Inflammatory Bowel Disease

Inflammatory bowel disease in Rottweiller

Question: HI DR MIKE I AM A NEW SUBSCRIBER. I HAVE A ROTTWEILLER WHO IS 4, HE WAS DIAGNOSED W/ IMFLAMMATORY BOWL DISEASE ABOUT 6 MONTHS AGO. HE HAS BEEN TAKING METRONIDAZOLE , 500 MG WHICH HAS BEEN WORKING FINE. MY DOG WAS A FEW POUNDS OVER WEIGHT SO THE VET RECOMMENDED PUTTING HIM ON LOW CALORIE FOOD. HE HAS BEEN ON PRO PLAN BEEF AND RICE FOR 4 YRS, SO I BOUGHT HIM THE LOW CALORIE PRO PLAN FOOD. I SLOWLY STARTED MIXING IT INTO HIS FOOD, HE IMMEDIATELY GOT DIARRHEA-SO I STOPPED THE LOW CALORIE FOOD. HE HAD DIARRHEA FOR 4 WEEKS SO WE INCREASED HIS METRONIDAZOLE TO 1000 MG. STILL NO CHANGE. THE VET RECOMMENDED SWITCHING HIS FOOD TO ANOTHER BRAND AND PROTEIN. SO I TRIED NUTRE LAMB AND RICE. STILL NO CHANGE. THEN WE TRIED NUTRE CHICKEN AND RICE, NO CHANGE. AT THIS POINT NOTHING SEEMED TO WORK MY VET WANTED TO PUT HIM ON CORTIZONE. I WASNT TO HAPPY ABOUT THIS, SO I DECIDED TO TRY COOKING FOR HIM. I MAKE HIM BOILED CHICKEN AND RICE OR BOILED CHOPMEAT AND RICE. WELL EVERYTHING CLEARED UP. IN THE PROCESS I HAVE SLOWLY TRYING TO PUT DOG FOOD BACK IN HIS DIET, I HAVE TRIED MANY BRANDS AND AS SOON AS I GET HIME TO 1/4 OF A CUP THE DIARRHEA RETURNS. I AM AFRAID HE IS NOT GETTING ENOUGH VITAMINS IN PEOPLE FOOD , IS THIS HEALTHY FOR HIM ?. HES 120 LBS AND HE SEEMED VERY HUNGRY SO I ADDED POTOTOES TO HIS FOOD, THAT SEEMED TO HELP. IN THE PROCESS HE HAS LOST 4LBS. MY VET HAS NOT RECOMMENDED ANY TYPE OF PRESCRIPTION FOOD FOR HIM. I FEEL IF I COULD CONTROL HIS IBD WITH DIET IT WOULD BE BETTER THAN THE O YOU CORTIZONE, DO YOU AGREE?? WHEN THE VET DID THE ENDOSCOPY & TOOK A BIOPSY OF HIS STOMACH AND INTESTINE, THEY FOUND IBD AND THAT HE ALSO HAS FOOD ALLERGYS. CAN YOU RECOMMEND ANY TYPE OF FOOD I COULD TRY?? I READ AN ARTICLE THAT SAID COCONUT HAS BEEN KNOWN TO RELIEVE DIARRHEA IN CROHNS DISEASE-DO YOU RECOMMEND TRYING IT?? THANKYOU , DEBBIE

