Therapeutics
Most clinicians start with a strict elimination diet for at least 6-8 weeks to exclude FRD. In regard to the diet used for the treatment trial, there are different possibilities to consider.
The first one consists of feeding exclusively a nutritionally balanced, highly digestible novel protein diet, where the protein source must not have been fed to the animal before. The second possibility consists of feeding diets with hydrolyzed proteins with the idea that these proteins are too small to evoke an allergic reaction. Nevertheless, it is clinically impossible to differentiate between a true food allergy and just food intolerance. If not responding, these animals can subsequently be treated with a 4-6 week course of antibiotics such as metronidazole or tylosin (Westermarck et al. 2005). If they respond to this treatment, they are considered to suffer from ARD, nowadays referred to as intestinal dysbiosis.Dogs with persistent signs of chronic enteropathy that are neither responding to elimination diet nor antibiotics are finally considered to be suffering from idiopathic IBD and are given glucocorticoids (mostly prednisolone) as the mainstay of therapy. Prolonged treatment with corticosteroids can be frustrating because of the numerous side-effects associated with it. Especially in large breed dogs, polyuria/polydipsia may become unbearable for the owners. When used in combination with other immunosuppressive drugs like azathioprine, the required dosage of corticosteroids and the associated side effects can eventually be decreased or the dogs can be weaned off corticosteroids sooner. For cases showing
severe side-effects with prednisolone, oral budesonide might be an option, but initial studies in dogs with IBD are not very convincing in regard to reduction of side-effects. A number of dogs treated with immunosuppressive doses of corticosteroids will show either no response at all to the drug or will experience a clinical relapse after weeks to months of treatment. Cyclosporine (Allenspach et al. 2007) and chlorambucil (Dandrieux et al. 2013) have been shown to be effective in steroid refractory IBD. Cobalamine supplementation for hypoco- balaminemia, increased omega-3 fatty acids (Ontsouka et al. 2012) and probiotics may perhaps not help in all cases, but they share the potential to ameliorate the clinical problems. The most important treatment options are summarized in Table 19.1.
Table 19.1 The most important therapeutic options for IBD in dogs and cats.
