L Toresson1,2, J M Steiner3, J S Suchodolski3. 1. Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, Helsinki University, Agnes Sjobergin katu 2, 00014, Helsinki, Finland. linda.toresson@evidensia.se. 2. Evidensia Specialist Animal Hospital, Bergavagen 3, 25466, Helsingborg, Sweden. linda.toresson@evidensia.se. 3. Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, 4474 TAMU, College Station, TX, 77843-4474, USA.
Abstract
BACKGROUND: In people, bile acid diarrhoea is a prevalent complication of Crohn's disease and diarrhoea-associated irritable bowel syndrome. Affected patients typically respond to bile acid sequestrants, such as cholestyramine, but human gastroenterologists often fail to recognize bile acid diarrhoea. Consequently, bile acid diarrhoea is regarded as an underrecognized and undertreated condition in human medicine. Due to lack of diagnostic tools, clinical response to bile acid sequestrants is often used to confirm a diagnosis of bile acid diarrhoea in people. Several recent studies have shown that bile acid dysmetabolism also occurs in dogs with chronic enteropathies. It has further been shown that dogs with chronic enteropathies have significantly decreased expression of a bile acid transport protein in the ileum compared to healthy dogs, which correlates with faecal bile acid dysmetabolism. Consequently, in spite of the lack of reports in the literature, bile acid diarrhoea is likely to exist in dogs as well. CASE DESCRIPTIONS: Two dogs, an 8-year old Rottweiler and a 4.5-year old Siberian Husky were evaluated for chronic watery diarrhoea. Neither dog responded to dietary trials, probiotics, cyclosporine, faecal microbial transplantations or metronidazole. One of the dogs responded to high daily doses of corticosteroids, which were however associated with unacceptable side effects. The other dog was refractory to all standard treatment protocols, including cyclosporine and corticosteroids. Since none of the dogs responded satisfactorily to standard treatment or modulation of the intestinal microbiome, a suspicion of possible bile acid diarrhoea was raised. Treatment with cholestyramine, a bile acid sequestrant was initiated and resulted in marked improvement of faecal consistency, frequency of defecation and activity level in both dogs. CONCLUSION: This report presents two dogs with presumed bile acid diarrhoea that were successfully treated with cholestyramine. Therefore, bile acid diarrhoea should be considered as a possible diagnosis in dogs with treatment-refractory chronic diarrhoea.
BACKGROUND: In people, bile aciddiarrhoea is a prevalent complication of Crohn's disease and diarrhoea-associated irritable bowel syndrome. Affected patients typically respond to bile acid sequestrants, such as cholestyramine, but human gastroenterologists often fail to recognize bile aciddiarrhoea. Consequently, bile aciddiarrhoea is regarded as an underrecognized and undertreated condition in human medicine. Due to lack of diagnostic tools, clinical response to bile acid sequestrants is often used to confirm a diagnosis of bile aciddiarrhoea in people. Several recent studies have shown that bile aciddysmetabolism also occurs in dogs with chronic enteropathies. It has further been shown that dogs with chronic enteropathies have significantly decreased expression of a bile acid transport protein in the ileum compared to healthy dogs, which correlates with faecal bile aciddysmetabolism. Consequently, in spite of the lack of reports in the literature, bile aciddiarrhoea is likely to exist in dogs as well. CASE DESCRIPTIONS: Two dogs, an 8-year old Rottweiler and a 4.5-year old Siberian Husky were evaluated for chronic watery diarrhoea. Neither dog responded to dietary trials, probiotics, cyclosporine, faecal microbial transplantations or metronidazole. One of the dogs responded to high daily doses of corticosteroids, which were however associated with unacceptable side effects. The other dog was refractory to all standard treatment protocols, including cyclosporine and corticosteroids. Since none of the dogs responded satisfactorily to standard treatment or modulation of the intestinal microbiome, a suspicion of possible bile aciddiarrhoea was raised. Treatment with cholestyramine, a bile acid sequestrant was initiated and resulted in marked improvement of faecal consistency, frequency of defecation and activity level in both dogs. CONCLUSION: This report presents two dogs with presumed bile aciddiarrhoea that were successfully treated with cholestyramine. Therefore, bile aciddiarrhoea should be considered as a possible diagnosis in dogs with treatment-refractory chronic diarrhoea.
Entities:
Keywords:
Bile acids; Cholestyramine; Diarrhoea; Dog
Authors: Jennifer Chaitman; Anna-Lena Ziese; Rachel Pilla; Yasushi Minamoto; Amanda B Blake; Blake C Guard; Anitah Isaiah; Jonathan A Lidbury; Jörg M Steiner; Stefan Unterer; Jan S Suchodolski Journal: Front Vet Sci Date: 2020-04-16