Answer: Debbie- I strongly agree with your feeling that it is better to control inflammatory bowel disease through dietary means than with corticosteroids, when it is possible to do that. It is also worth trying therapies other than corticosteroids prior to settling on them. I do think that there is a time when they are helpful and when it is necessary to consider their use, but if you can control the diarrhea through feeding a home-made diet, it is definitely possible to formulate a diet that will meet all of his needs. There are several dietary approaches that work to control different forms of inflammatory bowel disease. For dogs that are allergic or sensitive to certain food ingredients, all that is necessary is to avoid the food that causes problems. It can be difficult to identify the offending food, though. Since you seem to have had success with both chicken and beef in the home-made diet, they are probably causing problems. This makes a food allergy less likely, but some dogs are allergic to things like preservatives, dyes, or the plant proteins such as wheat, corn or soybean. There are a couple of new diets on the market that are composed of hydrolyzed proteins, which produces a protein molecule that is below the size that causes allergic responses, in theory making these diets ideal for dogs that have a tendency to react to food. Hills makes z/d (tm) diet and Purina makes HA and LA (tm) diets in this manner. We have not tried the z/d diet, yet, but we have some trouble getting dogs to accept HA diet. The other approaches to inflammatory bowel disease are to feed highly digestible diets, such as Hills i/d (tm) or Purina's OM (tm) diets, to feed low residue diets such as Iams Low Residue (tm) diet and to feed low fat diets, which is different than low calorie or increased fiber dietary foods. I think that you may be having success with the home-made diet because it is low fat. If you don't mind making the diet but would like advice on how to balance it, Dr. Rebecca Remillard has a web site (www.petdiets.com) on which she offers to formulate diets for individual patients for a fee. She is a board certified veterinary nutritionist. From a medication standpoint, if metronidazole works well, we are comfortable using it long term when it seems necessary but it has been linked to some long term problems, including cancer, so we usually try sulfasalazine (Azulfidine Rx) and tylosin (Tylan Rx) as alternatives. If they work, we are a little more comfortable using them long term. If you fnd that you do need to consider the use of corticosteroids at some point in the future, it would be worth checking into the current recommendations for immunosuppressive medications at that time, as there is current work on alternative medications, such as cyclosporin (Sandimmune Rx), which might work out to be a better option, although it is too early to tell right now. I have not seen any information on coconut use in dogs that I can remember but I'll try to remember to check into this and get back with you if I find anything. Mike Richards, DVM 11/15/2000

Inflammatory bowel disease in older Lab

Question: We have a 10 year old black lab who will be 11 in September. He has been diagnosed with Inflammatory Bowel Disease in the past and is on Metronidazole medication every other day indefinitely. Also, do you recommend any other course of treatment for the Inflammatory Bowel Disease? The medication he is currently taking seems to be effective, but we want to make sure that it is not dangerous long-term. We love him very much and want to make his life more comfortable and last as long as possible. We are not concerned with cost; we want to do whatever we can. lease help!!!!! Thanks! Shannon

Answer: Shannon We have used metronidazole long term in several patients. There are no problems with chronic use of metronidazole reported in the veterinary literature that I can find. However, there is some evidence that chronic use of metronidazole in lab animals can cause cancer. This does not mean that occurs in dogs but it should be factored into the "risk / benefit" analysis. There are a number of treatments for inflammatory bowel disease. Are you pretty sure that it is necessary to be using the metronidazole continuously? The reason I ask is that it surprises me that this medication would work on an alternate day (every 48hr) schedule. Many things work that I don't fully understand, so it is possible that an every other day schedule would work effectively and that your vet knows something about this that I do not. But if you haven't tried stopping the medication it would be worth asking your vet if he or she thinks it would appropriate to give that a try at this time. Inflammatory bowel disease is a pretty non-specific term. It covers several different diseases and disorders. If you know a more specific diagnosis, such as lymphocytic-plasmacytic enteritis or eosinophilic colitis, it would give me a better starting point for letting you know what alternative treatments are possible. Mike Richards, DVM 7/15/2000

Pain and inflammatory bowel disease in Jack Russell

Question: Dr. Mike, Our little Jack Russell Terrier has quite a lengthy medical story which is on the attached document. The basic problem is extreme pain that may be associated with inflammatory bowel disease, based on lab tests done so far. Treatment has not been very helpful in controlling the pain. Any help you can give us will be greatly appreciated. Thank you.

