Vet360 Vol 3 Issue 04 August 2016 - Page 25

GASTROENTEROLOGY 4. Conduct a probiotic trial In one study adding a probiotic cocktail to known FRE had no added benefit over diet therapy (Sauter et al 2006). In other studies a clear, safe benefit is suggested provided their use is continued (German et al 2010, Herstad et al 2010, Bybee et al 2011). It also may seem counterintuitive to give GI antibiotics with probiotics however clinical improvement is often seen when given in combination with each other. In another study in non FRE relapsing chronic IBD cases probiotics (VSL#3 strains) significantly improved clinical and histological scores, decreased CD3+ Tcell infiltration, increased regulatory T-cell markers (FoxP3+ and TGF-β+) and normalised intestinal dysbiosis in dogs with IBD compared to a combination of prednisolone and metronidazole (Rossi et al 2014). The dogs in this study treated with VSL#3 also showed significantly increased plasma citrulline indicating restoration of the mucosal barrier although this clinical parameter was not compared to the immunosuppressive treatment group (Dossin et al 2011). This finding is significant and warrants futher investigation. Probiotics are thought to have immunomodulatory effects and antimicrobial activities directed toward intestinal pathogens (Rath 2003). Recommendations are to use a product produced by a reputable veterinary company backed by research for at least 2 months. 5. Repeat an ultrasonographic examination Ultrasonographic studies are used to document abdominal changes consistent with IBD, aid in endoscopic biopsy site selection and help to detect extra-intestinal disease and intestinal neoplasia. Hyperechoic mucosal striations are indicative of lacteal dilation in dogs. Other common ultrasonographic findings associated with IBD include small intestinal wall thickening, hyperechoic mucosal speckles, abdominal effusion and mesenteric lymphadenopathy. Older cats with diffuse thickening of the muscularis layer of the intestine are more likely to have T-cell lymphoma than IBD. Lymphadenopathy is equally associated with both diseases. Fine needle aspiration can also be performed. 6. Conduct endoscopic and histopathological examinations Endoscopy is increasingly the preferred method of obtaining samples in dogs as it is minimally invasive, widely available and allows direct visualisation of the gastrointestinal mucosa. Endoscopic examination, biopsy and histopathology, using the WSAVA gastroenterology standardisation group guidelines, are recommended for animals presenting with severe disease or those not responding to initial therapeutic trials. Inter-operator variation in [X[\]][ۈ\œYXYHH\Hو[\\Y[H][X][ۈܛ\[[\\Y\]X[[\]\[ܚ]\XK\XH][[H\ۜY\YH[]]H[X]܈قU\YXX[]K [][ LJB\]H[ܘY[[\[و]X[[ [[X][ۈ[Xۙ\H[\ˈ\]\\›و[\[[\X\K[Y[[XؘX\\]\ܞ\ܚY][H[\]\[[\XKX^H[BXYۛY \HXHH[ܙHYX[XX[][H\[[YY H[][Hۜ\[H›]X\[[\[[[ۛH[[]Y[˂\\\XX[H[\ܝ[[]]YZ\[™[[X[\X\H[X[[[\XH SJKYH\\X^H\]Z\H[\[و[\X\B[X]X[\X\\\X[H HXH\\B܈\\^H\HXYۛ\X^HH[ۘ\]H[[X[H\]Y[\\˂\\H \\^JH\Y\Y\HY\YY]و؝Z[[[\\[H]\BX\HX[[[\[[[\XHٝ[\]Z\\Y\[X][ۈHP [[[ۛHYXY\X\[H[][H[Z[[HX\H[ܙHYX[[\H[X[K\]H\[]]P\H[[YY[X[HX]\H]\Z[[X[H[\]K[ܙH]Z[XH[X\\[[[][[\XZ[[˜[\\[H\Y[Y\[X]HX[[[\XHHPۈ[X[\\˂P\Y[Y][ۘ[H\YYYXܙ[B[[[X]ܞH[YZ[[H[[][H[\[[]XH[X\وH[\[H\YXY [\]X\\XX]X[\]\\H[[[ۈ\HوPY[[X[[[X[˂\ܛ\\H\Z[[][ۜو[[[X]][X\[]X XZ[HT\]]HXXܛY\H[ܘ[[X]\ XZ[HT[Y]]BXXܛY\H]X\[[[]\]\[\[\]\[[]YX[]Y[ˈ[[\Hو\X[[[[X][ۈ\[\YY\ۈH[]B[[][H\[H[[\[[ZXܛؚ[H\YœYH[\ݙ[Y[Y[XYH[HX]Y[قP HXY\\Y\YH[XX][ۜ]Z[XHHHUH\[\H[\\][ۂܛ\܈HܛY\\[ۈۈH[\\][ۈو[X^[Z[][ۜ[H[\[X\]Y\[\]X[[\]][ۈقP\\\[\[\\Y[X[\]H^[Z[][ۈܛ\˂\YYXYX[\X\X\H\H[\ܝY[\[[\X[\\ K\Zx&\[ܚ\H\Y\ٝ]Y\YH UQT M BU ͌UQT Mܚ[˚[ B M ̍H LN B