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 + T- cell 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 endoscopic interpretation is reduced by the use of standardised endoscopy evaluation forms and standardised histopathological templates and criteria .
Plasma citrulline is considered a sensitive indicator of GIT permeability . ( Dossin et al 2011 )
Histopathology allows grading and typing of mucosal inflammation and secondary changes . Other causes of intestinal disease , including helicobacter gastritis , cryptosporidium enteritis and neoplasia , may also be diagnosed . Where possible the more difficult to reach ileum is also biopsied . The ileum consistently shows mucousal changes most commonly in most patients .
This is especially important in cats to avoid missing focal ileal disease and small cell lymphoma ( SC-LSA ). Some cases may require sampling of focal disease and submucosal diseases surgically - via laparoscopy or laparotomy as the diagnosis may be inconclusive in endoscopically derived samples .
Laparoscopy ( laparotomy ) is suggested as the preferred method of obtaining samples in the cat where early small cell intestinal lymphoma often requires differentiation from IBD , and commonly affected areas tend to be ileum and jejunum which are more difficult to sample endoscopically .
Despite this most cats with IBD are still biopsied endoscopically because it is minimally invasive , more available and cheaper and immunophenotypic staining and other tests can be used to help differentiate small cell lymphoma from IBD on endoscopic samples .
IBD has been traditionally classified according to the inflammatory cells predominantly infiltrating the intestinal mucosa and which part of the intestine is affected . Lymphocytic-plasmacytic enteritis is the most common type of IBD seen in small animals .
Other forms are varying populations of eosinophilic , neutrophilic , histiocytic ( mainly PAS-positive macrophages ) and granulomatous ( mainly PAS-negative macrophages ) mucousal infiltrates causing gastroenterocolitis in individual patients . Linking type of histological inflammation to various studies on the innate immune system and intestinal microbiota has led to some improvements been made in the treatment of IBD .
The reader is referred to the open publications available from the WSAVA gastroenterology standardisation group for a thorough discussion on the standardisation of endoscopic examinations , biopsy sampling techniques and histopathological interpretation of IBD cases ; as well as standardised endoscopic and histopathology examination forms .
Other breed specific enteric disease are also reported in Boxers , French Bull Dogs , German Shepherd Dogs ( GSDs ), Shapei ’ s , Yorkshire Terriers , Soft Coated
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