Motility of the equine gastrointestinal tract: Physiology and pharmacotherapy

Normal gastrointestinal (GI) motility patterns are necessary to maintain transit of ingesta and to facilitate digestion and absorption of nutrients. Disorders of the equine GI tract are frequently encountered by the equine practitioner and these disorders are often associated with an interruption in normal intestinal motility patterns, thus complicating treatment of the primary disease. Consequently, numerous treatments have been investigated in horses to facilitate the return of normal intestinal motility. The purpose of this article is to provide a brief review of the anatomy and physiology of the GI tract in the horse and review medications available to the equine veterinarian that may potentially promote intestinal motility.     

Serum IgE and IgG responses to food antigens in normal and atopic dogs,and dogs with gastrointestinal disease

In human food allergy, with or without concurrent atopy, there may be significant increases in serum allergen-specific IgE. Serological methods have been tried but are not currently recommended for diagnosis of suspected food allergy in dogs. The aim of this study was to investigate humoral immune responses to food antigens in dogs. Serum IgG and IgE antibodies specific for food antigens were measured by enzyme linked immunosorbent assay (ELISA) using polyclonal anti-dog IgG and IgE reagents. Antigens tested were beef, chicken, pork, lamb, chicken, turkey, white fish, whole egg, wheat, soybean, barley, rice, maize corn, potato, yeast and cow's milk. Three groups were examined: normal dogs, dogs with atopic dermatitis (AD); and dogs with one of four types of gastrointestinal (GI) disease: small intestinal bacterial overgrowth (SIBO), inflammatory bowel disease (IBD), food-responsive disease, and infectious diarrhoea. Statistically significant differences in food-specific antibodies were not detected between the GI subgroups. There were statistically significant differences in the IgE concentration between the normal dogs, and dogs with atopic or GI disease, for all of the antigens tested. There were statistically significant differences in the average IgG concentrations between the normal dogs, and dogs with atopic or GI disease, for all of the antigens tested, except egg and yeast. The relationship of antigen responses for pooled data was analysed using principle component analysis and cluster plots. Some clustering of variables was apparent for both IgE and IgG. For example, all dogs (normal and diseased) made a similar IgG antibody response to chicken and turkey. Compared with other groups, atopic dogs had more food allergen-specific IgE and this would be consistent with a Th(2) humoral response to food antigens. Dogs with GI disease had more food allergen-specific IgG compared with the other groups. This may reflect increased antigen exposure due to increased mucosal permeability which is a recognised feature of canine intestinal disease.     

Enzyme digestion in the proximal digestive tract of the pig: A reviewLa digestion enzymatique dans la partie proximale du porc une revue bibliographiqueEnzymatiche verdauung im proximalen verdauungstrakt beim schwein ein ubersichtsreferat

Studies on enzyme digestion in the precaecal part of the digestive tract show that the pig posesses digestive enzymes that can completely break down dietary substrates to absorbable nutrients. Gastric pepsins, pancreatic proteolytic enzymes and intestinal peptidases are responsible for the hydrolysis of dietary proteins; salivary and pancreatic α-amylases start the hydrolysis of starch, its products being broken down by intestinal carbohydrases; dietary lipids, mainly triglycerides, are hydrolyzed in the intestinal lumen by the complex lipase—colipase—bile salts. Hydrolysis of food components may be complete, depending upon different factors such as the composition of the diet or the nature of the substrate.     

