Primary care veterinarians and internal medicine specialists alike say gastrointestinal (GI) disease comprises up to 25 percent of their caseloads. Diagnosing and treating the array of chronic cases can be complex.
With new pet foods created to prevent or maintain certain GI conditions, new in-house testing and diagnostic tools, more patients and clients can eliminate acute disease or minimize symptom flare ups in maintaining chronic cases.
“Parasites, digestive disturbances and food allergies are the most commonly seen GI issues,” says Cade Wilson, DVM, of Carter County Animal Hospital P.C. Ardmore, Okla. “But giardia, GI cancer, GDV are other conditions that require more work to treat. Giardia could be difficult to identify before the new SNAP giardia test was developed and chronic conditions require diagnostic tools or surgery to identify.”
Richard E. Goldstein, DVM, Dipl. ACVIM, Dipl. ECVIM, associate professor of small animal medicine at Cornell University, says SNAP tests such as the giardia and pancreatitis tests have brought testing in-house, minimizing missed disorders/diagnosis and expediting treatment.
“It takes less than 10 minutes to get a result from SNAP tests,” Dr. Goldstein says. “The shelf life is good and they’re economical. They’ve improved patient care for sure.”
Depending on presenting symptoms, blood work is often a starting point in chronic disease detection but getting the dog or cat to the practice can be delayed by owners’ missing signs of a problem.
“While vomiting and diarrhea can’t be ignored, more subtle symptoms like weight loss, constipation, borborygmus, flatulence, depression, lethargy, abdominal pain and loss of appetite can go unnoticed by owners for quite a long time,” says Dorothy Laflamme, DVM, Ph.D., Dipl. ACVN, veterinary nutrition communication specialist at Nestle Purina PetCare Research.
Veterinarians say owners will often consider frequent feline vomiting a normal occurrence when in fact it is a sign of a potential problem. Owners also feed dogs fatty table foods which can cause pancreatitis. The common delay of treatment and owner-induced conditions speaks to the need of preventive education, specialists say.
“While I believe every veterinarian would agree she has an obligation to educate pet parents about gastrointestinal health, I also feel we likely don’t do enough in this arena,” says Christopher G. Byers, DVM, Dipl. ACVECC, Dipl. ACVIM (SAIM), an internist at MidWest Veterinary Specialty Hospital in Omaha, Neb. “Why? Time constraints. How many hospitals have appointment schedules that afford a clinician and his/her nursing team adequate time to obtain a thorough patient history, do a complete physical examination, perform appropriate diagnostic tests, spend time with parents explaining what is going on with their pet and provide educational materials to reinforce your conversation?
“All of my new-patient consultations are 60 minutes long and I have been called ‘crazily efficient,’ but even with this amount of time I am still challenged at times to meet my own expectations for client education” Byers continues. “So I’m left asking myself, ‘Can one really accomplish all that is needed in a 15-minute appointment?’ The answer is no.
“And that means something has to be compromised, and typically it is the attention to owner education that falls to the wayside,” Bayers adds.
Veterinarians say people often buy or adopt breeds they’re unfamiliar with and don’t know how to recognize signs of a problem. Briefly outlining predisposed conditions during a wellness exam can make clients more vigilant.
“I found my dog in the woods without an owner,” says Steffen Sum, DVM, an assistant professor at the University of Georgia in Athens, Ga. “If I had found a different breed of dog–that’s the dog I’d have. For clients, they might not know anything about the breed they’ve found themselves owning and may not know preventive measures to take to avoid GI issues, like what to feed it outside of grocery brands.”
Nutrition and Supplements
Nutrition serves as a GI disease prevention tool and to maintain diagnosed conditions.
“There’s a growing body of evidence that the bacteria in the GI tract have an important role in overall health and diet can modify these bacteria,” says Joseph Bartges, DVM, Ph.D., Dipl. ACVIM, Dipl. ACVN, professor of medicine and nutrition at the University of Tennessee in Knoxville, Tenn. “Additionally, there are many GI diseases that can be maintained by diet.”
Some nutritionists suggest using probiotics to maintain GI issues caused by diet changes and stress.
“We use probiotics regularly at UGA within treatment plans,” Dr. Sum says. “Some studies say probiotics are helpful and others say they’re not. Dogs are interested in eating almost anything, so after what they’ve eaten causes GI upset or antibiotics have been administered, I use probiotics.”
The average dog food that meets nutritional requirements is adequate without supplements for many dogs, nutritionists say, but animals predisposed to GI upset or with existing disease conditions such as inflammatory bowel disease need to stay on a specific diet determined by the practitioner to minimize diarrhea.
The term “gastrointestinal diet” has been used as an umbrella term, but numerous formulas exist in company offerings that benefit different, specific causes of GI upset.
“We use zeolite, a microscopic natural mineral that is highly porous and absorbs 50 percent of its volume in water,” says Brent Mayabb, DVM, manager of education and development at Royal Canin US in St. Louis. “It prevents and treats diarrhea by absorbing a surplus of water and binding toxins and by covering the surface of the intestinal mucosa. This ingredient is added to large- and giant-breed formulations since these breeds tend to have more watery stool compared with smaller breeds.”
Dr. Mayabb says veterinarians shouldn’t wait until a patient is sick to suggest diets more likely to suit the patient. Foods that have highly digestible proteins might not be enough for large breed dogs if label claims say the food is 85 percent digestible. The other 15 percent goes to the large intestine and ferments, creating loose stool.
“Certain dogs come with compromised digestion straight from the factory, they’re just made that way,” Mayabb says. “There’s no one diet that is one-size-fits-all because of the different reasons dogs have GI diseases.”
Specialists say to consider the reason animals have GI tracts when making diet recommendations for individual patients.
“The GI tract serves to protect the body by digesting and absorbing essential nutrients critical for health and by providing non-immunological barriers and immunological defenses against bacteria and toxins attempting to enter the body from the outside world,” Dr. Laflamme says. “It cannot do this well without appropriate nutrition.
“In addition to provision of complete nutrition, key dietary components of importance in GI disease include fats, carbohydrates and fiber/prebiotics, B vitamins (especially vitamin B12) and protein,” Laflamme adds.
Nutrition specialists have expressed the importance of nutrition in preventing and treating disease and manufacturers continuously produce additional products to assist in maintenance of additional GI conditions.
“Most commercial pet foods, especially dry foods made with whole grains, contain sufficient dietary fiber to help maintain the beneficial microbiota of the intestinal tract,” Laflamme says. “On the other hand, in the face of a compromised GI tract, certain supplements, or dietary restrictions, can be beneficial. The specific supplement or restriction depends on the health problem. Probiotics are beneficial in helping to restore a balanced microflora which is often affected in cases of diarrhea.”
Veterinarians say owners might embrace only the clinical symptoms of GI conditions, not realizing much more complex conditions exist.
“GI conditions range from easy fixes to one of the biggest veterinary emergencies, a gastric dilatation volvulus (GDV),” Goldstein says. “IBD is often has a frustrating and prolonged regulating period balancing diet and medication. This comes after a sometimes difficult-to-determine diagnosis.”
When blood work and clinical testing don’t determine a GI condition and nutrition isn’t regulating patients, clinicians reach for non-invasive techniques to determine a root cause.
Endoscopy is an important diagnostic tool when detecting abnormalities in the GI tract, but it’s not without its flaws.
“Only about a yard and a half of the upper or lower intestinal tracts be evaluated with endoscopy, so some areas cannot be examined without surgery” Sum says. “Capsule endoscopy, or the capsule enteroscopy, is a technique used in human medicine that could advance GI diagnosis and treatment, but the cost of the technology prohibits its use as a regular tool for vets. Over time as the technology advances and becomes more cost effective, it will be more prevalent in the industry.”
Capsule endoscopy entails the patient swallowing a wireless pill-sized camera which records its journey through the digestive system by transmitting pictures to a recorder.
“Endoscopy also allows for less invasive biopsy samples,” says Mark Rondeau, DVM, Dipl. ACVIM (SAIM), department of clinical sciences at the University of Pennsylvania. “However, there are limitations. Only superficial biopsies can be taken, which means it’s possible to miss disease conditions in deeper layers of intestine. Surgery is still necessary for deep-tissue biopsies, but I trust technology will advance to allow for deeper tissue sampling in the future.”
Ultrasound is another tool to unveil chronic GI conditions. With more primary care practitioners incorporating ultrasound equipment into their practice, referrals aren’t always necessary.
“I perform an ultrasound before any surgical biopsy is taken,” Dr. Rondeau says. “Ultrasound is an important point-of-care GI tool.”
Despite quality nutrition and gold standard care, some animals will have GI issues despite best preventive measures.
“We know some dogs and cats have genetic predispositions to certain gastrointestinal diseases,” Dr. Byers says. “Yorkshire terriers are over-represented for developing lymphangiectasia and Norwegian Lundhunds are predisposed to develop protein-losing enteropathies.
“Manx cats are predisposed to developing chronic constipation and megacolon,” Byers continues. “Indeed there are several other dog breeds and cat pedigrees over-represented for various gastrointestinal conditions. While we currently have no preventive measures for these breed- and pedigree-specific conditions, proper preventive healthcare may help identify them early in their course. I am hopeful future research will identify various genetic therapies to allow us to truly prevent these conditions.”