THERAPEUTIC NUTRITION
THERAPEUTIC NUTRITION
Useful information about the needs of cats and dogs with nutritionally sensitive health conditions.
Gastrointestinal Disorders
Food-Responsive Enteropathy (Diarrhea) in Dogs
Food-responsive enteropathy is one of the most common forms of chronic enteropathy in dogs and includes those with adverse food reactions (i.e., food allergy and food intolerance) and those with intestinal inflammation that benefits from properties of a different diet.1 Food-responsive enteropathy is characterized by persistent or intermittent gastrointestinal (GI) clinical signs lasting 3 weeks or longer in the absence of other causes (e.g., dietary indiscretion, parasitism, identified enteropathogens, or neoplasia) and non-GI diseases.2,3
Dogs with food-responsive enteropathy are more likely to be younger, have less severe clinical signs, and exhibit more large-bowel diarrhea compared to dogs with immunosuppressant-responsive enteropathy.4─6
Since many dogs with chronic idiopathic GI signs respond well to dietary changes, an elimination diet trial is often recommended before endoscopy for those dogs with mild or moderate signs unless negative prognostic factors (e.g., hypoalbuminemia, hypocobalaminemia, high clinical activity index score) are present.1,2,4,7,8
The goals of nutritional intervention are to provide a complete and balanced diet that avoids known allergens or ingredients that cause adverse food reactions and resolves or minimizes clinical signs.
THERAPEUTIC NUTRITION
An elimination diet has been proven to be the most effective method for diagnosis and treatment of food-responsive enteropathy.6
Key Messages
- No single diet or approach to dietary management of chronic enteropathy works for all dogs, even when choosing a food for a diet elimination trial.4,7─9
- Identifying the intestinal origin of diarrhea as small or large bowel or mixed can help guide selection of an appropriate diet.
- Dietary strategies commonly used in general veterinary practices include:4,5,8,10─13
- hydrolyzed or novel protein diets, especially if food allergies or intolerance are suspected
- highly digestible, low-residue (i.e., low fiber) diets
- fiber-enhanced diets if fiber-responsive large bowel diarrhea is suspected
- Exclusive feeding of the recommended diet is essential to diagnosing and managing dogs with food-responsive enteropathy, especially if the underlying cause is food allergy or intolerance.
- Although improvement in dermatological signs often requires a diet elimination trial lasting 8 weeks or longer, improvement in gastrointestinal signs may be seen within 1 to 4 weeks.1,4
- Dogs who respond positively to a hydrolyzed or novel protein diet within the first 4 weeks of a diet trial are categorized as having food-responsive enteropathy.
- Not all dogs with food-responsive enteropathy will respond to a particular food within 1 to 4 weeks. If no response occurs during the initial dietary trial, a second dietary trial that uses a different nutritional approach may be beneficial before considering an antibiotic trial or intestinal biopsies.14
- Studies have shown, following 12 to 14 weeks of feeding an elimination diet after diagnosis, many dogs with food-responsive enteropathy could be gradually transitioned back to their original diet without recurrence of clinical signs.4,5
- Following resolution of clinical signs, some owners may decline to perform the challenge phase of an elimination diet trial to confirm the presence of a food allergy or intolerance. These dogs should be continued on dietary therapy for maintenance of their food-responsive condition.
- Dogs whose clinical signs resolve during an elimination diet trial and relapse upon challenge with the original diet (or its components) should be continued on dietary therapy for maintenance of their food-responsive condition.
- Diet characteristics and nutrients of concern include digestibility, protein, fat, and fiber.10,15 However, not every nutrient of concern is relevant for every patient.
- For dogs with suspected food allergies, protein is the nutrient of greatest concern since, in most cases of food allergy, the allergen is a dietary protein. Hydrolyzed protein, amino acid-based or novel protein diets can be used with these patients.
- Common food allergens in dogs are beef, dairy, wheat, chicken, and egg.16,17 Allergies can form to any protein since allergies are an inappropriate immune reaction to a normal protein.
- A comprehensive diet history is essential to identify a novel protein diet but is not critical to the selection of a hydrolyzed protein diet.
