Practice Scenario

Say hello to Duffy, a young adult dog with chronic small bowel diarrhea

Meet DUFFY

A 2-year-old, neutered male Bernese Mountain Dog

  • Duffy is presented today for intermittent chronic small bowel diarrhea. Although the owner reports he only defecates 2 to 3 times per day and has no urgency, he does have voluminous soft stools. The owner also reports the diarrhea and flatulence have occurred consistently over the past 6 months. What the owner finds concerning today is Duffy’s lethargy, which started 2 days ago.
  • Duffy currently eats a high-protein dry dog food formulated for all life stages that is purchased at a pet specialty store. The owner reports that the dog’s appetite has been good. Year-round, Duffy is given once-monthly medication to protect against heartworm disease, ticks, fleas, roundworms, and hookworms.
  • Physical exam findings are unremarkable. However, a comparison of Duffy’s weight today with previous body weights in the medical record reveals he has lost weight. His body condition score today is 4/9, compared to 5/9 at previous visits.
  • Blood, urine, and fecal samples are obtained and submitted to a reference laboratory for overnight evaluation. No evidence of intestinal parasites or ova are observed. However, the results of the serum chemistry profile reveal a mild panhypoproteinemia.

Gastrointestinal Disorders

Chronic Enteropathy in Dogs

Chronic enteropathy in dogs is a group of complex, nonspecific gastrointestinal (GI) disorders characterized by clinical signs lasting 3 weeks or longer and for which other causes (e.g., parasites, bacterial infections, cancer, and non-GI diseases) have been excluded.1─4 One or more segments of the GI tract can be affected so that dogs with chronic enteropathy may have any combination and severity of gastrointestinal signs, including chronic intermittent or persistent diarrhea and/or vomiting, weight loss, changes in appetite, borborygmus, nausea, and abdominal pain.1,5,6

The main factors believed to play a role in chronic enteropathy development include genetics, food components, intestinal barrier integrity, gut microbiota, and intestinal immune response.5,7,8 Studies in dogs have associated intestinal dysbiosis with various acute and chronic GI disorders, including chronic enteropathy.9─14 However, it is unclear whether dysbiosis is a cause of the enteropathy or is a consequence of it.15 

canine intestines icon


Chronic enteropathy can be grouped into four categories based on treatment response, intestinal biopsies and histopathology, or both:16

Diagnosis and therapeutic management of dogs with chronic enteropathy are closely linked. Initially, dietary intervention is used as a diagnostic tool with the goals of providing complete and balanced nutrition, avoiding known allergens or ingredients that cause adverse food reactions, and resolving clinical signs. Many dogs respond well to dietary changes and nutritional therapy, eliminating the need for biopsies and histopathology. An elimination diet trial is now frequently recommended before endoscopy for most dogs with chronic GI signs of mild to moderate severity for which no other causes are identified, unless negative prognostic factors (e.g., hypoalbuminemia, hypocobalaminemia, high clinical activity index score) are present.1,2,17-20 

The goals of nutritional intervention are to provide a diet that meets the dog’s nutrient requirements, minimizes irritation of the GI mucosa, supports normal GI motility, and resolves or minimizes signs.

Key Messages

conversation starter background image

“Your dog has a gastrointestinal disease known as chronic enteropathy and there are different types of this condition. I think [dog’s name] may benefit from a change in food, and I am recommending we start [him/her] on a therapeutic diet that is designed for this condition. We should see improvement within 2 weeks and, if not, we can discuss trying a different food or next steps.”

Related Tools and Content:

Taking a Good Diet History

The only way to know what each patient really eats is to ask ꟷ and document the information in the medical record.

View Brief 1 min to 5 min

Nutritional Assessment Is an Iterative Process: Extended Evaluation

An extended nutritional evaluation is important for pets at risk for nutrition-related problems.

View Brief 1 min to 5 min

Purina Fecal Scoring Chart

The Purina Fecal Scoring Chart is a practical, easy-to-use tool that can help clients describe their pets’ stools.

View Tool 1 min to 5 min

Why Distinguish Between Small and Large Bowel Diarrhea

Identifying which part of the gastrointestinal (GI) tract is involved is a first step in diagnosing GI problems.

View Brief 1 min to 5 min

Distinguishing Characteristics of Small and Large Bowel Diarrhea Chart

A practical, easy-to-use chart that helps localize diarrhea to the small or large intestine.

