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Background: Dogs with chronic inflammatory enteropathy (CIE) are typically classified into food-responsive enteropathy (FRE), antibiotic-responsive enteropathy (ARE), immunomodulator-responsive enteropathy (IRE), and nonresponsive enteropathy (NRE) based on response to therapy(ies). Reassessment of initial categorization (especially IRE and NRE) is lacking. Objectives: Investigate validity of categorization scheme when reassessed at least 1 year after diagnosis. Animals: Sixty client-owned with CIE. Methods: Retrospective study. Clinical information was gathered from records and owners from time of diagnosis (TD), time of initial response (TIR), and at least 1 year after diagnosis (T≥1y). Category change was defined as a switch between groups. Results: Median disease activity index (CIBDAI) at TD was 9 and reduced significantly to 1 at T≥1y (P < .0001). At TIR, dogs were categorized as: FRE 27/60 (45%, 95% binomial confidence intervals [CI], 0.32-0.58), IRE 30/60 (50%, CI 0.37-0.63), ARE 0/60 (0%), NRE 3/60 (5%, CI −0.01 to 0.11). Seventeen of 27 (63%) FRE dogs had previously had at least 1 unsuccessful diet trial. At T≥1y, categorization changed to FRE 44/60 (73%, CI 0.62-0.85), IRE 14/60 (23%, CI 0.13-0.34), ARE 0/60 (0%), NRE 2/60 (3%, CI −0.01 to 0.08). Group changes were found for 24/60 (40%) dogs, largest change was from IRE to FRE (19/24, 79%). Immunosuppressive dosages were administered as sole treatment in 1/30 (3%) IRE dogs at TIR. Conclusions and Clinical Importance: Chronic inflammatory enteropathy categorization based on initial response to therapy needs reassessment after 1 year. Frequent change from IRE to FRE suggests that dogs initially categorized as IRE might have been initially categorized as FRE if multiple dietary trials had been performed. In our study, antibiotics were not needed to achieve satisfying clinical responses.

Histological evidence of pancreatitis is commonly found in necropsy studies in cats. A clinical diagnosis of pancreatitis is challenging due to nonspecific clinical signs, a lack of diagnostic lipase cutoffs, and frequent presence of multiple diseases. It is still unknown how often pancreatitis alone is found in sick cats and how often clinicopathological evidence of pancreatitis in sick cats does not lead to a clinical diagnosis of pancreatitis. Our aims were to evaluate the extent of comorbidities in cats with suspected pancreatitis, evaluate how often sick cats with hyperlipasemia are diagnosed only with non-pancreatic diseases, and compare their clinical findings. Medical records of 563 client-owned hospitalized cats with available lipase activity measurement (LIPC Roche) > 30 U/L (RI, 6–26) were searched and medical diagnoses recorded and grouped by organ system. Clinicopathological findings were compared between cats with pancreatitis alone (PA), pancreatitis with concurrent disease (PD), and no suspected pancreatitis (NP). We found that PA was present in 33 (6%) cats, 159 cats (28%) were in the PD group, and 371 cats (66%) had no suspected pancreatitis (NP). Clinical, laboratory, and ultrasonographic findings did not differ between PA and PD cats. Lipase activities did not differ between the three groups. The most common disease categories in PD and NP cats were gastrointestinal, hepatobiliary, renal/urinary, and endocrine, and renal/urinary, gastrointestinal, cardiac, and musculoskeletal, respectively. We conclude that cats are rarely hospitalized because of suspected pancreatitis alone, and PA cats did not differ clinically from PD cats. Hyperlipasemia in sick cats without a diagnosis of pancreatitis may be due to a reactive pancreatopathy or preexisting chronic pancreatitis.

Measuring C-reactive protein (CRP) in serum is a useful surrogate marker for assessing disease progression and treatment response in dogs with autoinflammatory diseases. Affected dogs often receive high-dose glucocorticoid treatment, but the effect of such treatment alone on serum CRP concentrations is unknown. We evaluated serum CRP concentrations via immunoassay (sandwich enzyme-linked immunosorbent assay and particle-enhanced turbidimetric immunoassay) in 12 healthy beagle dogs administered high-dose hydrocortisone (8 mg/kg q12 h) per os vs. placebo over 28 days (days 0, 1, 5, and 28) in a randomized parallel study design. Serum CRP concentrations slightly decreased during treatment or placebo but without a significant association with hydrocortisone administration (p = 0.761). Compared to baseline, serum CRP concentrations were decreased by >2.7-fold (minimum critical difference) in three hydrocortisone-treated dogs and two dogs in the placebo group on day 28, whereas an increase to >2.7-fold was seen in one dog receiving placebo. These results suggest a lack of confounding effects of high-dose hydrocortisone administration on serum CRP concentrations in healthy dogs. This might also hold in dogs with autoinflammatory conditions and/or administration of other high-dose corticosteroids, suggesting that CRP presents a suitable biomarker to monitor inflammatory disease processes. However, this needs confirmation by further studies evaluating corticosteroid-induced cellular (e.g., hepatic) transcriptome and proteome changes.

