Gastrointestinal Disease in Exotic Small Mammals

Exotic small mammal medicine is a relatively new specialty area within veterinary medicine. Ferrets, rabbits, and rodents have long been used as animal models in human medical research investigations, resulting in a body of basic anatomic and physiologic information that can be used by veterinarians treating these species. Unfortunately, there is a paucity of veterinary articles that describe clinical presentation, diagnosis, and treatment options of gastrointestinal (GI) disease as it affects exotic small mammals. Although there is little reference material relating to exotic small mammal GI disease, patients are commonly presented to veterinary hospitals with digestive tract disorders. This article provides the latest information available for GI disease in ferrets (Helicobacter mustelae gastritis, inflammatory bowel disease [IBD], GI lymphoma, systemic coronavirus, coccidiosis, and liver disease), rabbits (GI motility disorders, liver lobe torsion, astrovirus, and coccidiosis), guinea pigs (gastric dilatation volvulus [GDV]), rats (Taenia taeniaeformis), and hamsters (Clostridium difficile). Both noninfectious diseases and emerging infectious diseases are reviewed as well as the most up-to-date diagnostics and treatment options.     

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.     

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.     

ULTRASONOGRAPHIC EVALUATION OF GASTROINTESTINAL DISEASES IN SMALL ANIMALS

Sonographic findings of 18 dogs and four cats with gastrointestinal (GI) diseases were reviewed. Wall thickness, wall layer identification, wall symmetry, extension of the lesion, nature of the GI contents, motility, and regional and/or systemic involvement were recorded for each animal. Ultrasonographic appearance of gastrointestinal neoplasms, gastrointestinal obstruction, ileus, intussusception, inflammatory GI diseases, and congenital disorders are discussed.     

Effects of pharmacological agents on gastrointestinal motility

The control mechanisms of gastrointestinal motility are complex. Extrinsic neurohormonal effects modulate an intrinsic system, often called the "gut brain," composed of nervous and neuropeptide components. To exert pharmacologic influence on GI motility, use is made of agents that mimic the external control system. Agents that stimulate opioid receptors, block adrenoceptors, block or facilitate acetylcholine action, or antagonize the action of prostaglandins are used to effect changes in GI motility. The major indications for pharmacologic intervention are to increase motility in constipation, to reduce it in most cases of diarrhea, and to restore propulsive coordination in postoperative ileus. In cases of clinical colic the primary requirement is control of pain. Agents used for this purpose may adversely affect motility, and choice requires knowledge of their actions in this respect. In addition, drugs used for other purposes, anthelmintics for instance, may also influence gut motility. A synopsis of the actions of the agents commonly employed in GI motility control and some associated drugs are displayed in Table 3. Recent advances in the understanding of drug action on the gut should help in the selection of drugs for clinical use.     

Modifiers of gastrointestinal motility of cattle.

Little clinically relevant, evidence-based data about the effect of motility modifiers on the GI tract of cattle are currently available. Additionally, some of the published results seem to be contradictory. Three main facts explain this apparent discrepancy: (1) Results may not be transferred from one species to another, because presence, concentration, location, distribution, and function of specific receptors may differ significantly among species. (2) The lack of a significant effect on smooth muscle preparations in vitro does not necessarily exclude a certain drug's motility-modifying property on affected animals in vivo. Certain drugs bind to receptors outside the myenteric plexus. Others, such as lidocaine and adrenergic-, dopaminergic-, and opioid-antagonists increase only GI motility, if inhibitory reflexes or a hyperactive state of the inhibitory sympathetic nervous system preexists. (3) Effects of motility modifiers as found in healthy experimental animals in vivo may not be similar to those found in spontaneously diseased animals. Accurate and reliable data on the effect of modifiers of GI motility of cattle will be obtained only from double-blinded, evidence-based, in vivo studies on spontaneously affected animals. Because well-documented results from such studies are extremely rare, intensive research in this field is warranted in the future.     