View Tool 1 min to 5 min

Intestinal Dysbiosis in Dogs and Cats

Diet modification is a key component of therapeutic plans for managing dogs and cats with intestinal dysbiosis.

View Brief 1 min to 5 min

Amino Acid-Based Enteral Diets For Canine Adverse Food Reactions and Gastrointestinal Disease

Learn about the history, uses, and benefits of amino acid-based enteral diets.

View Monograph 20+ minutes

To Share With Pet Owner:

Screening Diet History Form

This short, screening diet history form is a practical, easy-to-use document that can help clients provide important information about their pets’ diets.

View Tool 1 min to 5 min

How to Encourage Finicky Pets to Eat

Pets who are finicky, fussy or not interested in food can be a challenge.

View Brief 1 min to 5 min

Canine Body Condition System Sheet

A visual aid to the Purina Body Condition Score System for dogs.​

View Tool 1 min to 5 min

Considerations When Choosing a Probiotic Supplement

Probiotics are a nutritional intervention that may help manage pet health issues from gastrointestinal tract and beyond.

View Brief 1 min to 5 min

Switching Pet Foods - Dogs

Gradually transitioning onto a new diet minimizes the risk of stomach upset.​

View Brief 1 min to 5 min

References

  1. Dandrieux, J. R. S. (2016). Inflammatory bowel disease versus chronic enteropathy in dogs: Are they one and the same? Journal of Small Animal Practice, 57(11), 589─599. doi:10.1111/jsap.12588
  2. Dandrieux, J. R. S., & Mansfield, C. S. (2019). Chronic enteropathy in canines: Prevalence, impact and management strategies. Veterinary Medicine: Research and Reports, 10, 203─214. doi:10.2147/VMRR.S162774
  3. Hall, E. J., & Day, M. J. (2017). Diseases of the small intestine. In S. J. Ettinger, E. C. Feldman & E. Côté (Eds.), Textbook of veterinary internal medicine: Diseases of the dog and the cat (8th ed., pp. 3643─3820). Elsevier.
  4. Simpson, K. W., & Jergens, A. E. (2011). Pitfalls and progress in the diagnosis and management of canine inflammatory bowel disease. Veterinary Clinics of North America: Small Animal Practice, 41(2), 381─398. doi: 10.1016/j.cvsm.2011.02.003
  5. Procoli, F. (2020). Inflammatory bowel disease, food-responsive, antibiotic-responsive diarrhoea, protein losing enteropathy: Acronyms, clinical staging, and treatment of chronic inflammatory enteropathy in dogs. Advances in Small Animal Care, 1, 127─141.
  6. Schmitz, S., Glanemann, B., Garden, O. A., Brooks, H., Chang, Y. M., Werling, D., & Allenspach, K. (2015). A prospective, randomized, blinded, placebo-controlled pilot study on the effect of Enterococcus faecium on clinical activity and intestinal gene expression in canine food-responsive chronic enteropathy. Journal of Veterinary Internal Medicine, 29(2), 533─543. doi: 10.1111/jvim.12563
  7. Allenspach, K. (2011). Clinical immunology and immunopathology of the canine and feline intestine. Veterinary Clinics of North America: Small Animal Practice, 41(2), 345─360. doi: 10.1016/j.cvsm.2011.01.004
  8. de Souza, H. S. P., & Fiocchi, C. (2016). Immunopathogenesis of IBD: Current state of the art. Nature Reviews: Gastroenterology & Hepatology, 13(1), 13─27. doi: 10.1038/nrgastro.2015.186
  9. Honneffer, J. B., Minamoto, Y., & Suchodolski, J. S. (2014). Microbiota alterations in acute and chronic gastrointestinal inflammation of cats and dogs. World Journal of Gastroenterology, 20(44), 16489─16497. doi: 10.3748/wjg.v20.i44.16489
  10. Minamoto, Y., Otoni, C. C., Steelman, S. M., Büyükleblebici, O., Steiner, J. M., Jergens, A. E., & Suchodolski, J. S. (2015). Alteration of the fecal microbiota and serum metabolite profiles in dogs with idiopathic inflammatory bowel disease. Gut Microbes, 6(1), 33─47. doi: 10.1080/19490976.2014.997612
