Diagnostic and therapeutic approach to chronic inflammatory enteropathies in dogs

Chronic enteropathies are characterized by persistent or recurrent gastrointestinal signs for a minimum duration of 3 weeks. Clinical signs for chronic enteropathies include vomiting, diarrhea, borborygm, weight loss, and abdominal pain. Clinicopathologic parameters, fecal examination, and diagnostic imaging findings are important to exclude other (e.g., infectious or obstructive) gastrointestinal and extra gastrointestinal etiologies. Specific diagnostic tests, including the determination of the serum cobalamin and folate concentrations, can help to evaluate the patient for gastrointestinal disease and to determine the disease location (distal vs. proximal small intestine). Chronic inflammatory enteropathies are retrospectively classified as food-responsive enteropathy (FRE), antibiotic-responsive enteropathy (ARE), immunosuppressant-responsive or-refractory enteropathy (IRE), or non-responsive enteropathy (NRE), based on the response to empirical treatment. The term protein-losing enteropathy (PLE) is used for a subgroup of affected dogs with intestinal protein loss, and has been shown to display a worse prognosis. PLE can be induced by severe intestinal inflammation, neoplasia, or primary intestinal lymphangiectasia. Clinical scoring systems (CIBDAI, CCECAI) have been established in dogs, which can be applied to objectively assess the severity of clinical signs at the time of diagnosis and to monitor patient improvement during treatment. The prognosis in dogs with chronic enteropathy depends on the underlying etiopathogenesis. Dogs diagnosed with FRE typically respond favorably and display good long-term control with appropriate dietary management, whereas the response to treatment varies in dogs with IRE or PLE, with frequent relapses of clinical signs.