- Inflammatory Bowel Disease
- What is inflammatory bowel disease?
- What are the signs of inflammatory bowel disease?
- What causes this condition?
- How is irritable bowel syndrome diagnosed?
- What is a diet trial?
- How is this disease treated?
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Immunosuppressants
Glucocorticoids: This group of drugs has an anti-inflammatory effect by increasing the level of lipocortin (phospholipase A inhibitor), which reduces the synthesis of inflammatory mediators (leukotrienes, thromboxanes and prostaglandins). They also decrease the synthesis of interferon-gamma cytokines, IL1, IL-2, IL-3, TNFa, bradykinins and histamine. (5) (6) (8) (9) (18).
Generally, prednisone or prednisolone is usually used as the drug of choice for the treatment of this group of pathologies. The dose used ranges from 1-2 mg / kg every 12 hours orally for 2-4 weeks, then the dose is reduced by half (for 4 weeks), until the minimum effective dose is reached every other day or discontinuation of treatment
Dexamethasone can also be used orally if the patient exhibits excessive collateral signs due to the use of prednisolone (polyphagia, polyuria, panting, etc.).
Parenteral corticosteroids are an alternative for those patients who present with vomiting or if it is assumed that digestive absorption may be altered by the infiltrative process.
Methylprednisolone acetate may be useful for cats, who find it difficult to administer medications by mouth. 20 mg SC can be used every 2 weeks 3 treatments and repeat as long as the symptoms do not diminish. Likewise, it should be considered a last resort, since there can be no exact control of the daily dose of corticosteroid the animal receives
Budesonide is a steroid, two hundred times more potent than hydrocortisone, and that when it is destroyed mostly (90%) in the liver, it minimizes the risk of producing hyperadrenocorticism. The dose is 1 - 3 mg / day.
Sulfasalazine: This drug is the combination of 5-aminosalicylic acid and sulfapyridine, bound by azo binding. When approximately 70% of the administered dose reaches the colon, the bacteria break that azo junction, leaving both parts of the molecule apart. The one that has utility in the treatment is the 5-aminosalicylic portion that has anti-inflammatory properties. It is used in the treatment of patients with colitis, usually with a very good response. The dose that can be used is 12.5 mg / kg / 6 hours orally for 2 weeks in dogs, then the same dose is administered but every 12 hours for 28 days.
In cats, 10-20 mg / kg is administered every 24 hours orally for 14 days. The problem in this species is their greater susceptibility to this drug ...
Among the side effects in both dogs and cats, anorexia and vomiting can be cited as more common. The patient must be monitored monthly with a hepatogram as it can cause liver damage. The appearance of dry keratitis, or allergic dermatitis, is also usually possible adverse effects.
Olsalazine: This drug is formed by two molecules of 5 aminosalicylic acid, it has been used in humans as a replacement for sulfasalazine. The dose used in canines is 25 mg / kg / 8 hours.
Mesalamine: This drug is also used for colonic inflammatory diseases. Its dose is 10-20 mg / kg / 12 hours orally.
Azathioprine: It is a metabolite analog of purines, which is metabolized in the liver to 6-mercaptopurine, which inhibits cell proliferation (T and B lymphocytes) and reduces the cytotoxicity of natural killer cells. This immunosuppressant can be used when the response to conventional drugs is not good, or when the existence of adverse effects due to glucocorticoids makes dose reduction necessary. In dogs, it can be used at a rate of 50 mg / m² or 1 - 1.5 mg / kd / day for 2 weeks and then follow alternate days. There is a dose described for cats of 0.3-0.5 mg / kg every 48-72 hours, but it is generally not used because of the potent myelosuppression that this species produces. Anorexia is also cited as an adverse effect in cats.
Dogs should be checked periodically with a hemogram and hepatogram.
Cyclophosphamide This drug is very little used for the treatment of IBD in dogs and cats. And it would be restricted for those patients who are refractory to the treatments described above. The recommended dose is 50 mg / m² 4 days a week.
Monthly hematologic checks should be performed. The owner (in dogs) should be advised of the possibility of hemorrhagic cystitis.
Some authors prefer to use Azathioprine instead of chlorambucil, especially in cats. The recommended dose is 2 - 4 mg / m² every 2 - 7 days or oral 10 mg / m² every 14 days.
Cyclosporine: This drug is a potent immunosuppressant, which is frequently used in human medicine, as part of the treatment of a transplanted patient. Its effect is to alter the function of T lymphocytes and inhibits the release of IL-2 and interferon gamma. The dose is 5 mg / kg / day. The biggest problem is its high cost.
Mycophenolate Mofetil: This immunosuppressive drug is used in different pathologies in human medicine, since it produces a non-competitive inhibition in the synthesis of guanine required for the synthesis of DNA and RNA during the proliferation of T and B lymphocytes. The dose described for the dog is of 10-20 mg / kg / 12 hours oral
Antibiotics: Metronidazole This drug has antimicrobial effects, essentially on anaerobic, antiprotozoal microorganisms, and also inhibits the cell-mediated immune response.
