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Thank you to Joan Martin for putting together this article for SCARF.
Broadly defined, Inflammatory Bowel Disease (IBD) refers to a diverse group of intestinal disorders involving chronic inflammation in the gastrointestinal (GI) tract, stomach, small intestine (duodenum, jejunum, ileum) and/or large intestine (colon). More narrowly defined, IBD is a chronic condition of the gut involving inflammatory cell infiltrates that cannot be attributed solely to cancer, allergies, bacterial or parasitic infections.
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IBD is a chronic, abnormal concentration of inflammatory cells in the mucosa or lining of the stomach, small intestine (duodenum, jejunum, ileum) and/or large intestine (colon). The inflammation cannot be attributed solely to cancer, allergies, bacterial or parasitic infections.
Classification of IBD is based on the type inflammatory cell involved:
- Lymphocytes and plasmacytes: lymphoplasmacytic enteritis or IBD. In this type, plasma proteins may be lost into the gastrointestinal tract (protein-losing-enteropathy (PLE)). In severe cases nutrient absorption and gut motility can be compromised.
- Eosinophils: eosinophilic IBD
- Neutrophils: suppurative or neutrophilic IBD
In advanced cases, normal tissue may be replaced by fibrous or granulomatous (scar-like) tissue. Severity is believed to reflect the degree to which inflammatory cells have infiltrated the gut lining.
Note: Irritable Bowel Syndrome (IBS) is sometimes confused with IBD but is a completely diffferent condition: stress-related diarrhea. Treatment is aimed at reducing the stress.
Signs and Symptoms
General symptoms of IBD include diarrhea, vomiting, and weight loss, all of which may occur intermittently. Common signs depend on the location and severity of the inflammation:
Stomach and upper small intestine - chronic vomiting and weight loss;
Jejunum, ileum and colon - chronic diarrhea, weight loss and infrequent vomiting;
Small bowel - diarrhea and large volume of feces;
Large bowel - diarrhea, straining, some blood and mucous in small volume feces accompanied by frequent attempts to defecate.
IBD is a sensitization of the GI tract and overreaction of the immune system to a factor that would not normally cause such an extreme response. The cause is unknown but possible factors include food allergy, food intolerances, parasites, allergies, chronic intestinal infections with bacteria, fungi, or protozoa, and intestinal bacteria overgrowth. In the Shar-pei IBD is thought to result from food allergy coupled with an immunoglobulin A insufficiency.
Some breeds are more at risk (e.g. Shar-peis, Basenjis). Samoyeds are not a breed at high risk. IBD usually affects younger to middle aged dogs (mean age 6.3 yr), either gender. In Basenjis lymphocytic plasmacytic IBD is inherited by an unknown mechanism.
IBD diagnosis is one of exclusion. Systemic diseases, diseases of other organs, chronic parasitism (e.g. giardia), food allergies, infectious diseases and alimentary lymphosarcoma/lymphoma (cancer) need to be ruled out, because treatments used for IBD can mask other problems, such as cancer. Blood tests, urinalysis and fecal examination can be done as a first step. Food allergies, parasites and bacterial infections/overgrowth can each be addressed and eliminated by dietary therapy, broad spectrum deworming and antibiotics, respectively. Abdominal ultrasound can be used to assess thickening, architectural disruption and infiltration of the mucosal lining and enlargement of lymph nodes, giving an indication of the severity and extent of IBD. Ultrasound interpretation requires a veterinary specialist and is non-invasive. While not definitive, a blood test for several IBD markers can be useful. The only definitive test for IBD is a biopsy of the gut lining. This procedure requires a veterinary specialist to do an endoscopy, colonoscopy or surgery. It is expensive and invasive. Calculation of a canine disease activity index (CDAI) from analysis of biopsied tissues (using measures of architectural distortion, glandular necrosis or loss/hyperplasia, ulceration, villus atrophy and fibrosis of lamina propria in the mucosal lining of the gut) has been proposed to identify IBD and classify it as mild, moderate or severe. In addition biopsy can distinguish IBD from Intestinal Lymphangiectasia, a disorder in which the lymph vessels supplying the lining of the small intestine become enlarged and obstructed. Endoscopic exfoliation cytology (examination of cells brushed/scraped from the inner surface of the intestine) in conjunction with biopsy may be useful.
Note: Treatment of animals should only be performed by a licensed veterinarian. Veterinarians should consult the current literature and current pharmacological formularies before initiating any treatment protocol.
IBD is controlled, not cured. Anti-inflammatory therapy/immunosuppressive drugs in conjunction with dietary therapy may be successful for control. Unfortunately, the drugs used can have serious side effects. Additional treatments to consider are the use of agents that protect the lining of the gut and/or that reduce intestinal motility.
Keeping a log of signs and symptoms is useful both for the owner and the vet. Dietary therapy involves the dietary history of the dog and considerations are a consistent diet, a novel (new to that dog) carbohydrate and a novel single highly digestible protein source. Alteration of fiber content and increasing the ratio of enriched n3/n6 polyunsaturated fats may be of benefit as may hypoallergenic diets. Controlled diet tests require 6-8 weeks to assess results. Dietary and pharmacologic therapy may be required throughout life in severe cases.
Inflammatory Bowel Disease in Dogs, an excellent, concise summary
Inflammatory Bowel Disease from marvistavet.com. This article includes a picture of mucosal histology/pathology.
Protein-Losing Enteropathy in Dogs at petplace.com.
Inflammatory Bowel Disease in the Dog an inclusive description from lowchensaustralia.com
This group requires a biopsy-confirmed diagnosis of IBD to join:
Inflammatory Bowel Disease in Your Dog at 2ndchance.info A good article for laypersons
Inflammatory Bowel Disease in Dogs and Cats at holisticpetinfo.com A holistic approach, much advertising on site
Inflammatory Bowel Disease, a more technical summary from the Merck Veterinary Manual