) 0 – none 0 – none 1 – mild (<5%) 1 – mild (<5%) 2 – moderate (5 – 10%) 2 – moderate (5 – 10%) 3 – severe (>10%) 3 – severe (>10%) 0 –albumin >20g/L 1 – albumin 15 – 19g/L 2 – albumin 12 – 14g/L 3 – albumin <12g/L 0 – none 1 – mild 2 – moderate 3 – severe (possible pleural effusion) 0 - no pruritis 1 - occasional itching 2 – regular itching, stops if sleeping 3 – wakes up to scratch Interpretation of index score CIBDAI 0-3 Clinically insignificant CCECAI 0-3 Clinically insignificant 4-5 Mild disease 4–5 Mild disease 6-8 Moderate disease 6-8 Moderate disease 9 - 11 Severe disease > 9 ( 18) Severe disease > 12 (24) Very severe disease Issue 04 | AUGUST 2016 | 23 VET360 AUGUST 2016 working.indd 23 2016/07/25 11:04 PM