Inflammatory Bowel Disease (IBD) in Dogs
Dog Diseases & Symptoms >
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.
Home Care of Dogs with Inflammatory Bowel Disease (IBD)
Optimal treatment for your pet involves a combination of home and professional veterinary care. Follow-up can be critical, especially if your pet does not rapidly improve.
Administer all prescribed medications as directed. Alert your veterinarian if you are having problems treating your pet.
Strict adherence to a new diet is imperative to successful dietary therapy. The prescribed diet should be the only food that your pet eats. This means that all treats (unless made of the same formulation as the new diet), table scraps and natural chew toys or flavored toys must be eliminated. Even flavored vitamins or flavored heartworm pills should be avoided, as they often contain beef or chicken based protein sources. It is important to notify your veterinarian if your pet is not adjusting to the new diet and is not eating appropriate quantities. Problems with palatability may require changing the diet or even formulating a special home-cooked diet in certain cases. Recovery is dependent on adequate nutrient intake and this must be monitored. Ask your veterinarian to provide you with exact feeding guidelines to insure that your pet is receiving the proper number of daily calories.
Follow-up after the initial 2 to 4 weeks of therapy is very important, as drug dosages may be gradually decreased depending on the pet’s clinical response to therapy. Corticosteroids must be very slowly tapered over a several month period, and should never be abruptly discontinued, as this can make your pet quite ill. Some animals need to be treated with lifelong therapy if relapses occur. Dogs receiving azathioprine or other immunosuppressive drugs should also be monitored with serial complete blood counts every two weeks to monitor for decreased white blood cell or platelet counts which can be side effects of these drugs. Azathioprine should not be used in cats due to the side effects.
Animals that have abnormalities of the biochemical profile should also receive follow-up blood tests to look for improvement in the bloodwork following institution of therapy.
Because of the increased risk of secondary infection when being treated with immunosuppressive drugs, owners must watch for problems. Infections are most commonly seen in the urinary and respiratory tracts, as well as the skin. If you notice straining to urinate or blood in the urine, red, irritated or itchy skin, or coughing and/or nasal discharge, these could all be signs of infection. Contact your veterinarian if any of these symptoms arise.
Certain side effects of high dose corticosteroid therapy are to be expected; animals will drink and urinate more than normal and may have an increased appetite, and dogs may pant. Adverse effects of this therapy may include gastrointestinal upset and even bleeding or ulcer formation. This may manifest as vomiting, diarrhea, dark and tarry stools, or general weakness. Since many of these signs may be similar to the signs caused by IBD, any concerns should be brought to the attention of your veterinarian. You should be particularly alert with respect to changes or worsening of the clinical signs.
Side effects of sulfasalazine therapy may also be seen. These might include lack of appetite, vomiting, and keratoconjunctivitis sicca (KCS), which is decreased tear production. Animals receiving this drug should have periodic measurements of tear production by the veterinarian. If you notice discharge, redness, excessive blinking or rubbing at the eyes, this should be evaluated by the veterinarian.