- Food intolerance, which is an adverse reaction to a food or food additive, is not recognized as having a specific immune component.1,18
- These idiosyncratic reactions are variable, usually dose-dependent, can happen at any age, and may occur any time after the triggering food or ingredient is eaten.18
- Identifying the ingredient responsible for the adverse reaction can be challenging.
- For dogs with evidence of large bowel diarrhea, a high-fiber diet containing mixed fibers (e.g., soluble/fermentable and insoluble/poorly fermentable) may be indicated to help reduce tenesmus and assist mucosal repair in the colon.10,19
- Increased levels of omega-3 fatty acids, which have anti-inflammatory and immune response-modulating effects, may benefit dogs with food-responsive enteropathy.1,20
- Prebiotics, probiotics, or synbiotics may help dogs with food-responsive enteropathy by influencing the composition of the GI microbiome.1,10
Nutritional management approaches to consider
- No single diet or approach to dietary management of chronic enteropathy works for all dogs, even when choosing a food for a diet elimination trial.4,7─9
- Identifying the intestinal origin of diarrhea as small or large bowel or mixed can help guide selection of an appropriate diet.
- Dietary strategies commonly used in general veterinary practices include:4,5,8,10─13
- hydrolyzed or novel protein diets, especially if food allergies or intolerance are suspected
- highly digestible, low-residue (i.e., low fiber) diets
- fiber-enhanced diets if fiber-responsive large bowel diarrhea is suspected
- Exclusive feeding of the recommended diet is essential to diagnosing and managing dogs with food-responsive enteropathy, especially if the underlying cause is food allergy or intolerance.
- Although improvement in dermatological signs often requires a diet elimination trial lasting 8 weeks or longer, improvement in gastrointestinal signs may be seen within 1 to 4 weeks.1,4
- Dogs who respond positively to a hydrolyzed or novel protein diet within the first 4 weeks of a diet trial are categorized as having food-responsive enteropathy.
- Not all dogs with food-responsive enteropathy will respond to a particular food within 1 to 4 weeks. If no response occurs during the initial dietary trial, a second dietary trial that uses a different nutritional approach may be beneficial before considering an antibiotic trial or intestinal biopsies.14
- Studies have shown, following 12 to 14 weeks of feeding an elimination diet after diagnosis, many dogs with food-responsive enteropathy could be gradually transitioned back to their original diet without recurrence of clinical signs.4,5
- Following resolution of clinical signs, some owners may decline to perform the challenge phase of an elimination diet trial to confirm the presence of a food allergy or intolerance. These dogs should be continued on dietary therapy for maintenance of their food-responsive condition.
- Dogs whose clinical signs resolve during an elimination diet trial and relapse upon challenge with the original diet (or its components) should be continued on dietary therapy for maintenance of their food-responsive condition.
Diet characteristics, nutrients of concern, and related interventions
- Diet characteristics and nutrients of concern include digestibility, protein, fat, and fiber.10,15 However, not every nutrient of concern is relevant for every patient.
- For dogs with suspected food allergies, protein is the nutrient of greatest concern since, in most cases of food allergy, the allergen is a dietary protein. Hydrolyzed protein, amino acid-based or novel protein diets can be used with these patients.
- Common food allergens in dogs are beef, dairy, wheat, chicken, and egg.16,17 Allergies can form to any protein since allergies are an inappropriate immune reaction to a normal protein.
- A comprehensive diet history is essential to identify a novel protein diet but is not critical to the selection of a hydrolyzed protein diet.
- Food intolerance, which is an adverse reaction to a food or food additive, is not recognized as having a specific immune component.1,18
- These idiosyncratic reactions are variable, usually dose-dependent, can happen at any age, and may occur any time after the triggering food or ingredient is eaten.18
- Identifying the ingredient responsible for the adverse reaction can be challenging.
