General Testing - Video

• Nutritional intervention benefits many dogs with chronic enteropathy, although no single diet or approach to dietary management of chronic enteropathy works for all dogs.^1,16,17,19 Common dietary strategies include:^{4,5,17,19,21─23} 
  • highly digestible, low-residue (i.e., low-fiber) diets
  • diets made with hydrolyzed or novel protein ingredients
  • amino acid-based (i.e., elemental) diets
  • low-fat diets
  • fiber-enriched diets
• Identifying the intestinal origin of diarrhea as small bowel, large bowel or mixed can help guide selection of an appropriate diet. 
• Studies support the use of highly digestible, commercial therapeutic gastrointestinal diets in dogs with chronic idiopathic GI signs and is a reasonable first diet selection.^17,24 For dogs that do not respond to a GI diet, an elimination diet (i.e., hydrolyzed protein, amino acid based, or novel protein) should be used and has been supported by randomized controlled trials.^17,19,21
• Clinical response to dietary change is typically rapid, occurring within 1-2 weeks of changing the diet.^16,17,25 
  • Not all dogs with chronic enteropathy will respond to a particular food within 2 weeks. If no response occurs during the initial dietary trial and the dog is stable, a second dietary trial that uses a different nutritional approach (i.e., novel protein versus hydrolyzed protein diet) may be beneficial before proceeding to an antibiotic trial or intestinal biopsy.²⁶

• Diet characteristics and nutrients of concern include digestibility, energy, protein, fat, fiber, cobalamin, vitamin D, and magnesium.^27─29 However, not every nutrient of concern is relevant for every patient.
• A highly digestible diet is important because the ability of the GI tract to digest food and absorb nutrients, particularly protein and fat, may be compromised.^27,28 
  • High digestibility helps improve nutrient absorption and minimize complications associated with undigested food (e.g., osmotic diarrhea or altered colonic microbiota).
• Highly digestible protein, critical for normal GI tract function, helps dogs with compromised digestive function absorb sufficient essential amino acids. Dietary protein source may be very important to management of clinical signs, especially if adverse food reactions are suspected.²⁸ 
• For dogs with reduced appetite and/or decreased digestive function, an energy-dense diet can help reduce meal size.²⁸ However, dogs with pancreatitis or lymphangiectasia will benefit from dietary fat restriction.³⁰ In these dogs, replacing some of the fat with medium chain triglycerides may be beneficial.
  • When fat digestion and absorption are compromised, an increased amount of fat may pass into the colon where it potentially may induce dysbiosis, epithelial cell damage, and fluid secretion into the colon. 
  • Modifying the ratio of dietary omega-3 to omega-6 fatty acids may modulate intestinal inflammation by reducing production of proinflammatory metabolites.^30,31 
• Various amounts and types of dietary fiber have been suggested for dogs with chronic enteropathy.
  • In cases of vomiting and/or small bowel diarrhea, low-fiber foods are traditionally recommended to avoid delayed gastric emptying and to improve nutrient absorption.
  • For dogs with evidence of large bowel diarrhea, a high-fiber diet containing mixed fibers (e.g., soluble and insoluble) may be indicated to help reduce tenesmus and assist mucosal repair in the colon.²⁸
• Probiotics, especially those shown to modulate the immune system or to have anti-inflammatory properties, may benefit some dogs with chronic enteropathy as part of a multimodal therapeutic approach.³² 
  • Different probiotic strains have varying effects on the host. Specific probiotics should be chosen based on the desired goals.

• Food form and feeding frequency should be matched to the suspected problem and its location within the gastrointestinal tract to avoid inducing additional vomiting and/or diarrhea.
  • Food form (e.g., liquid, canned, or dry) influences how quickly the stomach empties. Liquid diets are the fastest to leave the stomach, followed by canned foods and finally dry kibble.
  • The increased moisture content of a wet formula or warm water added to dry food can help offset mild fluid losses while improving palatability.
• Dogs with chronic enteropathy may benefit initially from small, frequent meals (e.g., 3 to 6 meals per day) to help improve nutrient absorption and minimize adverse responses such as vomiting or diarrhea.^28,29 
  • If the enteropathy resolves, a gradual transition to the dog’s usual diet can be attempted over a 7-day period.
  • Depending on the suspected underlying cause, some dogs may need to remain on a therapeutic diet.

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