Lymphocytic Plasmacytic Enteritis in Dogs
Dr. Bari Spielman
A complete blood count (CBC) may be within normal limits, but it may reveal anemia (low red blood cell count) or mild elevations in white blood cell counts.
Certain diagnostic tests must be performed to diagnose the underlying disorder and exclude other disease processes that may cause similar symptoms. A complete history, description of clinical signs, and thorough physical examination are all an important part of obtaining a diagnosis. In addition, the following tests are recommended to confirm a diagnosis:
A biochemical profile will help evaluate the kidney, liver, protein, and electrolyte status. Hypoproteinemia is not uncommon with LPE. Hypocalcemia (low calcium) is often seen secondary to low protein levels.
A urinalysis is most often within normal limits, and is helpful in ruling out protein loss associated with kidney disease. If there is any suspicion of kidney related protein loss, a urine protein: creatinine ratio should be evaluated. It is a simple test that can be performed on the urine.
Fecal examinations should be performed to rule out parasitism.
Chest and abdominal X-rays, although often within normal limits, may be of benefit in ruling out other disorders.
Abdominal ultrasound may be indicated if the previous diagnostics have been inconclusive. It helps to evaluate the size, shape and integrity of the abdominal organs, and is especially helpful in evaluating for an intussusception or pancreatitis. It is a non-invasive procedure, but it may require a referral facility.
An upper gastrointestinal (GI) barium series may be considered. It will help rule out foreign bodies that cannot be seen on ordinary X-rays and other causes of intestinal blockage. It also helps evaluate for intestinal ulcers, and can assess intestinal wall thickness. A safe dye is given to the pet by mouth, and it is watched as it travels through the GI tract. It is non-invasive, and most often it can be performed by your veterinarian, although sometimes it may necessitate a referral facility.
Gastroduodenoscopy evaluates a portion of the stomach and small intestine with proper instrumentation. Biopsies can be obtained, without an abdominal incision, and submitted for microscopic evaluation. General anesthesia is necessary, but endoscopy is considered a relatively low risk procedure. It most often necessitates the expertise of a specialist and specialized instrumentation.
Your veterinarian may require additional tests to insure optimal medical care. These are selected on a case by case basis:
Serum folate and cobalamin are tests that generally increase and decrease levels respectively, in those cases with small intestinal bacterial overgrowth.
Radioimmunoassay of serum trypsin-like immunoreactivity (TLI) is generally considered the gold standard in definitively diagnosing EPI. Affected individuals have extremely low levels. This is a simple blood test that is performed after a 12 hour fast. Only certain laboratories perform the test, however most veterinarians have the capacity to draw the blood and send it to the appropriate lab.
Cytologic examination of feces and the rectal tissue may reveal histoplasmosis.
Laparotomy (abdominal surgery) allows surgical biopsies of intestines, lymph nodes, and other organs to be obtained. Laparotomy is not recommended unless all prior procedures are inconclusive, and/or the patient is not responding well to appropriate therapy. There are moderate risks associated with doing surgery on hypoproteinemic animals, therefore should be performed only if absolutely necessary.
Appropriate therapy for lymphocytic plasmacytic enteritis is largely dependent on the underlying cause, and varies according to the type and severity of clinical illness. Depending on the severity of clinical signs and/or stage of disease, hospitalization may or may not be recommended. Patients who have severe vomiting and/or diarrhea, dehydration, or hypoproteinemia and associated inappropriate fluid accumulation are hospitalized for aggressive treatment and stabilization. Stable patients can be treated as outpatients as long as they are monitored closely for response to therapy.
With appropriate therapy, many patients do quite well. It is very important that all recommendations by your veterinarian are followed closely, and any questions or concerns that arise during the treatment protocol are addressed immediately.
Dietary management is often recommended, and varies depending on the patient and underlying cause, if known.
Easily digestible and/or non-allergenic diets should be considered in cases of LPE.
In cases of associated lymphangiectasia, low fat diets should be considered.
In associated cases of gluten-induced enteropathy, diets with no gluten (wheat, grains) should be chosen.
Fluid therapy may be necessary in some patients with severe vomiting and/or diarrhea, and is directed toward correction of dehydration, acid-base derangements, replacement of electrolyte deficits, and to provide for ongoing losses.
Diuretics, drugs that help remove excess fluid from the body, may be indicated in those patients with associated hypoproteinemia and accumulation of fluid in body cavities or tissues.
Oncotic agents are products that help maintain normal fluid distribution in the body and may be helpful in patients with associated hypoproteinemia.
Corticosteroids are the mainstay of therapy in these patients. They aid in the suppression of inflammation and help control the immune system.
Azathioprine (Imuran) is an immunosuppressive drug that often works well in conjunction with corticosteroids.
Metronidazole (Flagyl) is an antibiotic that also has properties against protozoa (giardia) and inflammation, and is often helpful when used in conjunction with other drugs.