Objectives: Prevalence of inflammatory enteropathy versus lymphoma in dogs undergoing gastroduodenoscopy has not been evaluated. This retrospective study assessed outcome from 195 client-owned dogs scheduled to undergo upper gastrointestinal endoscopy as the next diagnostic step. Material and methods: Cases were grouped into the following diagnoses according to WSAVA guidelines: lymphoplasmacytic enteritis (LPE), eosinophilic enteritis (EE), mixed-cell enteritis (ME), histologically normal biopsies (N), and lymphoma (L). Clinical signs, and preendoscopic results from laboratory and ultrasonography examinations, were compared among groups. Results: LPE was diagnosed in 133 (68%), EE in 17 (9%), ME in 9 (5%), 32 (16%) dogs had histologically normal biopsies. Four (2%) dogs were diagnosed with lymphoma. Vomiting was the most frequent clinical sign (61%), followed by weight loss (43%), and diarrhea (39%). Vomiting also predominated when looking at individual histological disease categories, however clinical signs did not differ significantly between groups. Dogs with lymphoma were more likely to have ultrasonographic abnormalities, had significantly lower haematocrit, albumin and total protein concentrations compared to dogs with LPE and histologically normal biopsies. Clinical significance: Lymphoma was rarely found in this group of dogs with nonspecific results of pre-endoscopic work-up. Our results provide first reference for clinicians when discussing the possibility of a step-up therapeutic approach (such as multiple dietary trials) with owners before pursuing endoscopy. Understanding the likelihood of finding lymphoma is important in that histologic documentation of inflammatory enteropathy alone has limited therapeutic consequences. Future studies are needed to validate these findings in dogs undergoing combined upper and lower gastrointestinal endoscopy and biopsies.

Background: Lipase measurements and ultrasonographic (US) evidence of pancreatitis correlate poorly. Objectives: Identify explanations for discrepant lipase and pancreatic US results. Animals: Two hundred and thirty-four dogs with gastrointestinal signs. Methods: A retrospective study was conducted, in which lipase activity and US were performed within 30 hours. Medical history, clinical examination results, lipase activity, and US results were recorded. Results: Lipase and US results were weakly correlated (rs = .25, P < .001). At both evaluated time cut-offs, median lipase activities were significantly higher with shorter durations of clinical signs before presentation (≤2 days, 334 U/L; >2 days, 118 U/L; P = .03; ≤7 days, 334 U/L; >7 days, 99 U/L; P = .004), but US was not significantly more frequently positive. For both cut-offs (>216/≤216 U/L, >355/≤355 U/L; reference range, 24-108 U/L), median disease duration was significantly shorter (3 vs 4 days) with higher lipases. Previous pancreatitis episodes were significantly associated with an US diagnosis of pancreatitis (P = .04), but median lipase activities were not significantly higher (386 U/L vs 153 U/L; P = .06) in these dogs. Pancreatic US was significantly more often positive when the request contained "suspicion of pancreatitis" (P < .001) or "increased lipase" (P = .01). Only changes in pancreatic morphology, echogenicity, and peripancreatic mesentery were significantly associated with a positive US diagnosis, and also had significantly higher lipase activities. Conclusions and clinical importance: Duration of clinical signs before presentation differently affects laboratory and US evidence of pancreatitis. Previous pancreatitis episodes and information given to radiologists influence US results. These findings can be helpful for future studies on pancreatitis in dogs.

The majority of dogs with chronic idiopathic gastrointestinal (GI) disease respond to diet. So far, no study has assessed how much dietary information is obtained during consultations. We retrospectively evaluated what dietary information was available from dogs presenting to our Gastroenterology (GE), and Internal Medicine (IM) Service between 10/2017 and 01/2020. Data from 243 dogs presenting for first GE consultations were compared to 239 dogs presenting with chronic GI signs for first IM consultations. Referrals comprised 131 (54%) GE dogs and 112 (47%) IM dogs. Referral documents specified the previously fed diet in 53/131 (40%) GE and 14/112 (13%) IM dogs. No dog had received more than one previous diet trial for chronic GI signs. Irrespective of referral status, diet trials had been performed in 127/199 (64%) GE, and 56/156 (36%) IM dogs. The specific diet fed at the time of consultation could only be named by 106/199 (53%) GE and 40/156 (26%) IM dog owners. Data on response to subsequent newly prescribed diets were available from 86 GE dogs and 88 IM dogs. A positive response to diet was noted in 50/86 (58%) GE and 26/88 (30%) IM dogs. A further 23/35 (66%) GE dogs and 12/21 (57%) IM dogs responded positively to a second diet trial, and 4/9 GE dogs (44%) and 6/7 (86%) IM dogs responded positively to a third diet trial. In conclusion, overall dietary information gained from referring veterinarians and owners was often incomplete. More dietary information could be gained during GE consultations compared to IM consultations for chronic GI signs. A positive response to diet can still be seen after two diet failures. Further studies will help to ascertain if the percentage of diet-responsive GI disease increases when more complete dietary information is obtained at the time of consultations.