ULTRASONOGRAPHIC FINDINGS IN DOGS AND CATS WITH GASTROINTESTINAL PERFORATION

A retrospective study was performed to evaluate the sonographic features of gastrointestinal (GI) perforation in dogs and cats. Sonographic findings in 19 animals (14 dogs and 5 cats) included regional bright mesenteric fat (19), peritoneal effusion (16), fluid-filled stomach or intestines (12), GI wall thickening (11), presence of free air (9), loss of GI wall layering (9), regional lymphadenopathy (8), reduced GI motility (7), pancreatic changes (4), corrugated intestines (4), presence of a mass (3), presence of a foreign body (3), and mineralization of the gastric wall (1). In 14 patients, "perforation" was listed as a differential diagnosis by the sonographer. Abdominal radiographs and radiographic reports were available for 14 patients. Radiographic findings were decreased serosal detail (12), free air (8), peritoneal contrast medium (1), and suspected foreign body (1). GI perforation was listed as radiographic diagnosis in eight patients, seven of which had evidence of pneumoperitoneum, and one had leakage of contrast material on an upper GI study. In 9/14 patients with radiography, "GI perforation" was listed as a sonographic diagnosis. In three patients in which free air was diagnosed sonographically, radiographs were either not available (2) or the presence of free air was not detected at presentation (1). Peritoneal fluid analysis was performed in nine patients, five of which were identified as septic inflammation, and the remaining four were classified as neutrophilic inflammation with no etiologic agent identified. The histologic or surgical diagnoses were as follows: three intestinal surgical dehiscence; one percutaneous endoscopic gastrostomy tube site leakage; one duodenal adenocarcinoma; one ileocolic lymphoma; one trichobezoar; one ascarid impaction; and one bobby pin foreign body. In the remaining 10 patients, a focal area of gastric/intestinal ulceration or transmural necrosis with perforation was identified without evidence of an underlying cause.     

Self‐Reported Acute Health Effects and Exposure to Companion Animals

To understand the etiological burden of disease associated with acute health symptoms [e.g. gastrointestinal (GI), respiratory, dermatological], it is important to understand how common exposures influence these symptoms. Exposures to familiar and unfamiliar animals can result in a variety of health symptoms related to infection, irritation and allergy; however, few studies have examined this association in a large‐scale cohort setting. Cross‐sectional data collected from 50 507 participants in the United States enrolled from 2003 to 2009 were used to examine associations between animal contact and acute health symptoms during a 10–12 day period. Fixed‐effects multivariable logistic regression estimated adjusted odds ratios (AORs) and 95% confident intervals (CI) for associations between animal exposures and outcomes of GI illness, respiratory illness and skin/eye symptoms. Two‐thirds of the study population (63.2%) reported direct contact with animals, of which 7.7% had contact with at least one unfamiliar animal. Participants exposed to unfamiliar animals had significantly higher odds of self‐reporting all three acute health symptoms, when compared to non‐animal‐exposed participants (GI: AOR = 1.4, CI = 1.2–1.7; respiratory: AOR = 1.5, CI = 1.2–1.8; and skin/eye: AOR = 1.9, CI = 1.6–2.3), as well as when compared to participants who only had contact with familiar animals. Specific contact with dogs, cats or pet birds was also significantly associated with at least one acute health symptom; AORs ranged from 1.1 to 1.5, when compared to participants not exposed to each animal. These results indicate that contact with animals, especially unfamiliar animals, was significantly associated with GI, respiratory and skin/eye symptoms. Such associations could be attributable to zoonotic infections and allergic reactions. Etiological models for acute health symptoms should consider contact with companion animals, particularly exposure to unfamiliar animals. Prevention of pet‐associated zoonotic diseases includes commonsense measures such as hand‐washing, but are often overlooked by pet owners and non‐pet owners alike.     

Time to include the gut microbiota in the hygienic standardisation of laboratory rodents

The gut microbiota (GM) composition and its impact on animal experiments has become currently dramatically relevant in our days: (1) recent progress in metagenomic technologies, (2) the availability of large scale quantitative analyses to characterize even subtle phenotypes, (3) the limited diversity of laboratory rodent GM due to strict barriers at laboratory animal vendors, and (4) the availability of up to 300.000 different transgenic mouse strains from different sources displaying a huge variety in their GM composition. In this review the GM is described as a variable in animal experiments which need to be reduced for scientific as well as ethical reasons, and strategies how to implement this in routine diagnostic procedures are proposed. We conclude that we have both enough information available to state that the GM has an essential impact on animal models, as well as the methods available to start dealing with these impacts.     