Answer: Judy- At the present time there seem to be two favored strategies for dealing with painful inflammatory bowel disease conditions. The first is to use anti-spasmotics such as loperidine (Immodium AD tm), diphenoxylate (Lomotil tm) and a combination of chlordiazepoxide and clidinium bromide (Librax Rx). It is probably easiest to start with either loperidine or diphenoxylate to see if this strategy helps at all and then to use Librax for longer term use if there seem to be benefits. We have not seen any really significant side effects associated with loperidine or diphenoxylate in our practice but there are warnings about ileus (stopping intestinal action) and pancreatitis in the literature and it is possible to cause neurologic effects if the dosage used is sufficient. I can't give you any specific cautions about Librax use in dogs because I can't find any references to side effects in the literature available to me. I will continue to try to locate information on this. These medications are presently considered to be the best choices with anti-cholinergics considered to be more likely to cause problems and less effective. The second approach that seems to be recommended fairly frequently now is to try the truly novel protein diets, such as HA formula from Purina. This diet is made from hydrolyzed protein to ensure that the diet is unlikely to incite an allergic response. It may not be significantly better than the very novel proteins you have already tried. There has been some experimentation with a medication, budesonide, which is a form of cortisone that has been used in humans for inflammatory bowel disease conditions, as well. It is reported to work better than prednisone for some patients according to Alan Stewart and Joel Bolineck from Special Veterinary Services in Berkeley, CA. (presented at the ACVIM meeting 1997, reference located on the Veterinary Information Network). Simethicone (not sure of spelling on this one) might work better to relieve gas pressure than Curtail since I think it has more of a direct effect on gas that is present. There is some chance that if the pain is associated with pyloric stenosis or gastroesophageal reflux, which I think is why metoclopramide (Reglan Rx) is sometimes used. An alternative to this is cisapride (Propulsid Rx) which might also be an alternative to consider. The testing that has been done and the treatments attempted are all recommended for the types of problems that you are seeing with your Jack Russell. There are times when it is necessary to go through an extraordinarily frustrating diagnostic process before a solution to a problem can be found. I hope you are nearing the end of this search. Mike Richards, DVM 1/5/2000

Inflammatory Bowel disease

Q: I am fostering a rescue GSD that my vet is pretty sure has inflammatory bowel disease. He has had cow pie stools for 3-4 months now and vomiting or at least retching like he needs to vomit almost nightly. Did a blood work up and fecal sample. Blood work was pretty normal he said except for a slightly elevated white count which he said is normal in cases of IBD. I've tried 4 kinds of food including Proplan chicken and rice, Avoderm, Breeders choice lamb and rice, Eukanuba low residue, Pinnacle, and now something that is lamb and barley. I've also cooked potato and turkey for him and he does somewhat better on that but nothing stops the plops and retching. He always sounds burpy and gurgly. My vet had me give him cimetidine 3x's a day. Is there a danger in using that long term? We finally started him on pred and even that hasn't made a difference. He was on a high dose at first and now is down to 1 20mg every other day. Shouldn't there be some improvement by week 3? I also pop some Tums in his food when he eats . I try to feed him 3 meals a day if I'm home..2 if I'm not. He seems to vomit when his stomach is empty and has lots of mucous in the vomit. I had a call into my vet but haven't heard from him yet. Because he is a rescue dog, funds for tests are limited but I'm getting frustrated and desperate. He eats voraciously but is very thin. I also put Prozyme on his food. Any suggestions? He did have a slight giardia count but we treated him with metranidazole so that is not a problem now. My vet said that should have helped with the IBD too so we continued it for 4 weeks but no change. One thing I might mention is that when I pick up his stools, I have to hose the yard because they are so soft. The water froths almost like the stools are soapy. I also talked to the small animal clinic at UC Davis and they suggested peppermint in his food for the nausea. Barb

A: Barb- In the blood work, was there a test for trypsin-like immunoreactivity in the serum (TLI test?) or a test for folate levels? These tests help to rule out pancreatic enzyme deficiency as a cause for long term diarrhea. If this test has been run and enzyme deficiency has been ruled out it may be difficult to help much with this problem without advising spending a lot of money on further testing, such as intestinal biopsies. Prozyme does not seem to be adequate as an enzyme replacement for many dogs with pancreatic insufficiency, although it does seem to help some of them. When using dietary manipulation to try to help with IBD it is best to use a single antigen diet. To the best of my knowledge, it is necessary to make such a diet at home or to purchase one of the specialized diets from companies like Innovative Diets or Purina's and Hill's prescription diet lines. The diet should have one protein source and that should be a protein type that the dog has not eaten previously. This may be why the potato/turkey diet seems to help while the others don't. Most commercial foods have mixed protein sources, despite what the labels say. It is usually safe to use cimetidine long-term. Prednisone will often help with inflammatory bowel disease so it is worrisome that it is not helping, if that is the problem. Sometimes bacterial overgrowth problems complicate the treatment of underlying bowel disorders and the addition of antibiotics that favor the natural bacterial flora can be helpful, such as tylosin (Tylan Rx) and sulfasalazine (Azulfidine Rx). You might want to ask your vet whether or not he or she thinks that treatment with these antibiotics might be beneficial, as well. Good luck with this. Mike Richards, DVM