New ideas for the dietary management of gastrointestinal tract disease

Drugs are often given inappropriate precedence in the treatment of gastrointestinal tract diseases. Diet has a marked influence on gastrointestinal tract function and the manipulation of dietary composition provides clinicians with a powerful therapeutic tool. During acute gastroenteritis, a short period of fasting is recommended. ‘Feeding through’ diarrhoea (without a period of fasting) is recommended in human infants but has limited applicability in dogs and cats, primarily because different types of diarrhoea are commonly treated by veterinary surgeons compared to physicians. Following the fast, a change from the animal's regular food to a diet containing novel protein sources is advisable. This minimises the likelihood of acquired food allergies to staple proteins. Allergy avoidance may require special techniques such as rotation diets or protein hydrolysates. Dietary fat is usually kept to a minimum during gastrointestinal dysfunction as malabsorbed fatty acids and bile acids promote secretory diarrhoea in the large bowel. Recommendations to feed high fat rather than high carbohydrate diets to cats with diarrhoea need to be objectively examined. The type of fat fed may also prove to be an important consideration. Incorporation of omega-3 fatty acids into the diet has been shown to have anti-inflammatory effects on the gastrointestinal mucosa. In diseases of the small bowel, it is traditional to use low fibre diets. This recommendation needs re-examination because the binding and gelling properties of fibre are of potential benefit in the treatment of small bowel diarrhoea. High fibre diets are useful in most large bowel diseases. Soluble (fermentable) fibres (eg, psyllium, oat bran and fibrim) rather than insoluble (non-fermentable) fibres (eg, wheat bran) give better results in treating colitis. The benefits from soluble fibre probably relates to the binding of irritant bile acids and the generation of volatile fatty acids, such as butyrate, that nourish the colonic epithelium and encourage growth of normal bacterial flora.     

Enteric bacteria: Friend or foe?

The normal gastrointestinal tract contains an enormous number of aerobic and anaerobic bacteria which normally enjoy a symbiotic relationship with the host but can have adverse effects with local and systemic consequences. The small intestine constitutes a zone of transition between the sparsely populated stomach and the luxuriant bacterial flora of the colon. Regulation of the intestinal flora depends on complex interactions between many factors including secretion of gastric acid, intestinal motility, biliary and pancreatic secretions, local immunity, the surface glycocalyx and mucus layer, and diet. Microbial interactions are also important, and can involve alterations in redox potential, substrate depletion and production of substances such as bacteri-ocins that inhibit bacterial growth. The beneficial effect of the normal enteric flora include the competitive exclusion of potentially pathogenic organisms, and the production of nutrients such as short-chain fatty acids (which represent an important energy source for the colonic mucosa) and vitamins. Detrimental effects of the enteric flora include competition for calories and essential nutrients, particularly by bacteria located in the small intestine, and a capacity to damage the mucosa, in some circumstances causing or contributing to inflammatory bowel disease. These problems can be accentuated by interference with the physiological regulation of intraluminal bacteria allowing overgrowth by a normal resident, or colonisation by transient pathogens. The pathophysiological consequences may involve direct damage to the intestinal mucosa, and bacterial metabolism of intraluminal constituents, for example forming deconjugated bile acids and hydroxylated fatty acids which stimulate fluid secretion. Additional problems arise if there is interference with the mucosal barrier since this can result in increased passage of bacteria and bacterial products stimulating mucosal inflammation, while bacterial translocation can result in bacteraemia and septicaeniia. Problems associated with bacterial pathogens are illustrated by the properties of the spectrum of pathogenic Escherichia coli, some of which facilitate long-term colonisation by adherence to the surface or invasion of enterocytes.     

Animal health and foodborne pathogens: enterohaemorrhagic O157:H7 strains and other pathogenic Escherichia coli virotypes (EPEC,ETEC, EIEC,EHEC)

