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Health Issues:
Written by: Jeff Vidt, DVM
Inflammatory Bowel Disease
Inflammatory bowel disease is not so much a disease as it is a group
of clinical signs related to a large number of underlying causes. The
clinical signs primarily involve the gastrointestinal tract and can vary
somewhat based on what part of the GI tract is affected. Vomiting is
the primary sign if the stomach is affected. If the small bowel is
affected the signs are related to a protein-losing enteropathy -
diarrhea or loose stools, weight loss, loss of appetite, etc. If the large
bowel (colon) is affected signs are related to colitis such as loose
stools (cow-pie type), mucous and/or bloody stools, straining to
defecate and increased frequency of defecation. The underlying
pathology in IBD is infiltration of the gut wall by various types of
inflammatory cells such as eosinophils, macrophages, lymphocytes
and plasma cells. This infiltration causes thickening of bowel wall
which interferes with digestion of food and absorption of nutrients -
malabsorption/maldigestion syndrome. ANY SHAR-PEI WITH A NON
SPECIFIC ILLNESS SHOULD BE WORKED UP FOR IBD! Laboratory
findings are non-specific, but may include a low albumin and globulin
due to intestinal loss of these proteins mild anemia due to GI
hemorrhage and electrolyte abnormalities due to chronic vomiting
and diarrhea. Special testing such as B12/Folate levels may be useful.
Fecal alpha-1 protease inhibitor is a new test which may prove useful
in the diagnosis of IBD. The primary mode of diagnosis is intestinal
biopsy which may be done via gastrointestinal endoscopy which is
non-invasive or via exploratory laparotomy abdominal surgery. These
procedures should be considered early in the course of the disease
when the dog is the best anesthetic candidate. Waiting too long
increases the risk. Bear in mind also that there is a 5-7 day delay in
getting the biopsy results back. Therapy and prognosis does vary
somewhat based on the type of IBD seen on the biopsy. Exploratory
surgery also allows the veterinarian to rule-out other causes of GI
disease and chronic illness such as cancer, bacterial or fungal
disease, liver disease and intestinal foreign objects.
The cause of IBD in Shar-Pei is probably related to two breed
predispositions - food allergy and IgA deficiency. Anywhere from
70% - 90% of Shar-Pei are deficient in IgA which is an immunoglobulin found
in secretions of the GI tract, reproductive tract and the respiratory
system. IgA has an important immune system function in these areas.
It helps prevent infectious agents and antigens in the diet from
crossing the lining of the gut. When atigens in the diet gain access to
the gut wall an immune response is stimulated which eventually
results in inflammantion and damage to the gut wall. Allergic
responses to substances in the diet can also elicit a severe
inflammatory reaction. Other causes have yet to be elucidated.
Therapy of IBD involves the use of specific drugs and dietary
management. Drug therapy consists of immunosuppressive therapy
with prednisolone or other corticosteroid. These are used to
decrease inflammation and suppress the immune response so healing
can occur. Other drugs are often combined with corticosteroids
because of a synergistic effect. Sulfasalazine is often used for
immune-mediated colitis as an anti-inflammatory medication. It is converted to
aspirin in the colon. Sometimes other more potent chemotherapeutic
agents are needed such as azathioprine. Dietary therapy is also
extremely important. The use of novel protein sources is paramount
as is the use of simple diets with minimal additives. There are a
variety of diets available through your veterinarian specifically
formulated for use in IBD. They often use lamb, chicken, rabbit, duck,
turkey or venison as their protein source. All natural diets are
sometimes used as well. IBD should be one of the major
considerations in any Shar-Pei with weight loss and normal laboratory
findings.
The special GI functions tests described in this article are done at the
Gastrointestinal Function Test Lab. The address is: