Section: Treatment In-depth
Therapy In-depth
Treatment principles for IBD involve manipulating the diet to try to dampen any hypersensitivity of the immune system to certain foods. Most animals with IBD require treatment with drugs as well. Drug therapy is aimed at decreasing the inflammation associated with the infiltrate of white cells in the gut as well as decreasing the ability of the immune system to cause inflammation.
Dietary therapy consists of introducing a diet that the animal has never eaten. The protein source in the diet is usually thought to cause the greatest response on the part of the immune system, thus a highly digestible protein that the animal has not been previously exposed to is recommended. Available protein sources include rabbit, venison, whitefish, duck and others. To keep the diet as hypoallergenic as possible, additives and preservatives should be avoided. A number of prescription pet foods are available through veterinarians. Home-cooked diets are only recommended if appropriate vitamin and mineral supplementation is provided through the help of a veterinary nutritionist. The alternative to feeding this type of diet is to feed a hydrolyzed protein diet. Hydrolyzed proteins are partially degraded (broken down) such that they are less likely to cause an adverse immune response. Common protein sources such as chicken can be used, but the immune system does not recognize the protein as chicken because it is not in its complete form.
Addition of soluble fiber to the diet is sometimes recommended for cases of lower GI IBD, as it can normalize fecal consistency, improve the motility of the colon and improve general colonic function.
Antibiotics. Metronidazole is a widely used antibiotic for IBD. It has many mechanisms of activity including killing some GI bacteria, which may contribute to clinical signs, killing protozoal organisms, and dampening the immune response. Its effects on the immune system make it a good anti-inflammatory drug to use in management of IBD. Tylosin is another antibiotic that may be useful for treating dogs. The mechanism by which it acts is unclear, but it is effective for some dogs with lower GI signs. Other antibiotics have also been used.
Corticosteroids. Corticosteroids such as prednisone are both anti-inflammatory and immunosuppressive, depending upon the dose at which they are given. They are an important component of treatment for IBD. By inhibiting the immune system, they help control the influx of white cells and the resultant inflammation in the wall of the gastrointestinal tract. Initial doses are generally quite high. Depending on response to therapy, the dose is gradually tapered over weeks to months.
Sulfasalazine. This is an anti-inflammatory drug that works primarily in the colon, and is therefore used for cases of lower GI IBD.
Other immunosuppressive drugs. There are a multitude of other drugs that also suppress the immune system. An example of one of these drugs is azathioprine (Imuran). It works by a different mechanism than corticosteroids do, but also works to inhibit the immune system and decrease the inflammation in the gut wall. Multi-drug therapy with immunosuppressive drugs is sometimes needed in severe cases, or to enable a reduction in the corticosteroid dose. Reducing corticosteroid doses may be indicated if side effects are severe.
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