The majority of interactions between microorganisms and animals are based on convenient relations for both of them. Symbiotic microorganisms, like intestinal microbiota, produce important vitamins for animals and protects them from putative pathogens. In general, for monogastric animals, the main contribution of intestinal microorganisms is to supply with growth factors the animal diet, and in some cases they are responsible for providing essential vitamins (e.g. vitamin K). Some particular and relatively few microbes like viruses, bacteria, fungi, protozoa and algae are responsible for animal illness. Because microorganisms are easily dispersed, display physiological diversity, and tolerate extreme conditions, they are ubiquitous and may contaminate and grow in many products, including food and raw materials. Foodborne diseases are caused by consumption of contaminated food or beverages. Many different disease-causing pathogens can contaminate food, so there are many different foodborne infections. In addition, poisonous chemicals and biological toxins can cause disease if they are present in food. To know how a particular disease is spreading is an important matter to take appropriate steps to stop it. For example Escherichia coli O157:H7 infections can spread through contaminated food (meat, vegetables, cheese, etc.), contaminated drinking water or juices, contaminated swimming water and from person to person. Among foodborne pathogens, the most frequently detected are bacteria, but also parasitic protozoa and worms, viruses, natural toxins and other pathogenic agents like prions are important agents for foodborne diseases. Particular pathogenic types of E. coli, classified by their specific pathogenic mechanisms (toxins, adhesins, invasiveness, etc.) are actually known as E. coli virotypes. Enterohaemorrhagic E. coli (EHEC), which constitute the main part of this review, were also named verotoxigenic E. coli (VTEC) or Shiga toxigenic E. coli (STEC). EHEC strains cause haemorrhagic colitis (HC), haemolytic uremic syndrome (HUS) and thrombotic thrombocytopaenic purpura (TP) in humans. They synthetize shigatoxins (verotoxins) which are potent cytotoxic substances, adherence factors and enterohaemolysin. EHEC are responsible for many outbreaks of bloody diarrhoea caused by contaminated foods: beef, milk, fruits, juice, water, etc. The most important serogroups among EHEC are O26, O111 and O157, being O157:H7 the most relevant serotype in foodborne outbreaks. The normal intestinal microflora of cattle was found to be the most relevant reservoir of EHEC strains.     

Feline idiopathic inflammatory bowel disease: what we know and what remains to be unraveled

PRACTICAL RELEVANCE: Feline idiopathic inflammatory bowel disease (IBD) denotes one form of chronic enteropathy that is immunologically mediated and characterized by persistent or recurrent gastrointestinal (GI) signs and histologic inflammation. Signs of vomiting, diarrhea and weight loss generally predominate, and mucosal inflammation may occur in any portion of the GI tract (especially the small intestine). Affected cats may also have concurrent inflammation in other organs, such as the pancreas and liver, which may impact clinical disease severity. CLINICAL CHALLENGES: The exact etiologies of this heterogeneous group of disorders have yet to be determined, though results from basic science and clinical studies suggest that interplay between genetic factors and enteric bacteria is crucial for disease development. The diagnosis is one of exclusion and requires intestinal mucosal biopsy to characterize the type and severity of the inflammatory infiltrate, and to differentiate IBD from other disorders, including alimentary lymphoma. Controversy exists concerning the relative diagnostic accuracy of endoscopic versus full-thickness specimens for the diagnosis of IBD and its differentiation from alimentary lymphoma. AUDIENCE: This article is intended to provide veterinary practitioners with a comprehensive clinical update on idiopathic IBD in cats. It reviews the current evidence-based data, the diagnostic approach, the evolving histologic criteria, and treatment options and outcome for feline patients with this syndrome.     

Computed tomographic findings of the gastrointestinal tract in rabbits

BackgroundGastrointestinal (GI) diseases are common in rabbits. Although diagnostic imaging studies can assist clinicians in selecting therapeutic approaches, there are few reports of advanced imaging findings in normal rabbits. Computed tomography (CT) is recognized as a useful tool in dogs and cats, but there are few reports of normal findings on multidetector computed tomography (MDTC) in rabbits. The goals of this study are to describe the CT anatomic imaging appearance of the GI tract and their normal variation in healthy pet rabbits and to obtain the normal wall thickness measurements of normal GI tract structures.MethodsTwenty-three rabbits were scanned under general anesthesia and the CT abdominal images were analyzed by two experienced radiologists. Location and size of the major GI organs and structures were determined, and wall thickness of the stomach, small and large intestines were measured, including the interobserver agreement. Statistical analysis of quantitative and qualitative variables was performed.ResultsWall thickness values were established for the different parts of the stomach (cardia: 3.4 ± 0.4mm; fundus: 1.4 ± 0.2mm; body: 1.4 ± 0.1mm; pylorus: 2.9 ± 0.5mm), small intestines (duodenum: 1.4 ± 0.1mm; jejunum: 1.2 ± 0.1mm; ileum: 1.4 ± 0.1mm), and large intestines (cecum: 1.2 ± 0.1mm; colon ascending: 1.4 ± 0.3 mm and descending: 1.3 ± 0.3mm). When distended the stomach did not extend beyond the caudal limits of the L2 vertebra. The cecum occupied the ventral abdominal region from T12/T13 to L7/S1, the sacculus rotundus was identified in 11 of the 23 rabbits. The sacculus rotundus and vermiform cecal appendix were identified only in rabbits with mild large intestinal distension.Conclusions and clinical relevanceIt was possible to use CT to evaluate the different portions of the GI tract that are not normally readily visible on radiographs and ultrasound (US). Normal wall thickness values of the different portion of the GI tract were stablished. These results provide new and important reference values for CT studies in normal pet rabbits and provide data for further studies in rabbits with GI diseases.     

