Lymphocytic Plasmacytic Enteritis in Dogs

Overview of Canine Lymphocytic Plasmacytic Enteritis

Lymphocytic plasmacytic enteritis (LPE) is a form of inflammatory bowel disease characterized by the presence of particular microscopic cells, including lymphocytes and plasma cells, in excess within the intestinal wall in a dog.

Causes of Lymphocytic Plasmacytic Enteritis in Dogs

• Idiopathic, which means it has no known cause
• Infectious disorders such as giardia, Salmonella, Campylobactor
• Dietary agents such as meat proteins, food additives, preservatives, milk proteins and gluten (wheat)
• Genetic Factors

Lymphocytic plasmacytic enteritis is seen in both dogs and cats and is seen in all ages. It is most common in middle aged and older animal.

LPE can affect all breeds, although is seen most commonly in the German shepherd, shar-pei, and Wheaton terrier.

Although some patients with LPE may have no clinical signs, some may have life threatening manifestations. Signs vary greatly in type, severity, and frequency.

What to Watch For

• Diarrhea
• Vomiting
• Anorexia
• Ravenous appetite
• Lethargy
• Weight loss
• Abdominal distension
• Difficulty breathing
• Ascities, or fluid in the abdominal cavity
• Edema, or abnormal fluid accumulation in any part of the body
• Respiratory difficulty secondary to pleural effusion, which is fluid in the chest cavity

Diagnosis of Canine Lymphocytic Plasmacytic Enteritis

Diagnostic tests may include the following in your dog:

• Complete blood cell count (CBC)
• Biochemical profile
• Urinalysis
• Fecal examinations
• Thoracic (chest) and abdominal radiographs (X-rays)
• Abdominal ultrasound
• Gastroduodenoscopy and biopsy

Treatment for Canine Lymphocytic Plasmacytic Enteritis

Treatment of dogs with LPE should be directed at the underlying cause if identified. Most of these individuals can be treated as outpatients.

• Dietary management is often recommended and varies depending on the underlying cause.
• Fluid therapy may be necessary in some patients with severe vomiting and diarrhea, and is directed toward correction of dehydration and acid-base derangements, replacement of electrolyte deficits, and to provide for ongoing losses.
• Diuretics, or drugs that help remove excess fluid from the body, may be indicated in some patients with LPE.
• Oncotic agents are products that help maintain normal fluid distribution in the body.
• Anti-inflammatory drugs
• Antibiotic therapy

Home Care for Dogs with Lymphocytic Plasmacytic Enteritis

Administer all medication and dietary recommendations as directed by your veterinarian. Follow up as directed by your veterinarian. If your pet’s condition is not improving and is getting worse, seek veterinary attention at once.

Generally speaking, there is no preventative care for lymphocytic plasmacytic enteritis

In cases when a food intolerance or allergy is suspected or documented, avoid that particular item and adhere strictly to dietary changes.

Information In-depth on Lymphocytic Plasmacytic Enteritis in Dogs

The term lymphocytic plasmacytic enteritis (LPE) refers to the most common form of inflammatory bowel disease (IBD). It is characterized by a particular population of inflammatory cells – lymphocytes and plasma cells – that are microscopically over- represented, and that gather within the intestinal wall. Although a definitive cause has not been well established, LPE is felt to be associated with an abnormal immune response to environmental stimuli that when continued, creates a self-perpetuating inflammation resulting in the disease.

Signs associated with LPE vary greatly in type, severity, and frequency. In general, early in the disease process signs are often mild and intermittent, but they increase in severity and frequency over time. Some combination of vomiting, diarrhea, weight loss and appetite change are most often noted. Often there is an association with hypoproteinemia (low protein levels) caused by an excessive loss of protein into the gut. In animals that are hypoproteinemic, it is important to note that the initial step in the diagnosis is to exclude non-intestinal causes of hypoproteinemia, specifically related to the liver or kidneys. Many disorders must initially be considered when these individuals present.

Disorders other than primary gastrointestinal diseases that cause hypoproteinemia:

• Severe liver disease must be ruled out as a contributing cause of hypoproteinemia: Hepatitis (inflammation of the liver), cancer, and cirrhosis (end stage liver disease).
• Protein losing kidney disorders need to be considered in hypoproteinemic patients: Glomerulonephritis (inflammation of a part of the kidney) or amyloidosis, which is the deposition or collection of a type of protein in organs and tissues that compromise their normal function.
• Blood loss for any reason will decrease the protein level.
• Inadequate protein intake will contribute to hypoproteinemia.

Other infiltrative inflammatory bowel conditions:

• Eosinophilic enteritis, granulomatous enteritis
• Infectious diseases such as histoplasmosis. This is a fungal infection that affects many systems, including the gastrointestinal tract.
• Intestinal parasitism has been associated with PLE, especially in young pups that are anemic as well (Roundworms, hookworms, whipworms, coccidia, and giardia).
• Bacterial infections (Giardia, Salmonella, Campylobacter).
• Viral Infections.
• Exocrine pancreatic insufficiency (EPI) is a disorder where chronic diarrhea and weight loss develop secondary to inadequate production of digestive enzymes.
• Intestinal lymphangiectasia, which is blockage of the lymphatics of the gastrointestinal tract.
• Cancer of any sort must be ruled out. Lymphosarcoma is a malignant cancer that most often presents in the form of a microscopic infiltration into the bowel, however may form mass lesions.
• An intussusception, or telescoping of part of the bowel into an adjacent segment of bowel, especially chronic, may cause similar signs.
• Chronic foreign bodies of the intestinal tract are often associated with a number of gastrointestinal signs such as diarrhea, vomiting, and weight loss.
• Ulcerative gastroenteritis – interruptions in the lining of the gastrointestinal tract – must be considered. It may be secondary to inflammation, drug administration, cancer or foreign bodies.
• Small intestinal bacterial overgrowth is characterized by an overgrowth of normal intestinal flora (bacteria) usually secondary to various gastrointestinal diseases, but occasionally as a primary entity
• Hemorrhagic gastroenteritis (HGE) is a dramatic, potentially fatal disorder with no one known cause. It has a predilection for small breed dogs. HGE is characterized by the sudden onset of profuse bloody diarrhea and occasional vomiting.
• Food allergies, gluten-induced enteropathies, which are sensitivity to a component of wheat and other grains.

Diagnosis In-depth of Lymphocytic Plasmacytic Enteritis in Dogs

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 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.
• 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.

Therapy for Dogs with Lymphocytic Plasmacytic Enteritis

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.

Follow-up Care for Dogs with Lymphocytic Plasmacytic Enteritis

Optimal treatment for your dog requires a combination of home and professional veterinary care. Follow-up can be critical, especially if your dog does not rapidly improve.

• LPE is not necessarily cured as much as controlled. Relapses are common.
• Administer all prescribed medication as directed. Alert your veterinarian if you are experiencing problems treating your dog.
• Observe your dog’s general activity level, body weight, appetite, and evidence of return of clinical signs.