Inflammatory bowel disease

Q: Dear Dr. Mike, First of all, thank you for your wonderful service! Secondly, I have some questions about Duncan, a 70 lb 3 yr old Bassett Hound (my little buddy) who has been diagnosed with Infammatory Bowel Disease. I have read through your archives and have seen some info on it, but I have a few questions. Duncan had a history of throwing up, repeated swallowing, finecky eating, etc. After several trips to the vet, we decided to have an endoscopy. The vet that this affirmed the diagnoses of IBD. He said that there were small raised lesions in his intestine. They were not cancerous. After prescribing Canine ID food for Duncan (Is this a high fiber food as you suggest for IBD?) , without much luck, we are now giving Duncan a 5mg dose of Prednisone every other day. (which is better according to your other articles). He has responded quite well, his appetite has returned, he has all but totally stopped the vomiting , etc. My question: Is 5mg (70 lb dog) every other day a lot? You mentioned Cushing's disease, are there any early warning symptoms? I believe 3 yrs old is young for this kind of thing, will he develop cataracts or other complications from longterm use? Will he ever be cured with the prednisone? Do you have any suggested readings for IBD, or any info on the other two drugs you mention in conjunction with treating IBD,metronidazole and azulfidine? I wish there was something else I could do for him, I would hate to see him develop a problem from the use of Prednisone. He has already gained about 7-8 lbs, and frequently urinates on the days he takes the prednisone. Thank You, D.

A: Five milligrams of prednisone every other day is actually a pretty low dose for a seventy pound dog. It is not very likely that you would run into significant side effects using this dosage but with long term use it would still be possible. The helpfulness of increasing fiber in inflammatory bowel conditions is still being debated. There have been reports suggesting it is helpful and reports suggesting that it isn't. Low fiber diets (i/d is a low fiber diet) have been advocated as well. I think the best approach is to try either one and switch if there is no benefit. Dietary control alone rarely works but it can be helpful. In some dogs hypoallergenic diets help, too. There are a lot of specific causes of the general symptom "inflammatory bowel disease" in dogs. If the exact cause can be identified it is easier to decide on the treatment. Specific causes of small intestinal inflammation include eosinophilic enteritis, lymphocytic-plasmacytic enteritis, parasite infestation and food allergies or hypersensitivities. There are also a lot of conditions that can be confused with inflammatory bowel disorders of the small intestine, like maldigestion syndromes, malabsorption syndromes, cancer, and large intestinal disorders. Specific causes of colon (large intestine) inflammation include eosinophilic colitis, histiocytic ulcerative colitis, parasitism, cecal inversion, cancer and infectious diseases. In addition, there is a specific form of large intestinal diarrhea known as irritable bowel syndrome which is different than the inflammatory bowel syndrome. This is usually diagnosed by ruling out everything else possible. Irritable bowel syndrome often appears to be very painful for the dog and this is an important sign if it is present. This disorder responds to an entirely different treatment routine. It seems likely that your vet has a specific problem in mind and the treatment sounds successful. You might want to ask your vet about discontinuing the prednisone and get instructions on how to taper off the dose if your vet thinks it is advisable. It is possible to do this successfully after good control the inflammation is achieved, in some dogs. I am not aware of one specific reference that covers these disorders well. There is a lot of partial information in many veterinary texts and reading several is usually necessary to get an idea of what is going on. To sum up a long note: 1) prednisone at this dosage should be reasonably safe but it is still better to discontinue it if possible. 2) I wouldn't worry about dietary changes since the current treatment is working anyway. 3) metronidazole and sulfasalazine (Azulfidine Rx) are options for treatment but it seems like you have already found a good treatment and it may be possible to discontinue the prednisone and not have to use any treatment if your vet thinks that is advisable. Mike Richards, DVM

Last edited 08/30/02