  11. Suchodolski, J. S., Xenoulis, P. G., Paddock, C. G., Steiner, J. M., & Jergens, A. E. (2010). Molecular analysis of the bacterial microbiota in duodenal biopsies from dogs with idiopathic inflammatory bowel disease. Veterinary Microbiology, 142(3─4), 394─400. doi: 10.1016/j.vetmic.2009.11.002
  12. Suchodolski, J. S., Dowd, S. E., Wilke, V., Steiner, J. M., & Jergens, A. E. (2012). 16S rRNA gene pyrosequencing reveals bacterial dysbiosis in the duodenum of dogs with idiopathic inflammatory bowel disease. PLoS ONE, 7(6), e39333. doi: 10.1371/journal.pone.0039333
  13. Suchodolski, J. S., Markel, M. E., Garcia-Mazcorro, J. F., Unterer, S., Heilmann, R. M., Dowd, S. E., Kachroo, P., Ivanov, I., Minamoto, Y., Dillman, E. M., Steiner, J. M., Cook, A. K., & Toresson, L. (2012). The fecal microbiome in dogs with acute diarrhea and idiopathic inflammatory bowel disease. PLoS ONE, 7(12), e51907. doi: 10.1371/journal.pone.0051907
  14. Xenoulis, P. G., Palculict, B., Allenspach, K., Steiner, J. M., Van House, A. M., & Suchodolski, J. S. (2008). Molecular-phylogenetic characterization of microbial communities imbalances in the small intestine of dogs with inflammatory bowel disease. FEMS Microbiology Ecology, 66(3), 579─589. doi: 10.1111/j.1574-6941.2008.00556.x
  15. Ziese, A. L., & Suchodolski, J. S. (2021). Impact of changes in gastrointestinal microbiota in canine and feline digestive diseases. Veterinary Clinics of North America: Small Animal Practice, 51(1), 155─169. doi: 10.1016/j.cvsm.2020.09.004
  16. Makielski, K., Cullen, J., O’Connor, A., & Jergens, A. E. (2019). Narrative review of therapies for chronic enteropathies in dogs and cats. Journal of Veterinary Internal Medicine, 33(1), 11─22. doi: 10.1111/jvim.15345
  17. Allensbach, K., Wieland, B., Gröne, A., & Gaschen, F. (2007). Chronic enteropathies in dogs: Evaluation of risk factors for negative outcome. Journal of Veterinary Internal Medicine, 21(4), 700─708. doi: 10.1111/j.1939-1676.2007.tb03011.x
  18. Gaschen, F. P., & Merchant, S. R. (2011). Adverse food reactions in dogs and cats. Veterinary Clinics of North America: Small Animal Practice, 41(2), 361─379. doi: 10.1016/j.cvsm.2011.02.005
  19. Mandigers, P. J. J., Biourge, V., van den Ingh, T. S. G. A. M., Nakringa, N., & German, A. J. (2010). A randomized, open-label, positively controlled field trial of a hydrolyzed protein diet in dogs with chronic small bowel enteropathy. Journal of Veterinary Internal Medicine, 24(6), 1350─1357. doi: 10.1111/j.1939-1676.2010.0632.x
  20. Craven, M., Simpson, J. W., Ridyard, A. E., & Chandler, M. L. (2004). Canine inflammatory bowel disease: Retrospective analysis of diagnosis and outcome in 80 cases (1995─2002). Journal of Small Animal Practice, 45(7), 336─342. doi: 10.1111/j.1748-5827.2004.tb00245.x
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  25. Walker, D., Knuchel-Takano, A., McCutchan, A., Chang, Y-M., Downes, C., Miller, S., Stevens, K., Verheyen, K., Phillips, A. D., Miah, S., Turmaine, M., Hibbert, A., Steiner, J. M., Suchodolski, J. S., Mohan, K., Eastwood, J., Allenspach, K., Smith, K., & Garden, O. A. (2013). A comprehensive pathological survey of duodenal biopsies from dogs with diet-responsive chronic enteropathy. Journal of Veterinary Internal Medicine, 27(4), 862─874. doi: 10.1111/jvim.12093
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  32. Rallis, T. S., Pardali, D., Adamama-Moraitou, K. K., & Kavarnos, I. (2016). Effect of Enterococcus faecium SF68® (FortiFlora®) administration in dogs with antibiotic responsive or small intestinal bacterial overgrowth diarrhoea. Hellenic Journal of Companion Animal Medicine, 5(2), 8─16.