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Dietary Considerations for Dogs with Chronic Enteropathies
Adam J. Rudinsky
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The various options now offered by specialist petfood companies for a dog with chronic gastrointestinal disease can be quite baffling, and the clinician may be tempted to reach for the nearest product that claims to be effective for enteric disease. Adam Rudinsky offers some pointers to help the clinician.
Adam J. Rudinsky
DVM, MS, Dipl. ACVIM
Dr. Rudinsky received his DVM degree from OSU and completed a small animal rotating internship at Purdue University before returning to undertake a combined residency in internal medicine and MS degree at Ohio State. He is now on faculty as a staff internist where he provides the service with a specialized interest, clinical perspective and clinically applicable research in gastroenterology, pancreatology, and hepatology. He has received multiple teaching awards and hospital service awards.
Key Points
- Dietary management can be effective in many dogs affected by idiopathic chronic enteropathies but effective therapy requires an understanding of the patient, dietary options available, and the likely disease process.
- Diet ingredient profiles within a therapeutic class, for example low-fat diets, can be radically different, resulting in an inability to use these diets interchangeably.
- Some diets can fit into multiple therapeutic classes and can be used to the clinician’s benefit to potentially maximize the treatment response.
- Due to contaminants and variable processing rigor, over-the-counter diets are not acceptable alternatives to veterinary diets manufactured and designed to treat gastrointestinal disorders.
Introduction
Chronic enteropathy (CE) is a poorly defined term in veterinary medicine. In its most basic definition, it is a descriptor of all gastrointestinal (GI) disorders which are chronic in nature. The designation of “chronic” disease should be made on an animal-by-animal basis through a thorough assessment of the patient’s individual history and clinical signs ( Figure 1 ). Signs should be persisting in the animal for at least ten to fourteen days in duration before the classification of chronic is made. This distinction between acute and chronic GI disorders is important from both a diagnostic and therapeutic perspective; this article deals with chronic GI disorders and cannot necessarily be extrapolated to acute GI disorders and their associated dietary management. In addition, this broad definition of CE inherently includes all chronic GI disorders, including those that may result from inflammatory, autoimmune, metabolic, neoplastic and infectious etiologies.
As a practicing clinician, achieving a correct diagnosis and establishing what is causing the CE is essential to allow for targeted application of both dietary and medical therapies. A definitive diagnosis can be accomplished by assessing patient factors, utilizing a targeted diagnostic testing approach (e.g., clinical pathology, fecal testing, molecular diagnostics, imaging and GI biopsy), and performing therapeutic trials as indicated on a case-by-case basis. One of the primary goals when evaluating the patient should be to eliminate the systemic, infectious and neoplastic disorders which may be largely clinically indistinguishable from food-responsive CE and require specific treatment in conjunction with, or separate from, dietary management.
Understanding diet categories for dogs with GI disease
Understanding the variety of dietary options available for treating GI disease is the first step in being able to properly implement dietary therapy in CE cases. There is no “one size fits all” approach; each dietary category is suited for specific disease syndromes and situations while potentially not advisable in others. The proper implementation of specific dietary strategies is imperative for successful use of diets as a therapeutic tool. Canine CE can often be effectively managed with diet, and may avoid some of the problems that can develop with the use of long-term antibiotics (e.g., alteration of the gastrointestinal microbiome) or immunomodulatory medications (e.g., altered immune status and risk of infection). The clinician should always consider three things when making a diet selection, namely: (I) diet history (II) diet strategy, and (III) diagnosis ( Figure 3 ). The following diet types (therapeutic classes) are the most commonly employed and are readily available through many petfood companies for treatment of canine GI diseases: easily digestible, limitedingredient, hydrolyzed, low-fat, and fiber-fortified diets ( Figure 4 ). Identifying which category or categories a potential diet falls within is best done based on information provided by the manufacturer and the individual patient’s complete dietary history. Amongst GI diets available on the market, many overlap and meet the requirements for multiple of the above categories at the same time, and such overlap can be to the clinician’s benefit. It is also vital that clinicians are aware that the nutrient profiles of different diets may vary over time. In order to be certain that the prescribed diet meets the needs of the patient, up-to-date product information should be evaluated at least yearly. Lastly, diets in a given category (e.g., all easily digestible diets) are not the same; they often have different nutrient profiles and can have different effects in an individual animal if used interchangeably. [...]
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