chronic ENTEROPATHY IN SHAR-PEIS

Shar-peis with chronic diarrhea frequently have PLE due to moderate to severe IBD, and some also likely have intestinal bacterial overgrowth as well. Typical signs in shar-peis often include persistent diarrhea weeks to months in duration, weight loss, and an increased to ravenous appetite.

The prognosis for successful clinical control of symptoms is excellent as long as a definitive diag­nosis is made before the disease becomes too severe. Clinicians are reminded that although a great majority of shar-peis with chronic diarrhea have IBD and some also likely have SIBO, an occasional case of ' intestinal lymphoma, histoplas­mosis, or other disorder may still be found in this breed. Clinical signs and baseline laboratory param­eters may be similar in all of these disorders. Therefore it is always best to make every effort to establish a definitive diagnosis rather than simply assuming that the most common problem is indeed present and subsequently administering empiric therapy. This issue should be thoroughly discussed with owners who may initially be reluctant to sup­port the diagnostic testing that is necessary to make a diagnosis.

The most consistent laboratory parameters are panhypoproteinemia (usually ranging from 2.8 to 5.0 g/dl), indicating significant small intestinal involvement, and low cobalamin (vitamin B) lev­els, which are very commonly found in shar-peis, and which could be consistent with SIBO.

In addition to a complete blood count, serum biochemical profile, fecal examinations for para­sites (including Giardia and Cryptosporidium), fecal cytologic examination, fecal analysis for C. perfrin- gens enterotoxin,TLI assay for exocrine pancreatic insufficiency, and cobalamin, folate, and SUCA assays for intestinal bacterial overgrowth, shar-peis with chronic diarrhea should undergo upper and lower GI endoscopy to obtain biopsy specimens from the stomach, duodenum, jejunum (if it can be reached), ileum, and colon. Even if there are no clinical signs consistent with large bowel dis­ease, colonoscopy is still done because it is important that biopsy samples be obtained from the ileum. Usually there is diffuse involvement of the small intestine. However, histologic lesions will occasionally be found only in the lower small intestine (this highlights the importance of doing both upper and lower GI endoscopy). Other findings may include esophagitis (grossly evident at endoscopy), gastric hypomotility, and colitis.

Treatment

Treatment of shar-peis usually includes manage­ment of IBD and SIBO (prednisone, metronidazole, and amoxicillin or tylosin, which is administered for 1 month if there is laboratory evidence of SIBO). In severe cases of IBD it may be necessary to use aza­thioprine (see guidelines described earlier in this chapter). It may be useful to administer tylosin powder if the diarrhea is poorly responsive to initial therapy (reasons for poor response may include per­sistent bacterial overgrowth or CPE that did not respond to metronidazole and/or amoxicillin).

Esophagitis is managed with a restricted-fat diet, H₂-receptor antagonist therapy (e.g., famoti­dine once daily 30 minutes before food), and metoclopramide. Treatment for gastric hypo­motility includes a restricted-fat diet provided in divided feedings two to three times daily and a promotility drug (metoclopramide or cisapride). Colitis is managed with metronidazole, and in some cases sulfasalazine is used as well. Anemia often resolves as the inflammatory disease comes under control. Dietary therapy guidelines previ­ously described for IBD are followed.

Most shar-peis can be managed on a long-term basis, once remission has been achieved, with main­tenance doses of prednisone (every 2 to 3 days) and metronidazole (once daily to every other day). In some cases, medication can be discontinued alto­gether after 6 to 24 months. Hematologic param­eters and overall clinical condition should be consistently back to normal before all medication is stopped. Dogs with gastric motility disease (hypomotility) may require lifelong promotility therapy. If there are periodic flare-ups of large intestinal signs, sulfasalazine is used as needed, gen­erally for 7 to 21 days at a time (dose and fre­quency of administration depend on severity of clinical signs).