Analgesic and gastrointestinal effects of epidural morphine in horses after laparoscopic cryptorchidectomy under general anesthesia

ObjectiveTo evaluate the hypothesis that epidural morphine (0.1 mg kg^?1) decreases pain in horses after laparoscopic surgery without adversely affecting gastrointestinal (GI) motility.Study designRandomized clinical trial.AnimalsEighteen horses undergoing laparoscopic cryptorchidectomy under general anesthesia.MethodsHorses were randomly assigned to receive either epidural morphine (0.1 mg kg^?1) or no epidural before the start of surgery. Pain behaviors were assessed during the first two post-operative days using a numerical rating scale. Barium-filled spheres were administered through a nasogastric tube before anesthesia. GI motility was assessed by recording manure production, by quantitating the spheres in the manure, and by abdominal auscultation of intestinal sounds. Heart rates and cortisol concentrations were also measured during the post-operative period.ResultsPain scores increased for 12 hours after surgery in the control group and were significantly higher than in the morphine group for the first 6 hours. Pain scores remained unaltered in the morphine group throughout the observation period. Heart rate and plasma cortisol concentrations did not differ between groups or with time. No signs of colic were observed in any horse.Conclusion and clinical relevanceEpidural morphine (0.1 mg kg^?1) did not adversely affect GI motility in horses after laparoscopic surgery under general anesthesia.     

Free amino acids in plasma of neonatal calves are influenced by feeding colostrum for different durations or by feeding only milk replacer1

Introduction Newborn development is characterized by high protein synthesis and nitrogen (N) turnover rates in many tissues, especially in the gastrointestinal (GI) tract (G oldspink and K elly 1984; Y oung et al. 1988; S immen et al. 1990; X u 1996). Colostrum provides particularly large amounts of nutrients (especially proteins) and immunoglobulins as well as non-nutrient growth-promoting factors; it therefore plays a major role in the development of the neonatal gut, especially protein synthesis, and other organs, as shown in several species including cattle (B erseth et al. 1983; P atureau M irand et al. 1990; C ampana and B aumrucker 1995; O dle et al. 1996; X u 1996; B urrin et al. 1997). Rates of body protein synthesis and N turnover were greater during enteral than during parenteral feeding, indicating considerable involvement of the GI tract in protein metabolism (D uffy and P encharz 1986). Protein components in colostrum provided about 35% of amino acids (AA) in newborn lambs, suggesting that amounts of ingested protein with colostrum greatly influence the AA status of the neonate (Y von et al. 1993). Glutamine and glutamate are the most abundant AA in bovine milk protein (M eijer et al. 1993) and glutamine is of special interest for postnatal gut development (S ouba 1991; K imura 1996; H eird 1998). The glutamine:glutamate ratio was markedly changed in neonatal calves (D emign & eacute ; and R& eacute ; m & eacute ; sy 1979) after colostrum intake. Recently, we have demonstrated that gut growth and absorptive capacity of the intestine, as well as metabolic and endocrine changes in newborn calves, are greatly dependent on amounts of ingested colostrum (H ammon and B lum 1997, 1998; B& uuml ; hler et al. 1998). Based on that AA absorption, metabolism and status may be influenced by amounts of fed colostrum. Therefore in this study we have tested the hypothesis that feeding colostrum for different durations, or feeding only milk replacer, affects plasma protein and free AA concentrations during the first week of life in calves.     