- For dogs with evidence of large bowel diarrhea, a high-fiber diet containing mixed fibers (e.g., soluble/fermentable and insoluble/poorly fermentable) may be indicated to help reduce tenesmus and assist mucosal repair in the colon.10,19
- Increased levels of omega-3 fatty acids, which have anti-inflammatory and immune response-modulating effects, may benefit dogs with food-responsive enteropathy.1,20
- Prebiotics, probiotics, or synbiotics may help dogs with food-responsive enteropathy by influencing the composition of the GI microbiome.1,10
Related Tools and Content:
Diet Elimination Trials
Diet elimination trials are the gold standard for the diagnosis of food allergies and food intolerances.
1 min to 5 min
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.
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.
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.
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.
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.
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.
1 min to 5 min
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.
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.
1 min to 5 min
Canine Body Condition System Sheet
A visual aid to the Purina Body Condition Score System for dogs.
1 min to 5 min
Food Allergies & Food Intolerances in Pets
The terms “food allergy” and “food intolerance” are often used interchangeably, but they are not the same. How do they compare, and how are they diagnosed and managed?
6 min to 10 min
Switching Pet Foods - Dogs
Gradually transitioning onto a new diet minimizes the risk of stomach upset.
1 min to 5 min
References
- 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
- 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
- Jergens, A. E., & Simpson, K. W. (2012). Inflammatory bowel disease in veterinary medicine. Frontiers in Bioscience-Elite, 4(4), 1404─1419. doi: 10.2741/470
- Allenspach, 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
- Allenspach, K., Culverwell, C., & Chan, D. (2016). Long-term outcome in dogs with chronic enteropathies: 203 cases. Veterinary Record, 178(15), 368. doi: 10.1136/vr.103557
- Volkmann, M., Steiner, J. M., Fosgate, G. T., Zentek, J., Hartmann, S., & Kohn, B. (2017). Chronic diarrhea in dogsꟷRetrospective study in 136 cases. Journal of Veterinary Internal Medicine, 31(4), 1043─1055. doi: 10.1111/jvim.2017.31.issue-4
- 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
- Mandigers, P. J., Biourge, V., van den Ingh, T. S., Ankringa, 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
- 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
- Lenox, C. E. (2021). Nutritional management of dogs and cats with gastrointestinal diseases. Veterinary Clinics of North America: Small Animal Practice, 51(3), 669─684. doi: 10.1016/j.cvsm.2021.01.006
- Marks, S., Laflamme, D. P., & McAloose, D. (2002). Dietary trial using a commercial hypoallergenic diet containing hydrolyzed protein for dogs with inflammatory bowel disease. Veterinary Therapeutics: Research in Applied Veterinary Medicine, 3(2), 109─118.
- 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. doi: 10.1016/j.yasa.2020.07.010
- 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
- Rudinsky, A. J., Rowe, J. C., & Parker, V. J. (2018). Nutritional management of chronic enteropathies in dogs and cats. Journal of the American Veterinary Medical Association, 253(5), 570─578. doi: 10.2460/javma.253.5.570
- Zoran, D. L. (2017). Nutritional management of gastrointestinal disease. 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. 1892─1899). Elsevier.
- Mueller, R. S., Olivry, T., & Prélaud, P. (2016). Critically appraised topic on adverse food reactions of companion animals (2): Common food allergen sources in dogs and cats. BMC Veterinary Research, 12, Article 9. doi: 10.1186/s12917-016-0633-8
- Verlinden, A., Hesta, M., Millet, S., & Janssens, G. P. (2006). Food allergy in dogs and cats: A review. Critical Reviews in Food Science and Nutrition, 46(3), 259─273. doi: 10.1080/10408390591001117
- Craig, J. M. (2019). Food intolerance in dogs and cats. Journal of Small Animal Practice, 60(2), 77─85. doi: 10.1111/jsap.12959
- Leib, M. (2000). Treatment of chronic idiopathic large bowel diarrhea in dogs with a highly digestible diet and soluble fiber: A retrospective review of 37 cases. Journal of Veterinary Internal Medicine, 14(1), 27─32. doi: 10.1111/j.1939-1676.2000.tb01495.x
- Cave, N. (2012). Nutritional management of gastrointestinal diseases. In A. J. Fascetti & S. J. Delaney (Eds.), Applied veterinary clinical nutrition (pp. 175─220). John Wiley & Sons.