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
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