ENDOSCOPIC ULTRASOUND INSTRUMENTATION, APPLICATIONS IN HUMANS, AND POTENTIAL VETERINARY APPLICATIONS

Endoluminal scanning under endoscopic guidance, or endoscopic ultrasonography (EUS), has become the most significant advance for imaging the gastrointestinal (GI) tract wall and contiguous organs in the past 20 years. It was originally designed to overcome the limitations in humans to imaging the abdominal organs transabdominally, such as large penetration depths and GI air. This imaging modality provides detailed images of pathological processes both within and outside of the GI wall since a high-frequency transducer can be brought into close proximity with the target regions. It has found most success in humans for the staging of lung, gastric, and esophageal cancer, the detection of both lymphatic and hepatic metastases, and diagnosis of pancreatitis and pancreatic cancer, as well as achieving an important role in interventional and therapeutic procedures. The EUS examination can be performed to examine both the thorax and abdomen in animals when both conventional transthoracic or transabdominal ultrasound are inadequate due to intervening air, bone, large penetration depths, or obesity. The echoendoscope is similar to a conventional endoscope but has an ultrasound transducer at its tip. Both radial and linear multifrequency scanners are available. Linear scanners allow fine-needle aspiration (FNA) of the bowel wall or extraluminal structures. Transducer coupling is either by direct mucosal contact or by inflation of a water-filled balloon surrounding the transducer. Current thoracic applications for EUS in veterinary medicine include examination of the mediastinum, bronchial lymph nodes, esophagus, and pulmonary lesions as well as FNA of pulmonary masses. Abdominal applications include examination of both pancreatic limbs and the liver, including portosystemic shunts, detection of lymphadenomegaly, and examination of the gastric wall, duodenum, and jejunum. Other potential applications in dogs and cats include tumor staging and intrapelvic ultrasound.     

The use of chemotherapy in exotic animals.

Although there is little published data on successful treatment of neoplasia with chemotherapy drugs in exotic animal species, there has not been adequate research done, or even large case series on how these drugs should be dosed and which drugs are most appropriate to use for which tumor types. As people demand better treatment for their pets, hopefully more information will become available, and the reader is advised to keep track of the literature for new information as it becomes available.     

Modification of cardiopulmonary and intestinal motility effects of xylazine with glycopyrrolate in horses.

Xylazine (XYL) administration in horses is accompanied by significant cardiovascular depression characterized by a 25-35% decrease in cardiac output (CO) which is likely to compromise tissue oxygen delivery (DO2), and usually vagally mediated bradycardia is an important cause of this reduced cardiovascular performance. To examine the possible benefit of preventing the bradycardiac response, 6 healthy horses were treated with intravenous (IV) saline (SAL) or 2.5 micrograms/kg glycopyrrolate (GLY) in a blinded, randomized, crossover trial. Fifteen minutes later, 1 mg/kg XYL was administered IV and systolic, diastolic and mean blood pressures (SBP, DBP, and MBP, respectively), central venous pressure (CVP), mean pulmonary artery pressure, heart rate (HR), CO, and arterial and mixed venous blood gases were measured at the following times: baseline, 2, 5, and 10 min post-SAL or GLY; and 2, 5, 10, 15, 30, 45 and 60 min post-XYL. Determination of cardiac index (CI), stroke index (SI), left ventricular work, systemic vascular resistance (SVR), DO2, oxygen uptake, and oxygen extraction ratio were made at the same time. Gastrointestinal (GI) motility was evaluated by four-quadrant auscultation for 24 h post-XYL. Statistical analysis of continuous variables was carried out using ANOVA for repeated measures and Wilcoxon's rank-sum test for non-parametric data. In GLY treated horses, HR, SBP, MBP, DBP, CI, DO2 and mixed venous oxygen tension were significantly higher up to 30 min after XYL (P < or = 0.02) while CVP and SI were significantly lower 2 and 5 min post-XYL, respectively. In both groups, GI motility as assessed by auscultation was virtually abolished for an hour, with a non-significant tendency for the decrease in motility to last longer in the GLY/XYL group. None of the treated horses developed abdominal discomfort. No significant difference was observed in the other variables. The study shows that 2.5 micrograms/kg GLY premedication reduces the cardiovascular depression caused by 1 mg/kg XYL, without adversely affecting GI motility.     

