Diseases that require surgery to reach a definitive diagnosis are frustrating to deal with.
No matter how persuasive I try to be, owners are understandably reluctant to think that biopsying some internal bit of their sick dog is a great idea. Now the shoe’s on the other foot, so to speak.
I recently adopted a pup with just such a condition – inflammatory bowel disease. I feel your pain.
Inflammatory Bowel Disease (IBD, not to be confused with IBS or Irritable Bowel Syndrome) is relatively common in dogs. Basenjis, Soft Coated Wheaten Terriers, German Shepherd Dogs, Shar-peis, Rottweilers, Weimaraners, Border Collies, Boxers, and some other breeds have a higher than normal incidence of IBD, but we don’t know exactly why particular dogs develop it and others do not. A combination of genetics, environmental stress, immune dysfunction, and antigenic stimulation (food allergies, bacterial overgrowth, metabolic diseases, food intolerance, parasites, etc.) seem to play a role in most cases.
Most dogs are diagnosed with IBD in their middle years, but the typical symptoms of vomiting, diarrhea, weight loss, and/or poor appetite can develop at any age. A dog may have mild or intermittent signs of the disease at first but often his condition will worsen with time.
What is IBD?
A healthy GI system has many layers of defense against the offensive substances (bacteria, toxins, potential allergens, etc.) that it comes in contact with every day. When these systems are broken down or defective to begin with, triggers are absorbed into intestinal tissues and stimulate the immune system resulting in inflammation. Unfortunately, this inflammation makes the gut wall even “leakier” resulting in a self-perpetuating cycle of immune stimulation leading to increased inflammation and so forth.
Why Does Diagnosing IBD Require Surgery?
The symptoms of vomiting, diarrhea, and loss of appetite and weight fit with a laundry list of canine diseases. Blood work, x-rays, and other non-invasive tests can rule many of these conditions out and raise the level of suspicion for inflammatory bowel disease, but the only way to definitively diagnose IBD is to biopsy the intestinal wall and have a pathologist evaluate the tissue samples.
Biopsies can be taken either with an endoscope or via abdominal surgery.
Both procedures require general anesthesia and have their pros and cons (e.g., endoscopy is less invasive but usually can’t reach the entire intestinal tract). Your veterinarian can help determine which is best in your dog’s individual case.
The pathologist’s report will also help determine what type of IBD a dog has with regards to the part of the GI tract that is affected as well as the predominant type of inflammatory cell involved. This information can help your veterinarian determine the most appropriate treatment and give you an idea of your dog’s prognosis.
How Is IBD Treated?
Treatment for inflammatory bowel disease centers on reducing the numbers of pro-inflammatory triggers the lining of a dog’s intestinal tract is exposed to and if necessary, suppressing the immune system.
Hypoallergenic diets play an extremely important role in IBD treatment. Some dogs thrive on foods made with novel ingredients (e.g., venison and sweet potato). Others do better one diets made from hydrolyzed protein (i.e., proteins broken down into pieces so tiny that they evade detection by the immune system) and a single carbohydrate source. Some owners swear by home-prepared diets. Finding the right food for a dog with IBD usually requires some trial and error.
Many dogs with IBD suffer from bacterial overgrowth within their intestinal tracts.
Antibiotics can help control their numbers, and some like metronidazole also have an immunosuppressive effect. Duralactin, a product that contains dried milk protein from hyperimmunized cows, may also help some dogs.
If relatively benign therapies like these do not sufficiently control a dog’s symptoms, it’s time to reach for the big guns. Corticosteroids and/or other medications like azathioprine are used to suppress the immune system.
Response to treatment depends on the type of IBD a dog suffers from and its severity.
I’ve had some patients live symptom-free with dietary modification alone, but have had to euthanize others despite trying everything in the book, which is just another reason why inflammatory bowel disease is so frustrating to deal with.
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Dr. Coates has recently joined the PetMD team and she is now writing for the Fully Vetted column; great blog, do check it out.
Jennifer also writes short stories that focus on the strength and importance of the human-animal bond and freelance articles relating to a variety of animal care and veterinary topics. Dr. Coates lives in Fort Collins, Colorado with her husband, daughter, and pets.
Articles by Dr. Coates:
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Common Misdiagnoses (Part 2)
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