It is generally not used as a single drug, but in combination with glucocorticoids. This allows reducing their dose. It can be used at a rate of 10-20 mg / kg / 12 hours.
With the same purpose, tylosin 10 mg / kg / 8 hours can be used.
Vitamins: There is evidence of Vitamin B12 deficiency, especially in cats, so the administration of cyanocobalamin 20 µg / kg weekly SC 4 treatments is recommended. (16) (22)
Conclusions
When treating patients involved in inflammatory bowel disease, the owner must be informed about:
a) That your pet has a disease of unknown origin.
b) That the treatment to be implemented will be symptomatic.
c) It may require a lifetime treatment (cost).
d) Consider cost / benefit risk patients.
e) That periodic controls (blood count, urea, creatinine, blood glucose, ALT-AST-FAS, etc.) should be implemented.
f) That in order to arrive at a diagnosis, it is necessary to previously exclude other pathologies (cost)
To conclude in Human Medicine, in Crohn's disease (a type of inflammatory bowel disease) treatments with TNFa antagonists, such as infliximab and Adalimumab, have been implemented. (23) These drugs are monoclonal antibodies, which selectively inhibit TNFα. In the same studies, it was also determined that patients who receive these drugs for long periods of time may suffer from tuberculosis, sepsis, pneumonia, and even a higher incidence of lymphoma was observed.
This shows that the search for better therapeutic alternatives to immunosuppressive drugs remains a challenge.
What is IBD, what are its symptoms and how does it affect a dog?
It is known as IBD ( Inflammatory bowel disease in English) to any chronic inflammatory bowel disease that affects or can affect a dog's digestive system.
It consists of inflammation of the digestive tract or the walls of the intestine and can cause serious problems in the health of a dog:
- Ulcers
- Bleeding
- Abdominal pain
- Diarrhea and / or vomiting
- Moderate or extreme thinness
- Weakening, anemia
When the intestine or part of the intestinal wall becomes inflamed, the absorption of nutrients decreases considerably causing what is known as malabsorption syndrome. This causes the dog can not absorb nutrients properly from food, acquiring significant nutritional deficiencies and showing a progressive thinness that can lead to extreme.
Other important symptoms such as diarrhea or bloody diarrhea are also noticeable as the disease worsens.
How can a dog get an IBD or inflammatory bowel disease?
An IBD is not something that is spread by a virus or bacteria, so it is not a contagious disease. There are multiple causes for which it is suspected that a dog can get an IBD, among which are:
- Poor quality food
- Continued toxin intake
- Allergic response
- Immune-mediated disease
- Referral of another disease
Poor quality food It can deteriorate the digestive system of our dog, seriously damaging it and sometimes irreversibly. We must take great care of our dog's diet, to avoid precisely diseases such as this.
Toxin intake It also plays an important role in developing an IBD. That is why it is important to take care of both the food of our dog and the materials of its toys and feeder / drinker.
An allergic response An external or nutritional factor can also produce an IBD. Although when it comes to allergies, other very specific symptoms are usually shown together: Common allergies in dogs.
Immunomedial IBD due to a malfunction of our dog's organism, which for some reason "believes" that there is a danger attacking the dog's intestinal tract.
An IBD may also appear as secondary symptom of another diseasehow for example the Addison syndrome in dogs.
Treatments for inflammatory bowel disease or IBD in dogs
Any treatment should always be supervised by a veterinarian, who will prescribe the appropriate medications for our dog's problem and the optimal amount depending on his weight.
At general levels, the medications used to treat an inflammatory bowel disease or IBD are:
- Prednisone (corticosteroids)
- Metronidazole
Prednisone is used in anti-inflammatory doses as shock therapy to decrease it later and assess. By way of two to four milligrams per kilo of weight and day, in two shots (every 12 hours). While Metronidazole is used as a potent anti-bacterial and antiparasitic supplement with prednisone, by way of ten to thirty milligrams per kilogram of weight and day, divided into two doses (every 12 hours).
Another alternative treatment for when the first does not achieve the desired effects is:
- Azathioprine
Azathioprine is a potent derivative of purine, an immunosuppressant that generally acts as a potent corticosteroid but without its side effects. Although that does not mean that it has no side effects. It is usually administered as two milligrams per kilo of weight and day in a single daily intake.
Nutritional treatment for dogs with IBD
The treatment of a dog with IBD not only consists in taking a specific medication, but it must be complemented with adequate food. We cannot feed a dog with IBD with poor quality feed or toxic ingredients.
At general levels it is recommended to feed dogs with IBD with a low fat and fiber diet, without exceeding protein. Given the quality of commercial feed, the best option is to feed our dog with 100% natural foods.
How to prevent an IBD in my dog?
It is not something that can be prevented and our dog is completely protected, but measures can be taken to avoid it as much as possible.
A diet based on natural foods and free of chemicals and processed foods is the best prevention. There are no magic ingredients or special herbs…. Simply a healthy diet and a healthy life is enough.
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