Esophagitis denotes a localized or diffuse inflammation of the esophageal mucosa. It is generally thought to result from a caustic or chemical (ie, gastric acid, bile acids) injury. In humans, the most frequent mechanism causing esophagitis is gastroesophageal reflux (GER) leading to GER disease (GERD). GERD is thought to result from lower esophageal sphincter (LES) incompetence. In small animal medicine, GERD secondary to a primary functional LES abnormality is poorly understood, most probably because diagnosing GERD based on a detailed questionnaire on perceived symptoms, as it is done in human medicine, is not applicable. The situation becomes even more complicated when considering that the nonerosive form of GERD (ie,absence of visible lesions on esophagoscopy and the presence of reflux-associated symptoms) comprises the majo rity of patients in human medicine.

Disorders of cobalamin (vitamin B$_{12}$ ) metabolism are increasingly recognized in small animal medicine and have a variety of causes ranging from chronic gastrointestinal disease to hereditary defects in cobalamin metabolism. Measurement of serum cobalamin concentration, often in combination with serum folate concentration, is routinely performed as a diagnostic test in clinical practice. While the detection of hypocobalaminemia has therapeutic implications, interpretation of cobalamin status in dogs can be challenging. The aim of this review is to define hypocobalaminemia and cobalamin deficiency, normocobalaminemia, and hypercobalaminemia in dogs, describe known cobalamin deficiency states, breed predispositions in dogs, discuss the different biomarkers of importance for evaluating cobalamin status in dogs, and discuss the management of dogs with hypocobalaminemia.

Neu gibt es einen Therapieleitfaden für Hunde und Katzen. Dieser gibt Tierärztinnen und Tierärzten Empfehlungen für die Antibiotika-Behandlung ab. Er soll bei der Entscheidung helfen, ob Antibiotika nötig sind und wenn ja, welche verwendet werden sollen. Die Vetsuisse Fakultät, die Gesellschaft Schweizer Tierärztinnen und Tierärzte (GST) und die Schweizerische Vereinigung für Kleintiermedizin (SVK) haben unter Koordination des BLV den Therapieleitfaden gemeinsam erarbeitet.

This report describes the clinical and histologic recovery of a 2-year-old mixed-breed dog presented with hypovolemic shock, markedly increased serum alanine amino transferase activity, and hemoabdomen. Emergency exploratory surgery revealed a friable liver with multiple capsule hemorrhages necessitating removal of the left lateral lobe. Histologic evaluation showed acute massive hepatic necrosis with centrilobular and midzonal distribution. The dog survived, and all monitored laboratory values normalized within 7 weeks. A liver biopsy taken 8 weeks after presentation revealed normal hepatic architecture with a few, randomly distributed neutrophilic foci. Follow-up included intermittent determination of liver variables including liver function tests for a period of 7 years. The dog's health status, and all test results remained normal during this time. Complete recovery and good long-term quality of life after life-threatening acute liver failure secondary to massive hepatic necrosis is possible in dogs.

BACKGROUND: Efficacy of PO cobalamin (Cbl) supplementation in dogs with hereditary Cbl malabsorption (Imerslund-Gräsbeck syndrome, IGS) is unknown. OBJECTIVES: To evaluate PO Cbl supplementation in Beagles with IGS previously treated parenterally. We hypothesized that 1 mg cyano-Cbl daily PO would maintain clinical and metabolic remission. ANIMALS: Three client-owned Beagles with IGS and 48 healthy control dogs. METHODS: Prospective study. Daily PO cyanocobalamin (cyano-Cbl; 1 mg) supplementation was monitored for 13 (2 dogs) and 8 months (1 dog). Health status was assessed by owner observations. Methylmalonic acid (MMA)-to-creatinine concentrations were measured using an ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-TMS) method on urine samples collected monthly. Concurrent measurements of serum MMA concentration (n = 7; UPLC-TMS) were available for 1 dog. RESULTS: All dogs remained in excellent health during PO supplementation. Urine MMA remained consistently low in 2 dogs (median, 2.5 mmol/mol creatinine; range, 1.2-9; healthy dogs [n = 30], median, 2.9 mmol/mol creatinine; range, 1.3-76.5). Urine MMA ranged from 38.9-84.9 mmol/mol creatinine during the first 6 months in 1 dog already known to excrete comparable amounts when supplemented parenterally. Brief antibiotic treatment for an unrelated condition after 6 months resulted in low urine MMA (median, 2.8 mmol/mol creatinine; range, 1.9-4.8) for the next 7 months. All concurrent serum MMA concentrations (median, 651 nmol/L; range, 399-919) before and after month 6 were within the established reference interval (393-1476 nmol/L; n = 48). CONCLUSIONS AND CLINICAL IMPORTANCE: One milligram of cyano-Cbl daily PO appears efficacious for maintaining normal clinical status and normal cellular markers of Cbl metabolism in Beagles with IGS.