Involvement of neuronal nitric oxide synthase (nNOS) in the regulation of migrating motor complex (MMC) in sheep

The objectives of this study were to evaluate the role of nitric oxide (NO) synthase isoforms (nNOS, eNOS, and iNOS) in the regulation of the migrating motor complex (MMC) in sheep using electromyography and their expression in the gastrointestinal (GI) tract by Western blot (WB) and immunohistochemistry. Intravenous administration of L-NAME or the nNOS inhibitor 7-nitroindazole (7-NI) decreased the MMC interval. Myoelectric activity of intestinal phase II was increased, whereas antral activity was reduced. These effects were blocked by L-arginine. Inhibitors of either iNOS (aminoguanidine and S-methylisothiourea) or eNOS (L-NIO) were ineffective. The NO donor sodium nitroprusside decreased GI myoelectric activity, inhibited the MMC pattern, and prevented the effects induced by L-NAME and 7-NI in the intestine. Intracerebroventricular administration of these agents did not modify GI motility. In the rumen, abomasal antrum, duodenum, and jejunum, WB showed three bands at about 155, 145, and 135kDa corresponding to nNOS, and a 140-kDa band (eNOS); however iNOS was not detected. Positive nNOS immunostaining was observed in neurons of the myenteric and submucous plexus of all GI tissues, while eNOS was found in the endothelial cells, ruminal and intestinal epithelium, as well as in some enteric neurons and in endocrine-like cells of the duodenal Brunner's glands. In contrast, only weak iNOS immunoreactivity was found in ruminal epithelium. Taken together, our results suggest that NO, synthesized at a peripheral level by nNOS, is tonically inhibiting the MMC pattern and intestinal motility in sheep.     

ULTRASONOGRAPHIC DIAGNOSIS OF GASTROINTESTINAL SMOOTH MUSCLE TUMORS IN THE DOG

Historical, physical examination, clinicopathologic, radiographic and ultrasonographic findings of 13 dogs with gastrointestinal (GI) smooth muscle tumors (11 leiomyosarcomas, 2 leiomyomas) were reviewed. History, including signalment and chief complaint, physical examination and bloodwork were neither sensitive nor specific for GI neoplasia. Imaging procedures, radiology and ultrasonography, detected the presence of abdominal masses in 12 patients, including 9 animals lacking a palpable mass on initial examination. Survey radiographs of 10 of the 13 dogs revealed a mass effect in 5/10 dogs, evidence of peritoneal effusion or free abdominal gas in 3/10 dogs, and an obstructive pattern with gas and fluid distension of the intestinal tract in 1/10 dogs. Ultrasonography identified an abdominal mass in 12/13 dogs, and peritoneal effusion in 5 animals. Ultrasonography correctly recognized an association of the mass with bowel segments by the presence of intraluminal gas, within or adjacent to the mass effect, in 10 dogs, and strongly suggested an intestinal origin in one additional animal. GI smooth muscle tumors often appeared as large masses, eccentrically projecting from the bowel wall, frequently containing single or multiple hypo/anechoic regions. Based on this study we conclude that ultrasonography is more sensitive than survey radiography in the detection of GI smooth muscle tumors, and may present specific features to distinguish smooth muscle tumors from other types of GI tumors. Ultrasonography is recommended as a screening procedure for cases where GI neoplasia is suspected.     

GI PiCO2: Tissue Specific Monitoring For Improving Patient Outcomes

Improvements in human patient monitoring despite their development in animals, do not always find their way into veterinary clinical use due to financial constraints. Gastrointestinal intraluminal CO₂ partial pressure (Gip₁CO₂) monitoring, however, is not only proving very beneficial in human trauma and critical patient care but is also very likely to become relatively inexpensive. By providing information on the perfusion adequacy of a high risk, critically important tissue, the GI mucosa, GI P₁CO₂ monitoring offers an easily accesible indicator of the efficacy and adequacy of resuscitative interventions. The potential for decreasing morbidity and mortality is enormous. Therefore, the practicing veterinarian should become familiar with GI P₁CO₂ monitoring theory and technology so he or she can be better prepared to incorporate it into practice when in becomes available.     