Intestinal permeability testing in dogs with diet-responsive intestinal disease

Fifteen dogs with signs of small and, or, large bowel disease that responded clinically to an exclusion diet were studied, using differential sugar absorption as an objective parameter of the mucosal response to the diet. Intestinal permeability and function were assessed by determining the urinary excretion ratios of lactulose/rhamnose and xylose/3-O-methylglucose, respectively, following oral administration of a mixture of these four sugars. Five dogs, all retrievers, were tentatively diagnosed as having dietary hypersensitivity, based upon resolution of clinical signs and normalisation of high intestinal permeability following an exclusion diet and recurrence of signs (in four of five dogs) upon challenge with the original diet. The fifth dog did not become symptomatic when challenged, but intestinal permeability increased. The remaining 10 dogs were diagnosed as having food intolerance, based upon clinical improvement on an exclusion diet, relapse on challenge with their original diet, but lack of improvement in intestinal permeability. These findings suggest that a differential sugar absorption test may be useful to determine the reasons for clinical response to exclusion diets. Demonstration of increased intestinal permeability with subsequent normalization following an exclusion diet may be useful in the diagnosis of dietary hypersensitivity, while persistent abnormalities in intestinal permeability are suggestive of underlying intestinal disease and food intolerance.     

马肠道微生物组成及影响因素的研究进展

马肠道微生物群对其营养消化及维持机体健康具有重要作用,肠道不同部位的微生物具有不同功能,易受到各种因素的影响。马肠道正常微生物群结构遭到破坏,可导致肠道微生物失衡和机体功能紊乱,进而引起多种疾病。介绍了马肠道不同部位的微生物群结构组成特征,阐述了影响马肠道微生物群变化的各类因素,以期为改善马肠道营养健康、开发马健康监测和疾病预防工具提供科学依据,也为马肠道微生物研究提供新的视角。     

日粮纤维与猪肠道健康的相关性研究与应用

在生猪产能恢复中,需要特别关注猪只肠道健康问题。很多营养素与猪的肠道健康密切相关,其中日粮纤维就是影响猪只肠道健康的重要营养素之一。日粮纤维在调节猪肠道微生态环境方面表现出异常活跃的营养学功能。日粮中适宜的纤维水平可改善猪肠道微生物种群多样性,调节菌群结构组成,维持猪肠道微生态平衡,提高饲料转化率,具有促进猪只的生长发育以及预防疾病的功效。文章综述了日粮纤维的构成及营养学功能、对猪肠道的主要作用机制以及对猪肠道微生态环境的影响研究,旨在为进一步探究日粮纤维在猪生产实践中的研究应用提供理论借鉴。     

Expression of the Bcl-2 apoptotic marker in cats diagnosed with inflammatory bowel disease and gastrointestinal lymphoma

Immunolabeling for the critical lymphocyte survival factor, Bcl-2, of intestinal biopsies from cats with histologic evidence of inflammatory bowel disease (IBD) or gastrointestinal (GI) lymphoma was evaluated to determine if expression differed significantly between these two disease processes. Immunolabeling for Bcl-2 was performed on small intestinal endoscopic or full thickness biopsy sections from 55 cats. Diagnosis of IBD, T-cell lymphoma or B-cell lymphoma was established previously. The percentage of infiltrating lymphocytes that were positively labeled for Bcl-2 was subjectively determined for each case. Eight cats were diagnosed with IBD and 47 cats with lymphoma. A significantly higher percentage of cells were positively immunolabeled for Bcl-2 in cats with GI lymphoma [median (range); 90 (5-95)%] compared with cats with IBD [60 (15-95)%] (P = 0.029). However, the overall degree of positive immunolabeling in both groups tended to be high. This over-expression of Bcl-2 may prove useful as a therapeutic target for IBD and GI lymphoma in cats.     

