Lecture 9 2/7/25 Flashcards
What are the components of chronic enteropathy treatment?
-diet
-microbiome
-vitamin status
-immunosuppression
What can lead to treatment failure when treating chronic enteropathy?
-failure to approach all aspects of treatment
-failure to recognize mild improvement
What are the general steps to chronic enteropathy treatment?
step 1: empirical deworming and diet trials
step 2: microbiome-directed trials
step 3: GI biopsies
step 4: immunosuppression: corticosteroids +/- second agents
How does food intolerance differ from food hypersensitivity?
-food intolerance is non-immunologic
-food hypersensitivity is immunologic
What are the characteristics of patient response to diet trials?
-50 to 60% of patients with chronic enteropathy respond to a diet trial
-response typically takes 2 weeks; dermatologic signs and cyclical signs can take longer to see improvement
When are patients more likely to respond to a diet trial?
-concurrent atopic dermatitis
-younger age
-normal, hypoechoic bowel mucosa in dogs with chronic diarrhea when assessed via ultrasound
Which factors are NOT reliable predictors of diet trial response?
-severity of histologic changes
-degree of bloodwork changes
-serum IgE screens for dietary allergens
How does the treatment for food allergies differ from the treatment for lymphangiectasia?
-food allergies require a hypoallergenic elimination diet with either hydrolyzed or novel protein; nothing else should be fed during trial
-lymphangiectasia requires a low-fat diet in addition to hypoallergenic
Which type of diet is preferred for small intestinal dz?
highly digestible, low-residue diet or elimination diet
Which type of diet is preferred for large intestinal dz?
fiber-enriched diet or elimination diet
Which type of diet is preferred for fat malabsorption?
low fat diet
Which type of diet is preferred for dermatological signs?
elimination diet that removes pet’s specific allergy
Which aspect of diet is important when a pet shows signs of delayed GI motility?
ensuring the diet is low fat
What are the indications for an elimination/hypoallergenic diet trial?
-most chronic enteropathies
-chronic large intestinal dz that fails fiber-enriched diet
-concurrent dermatological signs
What is a novel protein diet?
diet that introduces a new protein source that the pet has never eaten before
What is a hydrolyzed diet?
diet in which the proteins are hydrolyzed to small peptides; intends to “hide” the peptides from the immune system
Which carbohydrate sources are commonly used in novel protein diets?
-potatoes/sweet potatoes (dogs)
-green peas (cats)
Why is it important to know whether a pet completing a diet trial has eaten a grain free diet?
grain free diets often use potatoes and peas as carbohydrate sources; it is possible for the patient to have an allergy to these, which would persist through the diet trial
Why is it ideal to use a prescription novel protein diet?
over the counter diets are more likely to be contaminated; risk exposing pet to food allergen
What are the hydrolyzed/elemental diets available?
-purina HA; soy based, low fat
-hill’s z/d ULTRA; chicken and soy forms
-rc HP; soy based
-rc Ultamino; chicken based
-purina Elemental; individual amino acids from the start
What are the indications for low fat diet trials in dogs?
-suspicion of lymphangiectasia
-evidence of fat malabsorption; esp. hypocholesterolemia
-concurrent pancreatitis
-delayed gastric emptying
What are the important notes regarding diet trials?
-new diet should be transitioned to over 1-2 weeks; abrupt change could worsen or cause clinical signs
-nothing else should be fed during trial, including treats, flavored vitamins, flavored medications, flavored toothpaste, and chew toys
Why should a low fat diet NOT be fed to a patient with exocrine pancreatic insufficiency?
it can lead to fat soluble vitamin deficiencies
What are the characteristics of capromorelin?
-ghrelin-agonist
-appetite stimulant
-flavored
-side effects include vomiting, diarrhea, and hypersalivation