Nutritional management of gastrointestinal disease

The gastrointestinal (GI) tract is primarily responsible for acquiring and digesting food, absorbing nutrients and water, and expelling wastes from the body as feces. A proper diet and normally functioning GI tract are integral for the delivery of nutrients, prevention of nutrient deficiencies and malnutrition, repair of damaged intestinal epithelium, restoration of normal luminal bacterial populations, promotion of normal GI motility, and maintenance of normal immune functions (eg, both tolerance and protection from pathogens). The amount of food, its form, the frequency of feeding, and the composition of diet each have important effects on GI function and may be used to help ameliorate signs of GI disease. Although both nutrients and nonnutritional components of a diet are important to GI health, they also may cause or influence the development of GI pathology (eg, antibiotic responsive diarrhea, inflammatory bowel disease, dietary intolerance, or sensitivity and/or allergy). The appropriate diet may have a profound effect on intestinal recovery and successful management of chronic or severe GI disease.     

Effects of epidural morphine on gastrointestinal transit in unmedicated horses

ObjectiveTo evaluate the effect of epidural morphine on gastrointestinal (GI) motility in horses.Study designRandomly ordered crossover design.AnimalsSix healthy adult horses weighing 585 ± 48 kg (mean ± SD).MethodsHorses were randomly assigned to receive either 0.2 mg kg^?1 morphine or an equal volume (0.04 mL kg^?1) of saline epidurally (the first inter coccygeal space) with 2 weeks between treatments. The horses were stabled, fed a standardized diet and allowed water ad libitum throughout the duration of the study. Radiopaque spheres were administered by stomach tube. Xylazine 0.2 mg kg^?1 intravenously was administered prior to epidural injection. Heart rate, respiratory rate, GI sounds score and behavior score were recorded before drug administration and after epidural injection at 4, 8, 12, 18, 24 hours and every 12 hours thereafter for 6 days. Feces were weighed, radiographed and the number of spheres counted. Data were analyzed using a mixed effect model.ResultsAt no time did horses exhibit signs of colic or show significant differences between treatments regarding heart rate, respiratory rate, GI sounds score, behavior score, or cumulative number of spheres. The concentration of spheres per kg of feces was significantly lower (p < 0.05) for the morphine group at 18 and 24 hours. Using the centroid of the curves (spheres kg^?1 plotted versus time) the average transit time after saline epidural was 38 hours and after morphine it was 43 hours. The weight of feces hour^?1 was significantly lower (p < 0.05) at only 4 and 8 hours after morphine.Conclusions and clinical relevanceEpidural morphine, at a dose of 0.2 mg kg^?1, temporarily reduced GI motility but did not cause ileus or colic in this small group of healthy unfasted horses. Care should be taken when extrapolating these data to situations in which other factors may also affect GI motility.     

IMPROVING CONSPICUITY OF THE CANINE GASTROINTESTINAL WALL USING DUAL PHASE CONTRAST‐ENHANCED COMPUTED TOMOGRAPHY: A RETROSPECTIVE CROSS‐SECTIONAL STUDY

Gastrointestinal (GI) disease is a common clinical complaint in small animal patients; computed tomography (CT) examinations enable a global overview of the GI tract and associated structures. Previously, the GI wall has been reportedly identified from serosa to mucosa in 77% of standard postcontrast CT studies and wall layers seen in ultrasound have not been distinguished. Inconsistent strong contrast enhancement of the inner layer of the GI mucosal surface was noted on dual phase CT studies acquired in our institution, which increased the visibility of the GI tract and disease processes. The aim of this retrospective, observational, cross‐sectional study was to determine the optimal portal vein attenuation for maximizing GI wall conspicuity using dual phase contrast‐enhanced CT. Patients with abdominal CT for a non‐GI related disease were included. In a pilot study, 175 GI segments from 35 CT studies were graded for presence of mucosal surface enhancement (MSE). The strongest mucosal surface enhancement grade correlated with portal vein attenuation of 43–150 HU; this value was used as inclusion criterion in the main study. A total of 441 GI segments were evaluated in 42 CT studies postcontrast for GI wall conspicuity. The GI wall was conspicuous in 56.7% precontrast, 84.5% at 30s, and 77.3% late postcontrast; 4.7% of segments were removed due to motion blur. At 30 s distinct mucosal surface enhancement was seen in the small intestine and gastric mucosal surface enhancement was poor. Findings supported the use of dual phase contrast‐enhanced CT for improving conspicuity of the GI wall.