不同纤维源日粮对猪肠道菌群影响的研究进展

猪只日粮中添加纤维会在一定程度上降低营养物质的吸收效率,但是饲粮纤维可在猪只肠道后端进行一定程度的发酵,并产生大量的挥发性脂肪酸,具备了一定的营养作用。同时,也因此而降低猪只肠道pH,影响肠道菌群丰度及菌群结构。通过改变纤维日粮的组成来影响肠道中的菌群,发挥肠道上皮屏障功能,并且通过调节肠道微生物的组成来维持肠道微生物生态的稳定,是猪只肠道健康的关键控制点。肠道菌群与宿主相互协同,构成了肠道微生态系统,能够促进猪只对营养物质吸收利用。文章综述了不同纤维源日粮对猪只肠道菌群的影响,为养猪生产实践中应用不同纤维源提供一定理论依据。     

Diagnosis and management of malabsorption in dogs

Malabsorption can result from interference with either the degradation or absorption phases in the handling of dietary constituents and represents an important cause of weight loss and diarrhoea in dogs. Effective treatment depends on identification and understanding of the underlying disease which could affect the functional capacity of the exocrine pancreas or small intestine. Exocrine pancreatic insufficiency (EPI) can be identified by a low concentration of trypsin-like immunoreactivity in serum and results in serious malabsorption due to interference with degradation of carbohydrate, protein and fat. Treatment with oral pancreatic extract complemented by a low fat, high quality protein diet, is effective in many cases. Refractory cases may need additional treatment with an oral antibiotic for small intestinal bacterial overgrowth (SIBO), and H₂-receptor blockers to help prevent denaturation of the pancreatic extract by stomach acid. The pancreas plays a key role in the normal absorption of cobalamin (vitamin B₁₂) in dogs and malabsorption of cobalamin in EPI may not resolve with treatment so that cobalamin may need to be given parenterally. Small intestinal disease may result in interference with the number or functioning of individual enterocytes, in some cases accompanied by cellular infiltration of the mucosa. Diagnosis depends on indirect assessment of intestinal damage, for example by assay of serum vitamins and determination of intestinal absorption and permeability, and in selected cases followed by endoscopic examination, intestinal biopsy and culture of duodenal juice. Treatment depends on the disease and may include oral antibiotic for SIBO and immunosuppressive drugs for infiltrative disease. Dietary management is also important, for example with a restricted fat diet containing highly digestible carbohydrate and high quality protein, and when a dietary sensitivity is suspected a restriction diet of a selected protein source may be needed.     

Food and water intake and selective feeding in rabbits on four feeding regimes

Diet plays an important role in maintaining rabbit health. Feeding an incorrect diet, particularly a low fibre diet, has been linked with digestive, dental and urinary tract disease. However, food intake and dietary requirements have been poorly studied in pet rabbits. This study assessed the effects of two commonly fed pet rabbit diets [extruded nuggets with hay (EH) and muesli with hay (MH)] alongside hay only (HO) and muesli only (MO) on food and water intake in 32 Dutch rabbits. Dry matter (DM) intake was greater in the HO group and lower in the MO group than in the EH and MH groups (p < 0.001). The portion of the diet made of hay was greater in the EH group than in the MH group (p < 0.001). Water intake was positively correlated with DM intake and was greatest in the HO group (p < 0.001). Selective feeding occurred in all rabbit groups fed muesli, whether or not hay was also available. Pellets were rejected, and grains and extrudates selected. The presence of selective feeding in all rabbits fed muesli leads to the consumption of an unbalanced diet. In addition, hay intake and water intake were lower when muesli was fed. Conclusions drawn from this study are based on general recommendations for pet rabbits, and clinical disease may have developed by feeding the study diets over a longer time period, as many diet‐related conditions typically present in older rabbits. However, the study demonstrates that the feeding of muesli diets cannot be recommended.     

