Treating IBD in Dogs
The treatment of inflammatory bowel disease usually involves a combination of change in diet and the use of various medications.
Dietary Management: A food trial using hypoallergenic diets is usually one of the first steps in the initial treatment, and can also be used to help verify the diagnosis. The key is to use a protein source and carbohydrate source the dog has never eaten before, such as duck and potato. The pet mustn’t eat anything else, including treats, and the trial diet should be maintained for two to three months if possible. If a hypoallergenic diet does not improve the condition, other diets may be tried.
When the colon is the major portion of the digestive tract that is involved, diets high in fiber are usually beneficial. Oat bran could also be added to the diet as an easy way to increase the fibre content. When the small intestine is the primary site of involvement, some dogs benefit from a highly digestible, low-fibre diet. Diets low in fat are generally also better tolerated in dogs with IBD. Carbohydrates low in gluten may also be helpful; avoid wheat, oats, rye, and barley.
Diets that have shown a lot of success are the hydrolyzed protein diets. Hydrolyzed proteins are “predigested” so as to create protein segments that are too small to stimulate the immune system. They are made with medium chain fatty acids, which are easier to absorb than the usual long chain fats, and favourable omega 3 to omega 6 fatty acid ratios. In other words, there is more to these diets than just their predigested proteins, but approximately 50% of patients showed good improvement after approximately one month on a hydrolyzed protein diet.
Home-made diets are sometimes used, however, they often are not completely balanced and commercial diets are preferred for the long term. So as you can see, multiple diets may have to be tried before there is any improvement in the dog’s condition. This takes a lot of patience on the part of the owner.
Fatty Acids: Some studies have suggested that diets with added omega-3 fatty acids may help decrease the inflammation in the gastrointestinal tract. EPA and DHA (omega-3 fatty acids from fish oil) have been beneficial in human patients. However, more research still needs to be done to determine their benefit in dogs with inflammatory bowel disease.
Anti-inflammatory Medications: A vital aspect of treatment for IBD in dogs is suppressing the inflammation. In milder cases of large intestinal IBD, metronidazole might be enough for control but usually prednisone is needed. Prednisone will work on IBD in any area of the intestinal tract. Corticosteroids (such as Prednisone) are used in dogs when dietary management and sulfasalazine do not adequately improve the condition. Because steroids have potentially severe side effects, the aim is to gradually adjust the dose to the lowest possible amount that controls symptoms.
Sulfasalazine, 5-ASA, and Mesalamine Compounds: These drugs and related compounds are the drugs of choice in dogs with mostly large intestine involvement. They can, however, cause a condition called keratoconjunctivitis sicca or dry eye so they must be used with caution. KCS results from an abnormally low tear production. Sulfasalazine can sometimes irreversibly reduce the amount of tears produced. Sulfasalazine or related compounds are generally given in high doses and the dose is maintained for 3-4 weeks after improvement is noted.
Azathioprine and Cyclophosphamide: These drugs are immunosuppressive drugs and are generally used only if other treatments haven’t worked, or in combination with corticosteroids to allow a lower dose of the steroid to be used. These drugs can suppress the bone marrow (meaning less blood cells are then produced), so again careful monitoring through regular complete blood counts is recommended.
Metronidazole: Metronidazole can be used alone or in combination with sulfasalazine or corticosteroids. It is an antibiotic and also inhibits the immune system.
Drugs Affecting Motility (or the movement of food through the GI tract): Antidiarrheal drugs such as loperamide (Imodium) or diphenoxylate (Lomotil) can have some beneficial effects. Antispasmodic drugs have also been used in some cases.
Newer drugs are being used in humans with Crohn’s disease and inflammatory bowel disease. But the benefits, risks, and dosages of these drugs in dogs has not been determined. Some of these drugs include cyclosporine, sodium cromoglycate, and clonidine.
The Prognosis for Dogs with Inflammatory Bowel Disease
Inflammatory bowel disease in dogs can be controlled, but, unfortunately, not cured. Control depends on the proper selection of diet and medications, the correct long-term maintenance dosages, careful monitoring by the vet and owner, and the absence of other concurrent diseases. Even so, persistence of mild signs, or recurrence of more severe signs may occur. Most dogs with IBD do well for many years while others require alterations in treatment every few months to treat flare-ups and recurrent symptoms.