Management of anorexia in the cat.

One of the most frequent motivations for seeking veterinary attention for a cat is when the owner recognises a loss of normal appetite in his pet. The medical term for a lack of appetite for food is 'anorexia', and it may be partial or complete. While anorexia is a common manifestation of disease, the mechanisms underlying decreased food intake are complex and not completely understood. The regulation of appetite involves interaction of external stimuli with signals from the gastrointestinal tract and central nervous system. Aberrations in any of the internal control systems for hunger and satiety, or changes in external factors such as diet or feeding environment, can result in partial or total anorexia. The challenge for the practitioner is not only to diagnose and treat the underlying condition, but to recognise at what point inadequate food intake has or will impinge on the patient's nutritional status to the extent that it might deleteriously affect clinical outcome. It is also important to bear in mind the significance that the patient's appetite and food intake has for the cat owner in his overall perception of his pet's condition and quality of life.     

Phosphorus excretion by mares post-lactation

Across the equine literature, estimates of true P digestibility range from −23% to 79%. This large range cannot be explained by differences in P intake or phytate-P intake alone. However, differences in endogenous P secretion into the GI tract may explain the variation. In horses, excess absorbed P is not excreted in the urine but is re-secreted into the GI tract, increasing faecal P and leading to estimates of low P digestibility. Thus, accurate estimates of P digestibility can only be obtained if absorbed P is retained in the horse. The objective of this study was to examine P digestibility in post-lactational mares and control mares that were fed similar amounts of P. It was hypothesized that post-lactational mares would have greater P retention and higher apparent P digestibility than control mares. Prior to the study, four lactating and four non-lactating mares were fed a diet that provided 100% of the control mares’ P requirement, but only 55% of the lactating mares’ P requirement. During the study, both groups were fed P at the rate recommended for non-lactating mares. Post-lactational mares did not retain more P than control mares but tended to excrete more P than control mares (p = .082), presumably due to differences in endogenous P secretion into the GI tract. Metabolic changes occurring during mammary gland involution may have contributed to the increase in P excretion. However, faecal P excretion exceeded P intake in both groups (p = .08) and both groups lost weight during the study. Tissue mobilization during weight loss may have influenced P secretion into the GI tract.     

GASTROINTESTINAL NUCLEAR MEDICINE

Nuclear medicine has achieved an important role in the diagnosis of gastrointestinal (GI) disease in humans. Esophageal and gastric motility problems, gastroesophageal reflux, abnormal gastric secretory function, GI bleeding, and inflammatory diseases of the GI tract can all be evaluated using nuclear scintigraphy. The use of these techniques in human medicine, their advantages and disadvantages relative to other available diagnostic tests, and their potential application to veterinary medicine are discussed. Examples of esophageal and gastric motility studies performed on normal and abnormal dogs are included.     

Gastrointestinal ultrasonography of the dog: a review of 265 cases (1996-1998)

The findings of ultrasonography of the gastrointestinal (GI) tract of 265 dogs with GI disorders were analysed retrospectively. The sonographic changes associated with various inflammatory and neoplastic conditions and mechanical obstruction of the GI system were recorded and discussed. Sonographic alterations of the pancreas and the tissues adjacent to the GI tract were also included in the study. Ultrasonographic alterations of the GI tract were classified into three main categories: thickening of the GI wall, changes in peristalsis and dilation of the lumen. Localised thickening of the GI wall with disruption of its structure was caused by both neoplastic diseases and by inflammatory disorders. However, diffuse thickening with retained wall structure was generally associated with inflammatory diseases. The criteria previously established for the ultrasonographic diagnosis of intestinal obstruction were successfully applied to a large number of GI disorders. Pancreatitis was most often associted with hyperchoic mesentery and hypoechoic pancreas mass, but similar alterations were encountered in some cases of gastric or duodenal ulceration. Except in cases of invaginations and intestinal obstructions, the observed ultrasonographic changes were not specific enough for a definitive diagnosis. Nevertheless, ultrasonography proved to be a valuable technique in the diagnostic process of GI disorders of the dog.