Medical management of inflammatory bowel disease in a spider monkey.

Inflammatory bowel disease was diagnosed in a 3-year-old, captive-born, hand-raised, female spider monkey (Ateles geoffroyi). The diagnosis was based on clinical signs, positive-contrast radiographic series, endoscopy, histologic appearance of intestinal biopsy specimens, and the monkey's response to treatment. Treatment consisted of oral administration of prednisone, sulfasalazine, and trimethoprim-sulfamethoxazole. Supportive care included a bland diet and an electrolyte solution given free choice. Although several infective agents were considered, this case illustrates that recurrent enteritis in primates may be noninfectious and may respond to anti-inflammatory agents.     

Feline inflammatory bowel disease: a review

Inflammatory bowel disease (IBD), while a popular diagnosis, may not occur as commonly as it is diagnosed. It is a diagnosis of exclusion, meaning that it is important to eliminate diseases that mimick it. Dietary intolerance or allergy in particular, can have the same clinical and histologic appearance as IBD. Likewise, well-differentiated alimentary lymphosarcoma can also be confused with it. Intestinal biopsies are useful, but must be taken carefully and then evaluated by someone with interest and expertise in alimentary tract pathology. Therefore, it behoves the clinician to carefully consider the diagnosis instead of starting multiple drug therapy in a cavalier fashion. Well constructed dietary therapy can often be beneficial for both dietary problems and IBD.     

Clinical assessment of disease activity for canine inflammatory bowel disease

Clinical indices, consisting of gastrointestinal signs and laboratory parameters, are widely used for assessing disease activity in human inflammatory bowel disease (IBD). The development of a standardized scoring index for use in dogs with IBD would be useful in the management of clinical cases, both at diagnosis and in response to medical therapy. This review provides a synopsis of current strategies used to assess IBD activity in humans and companion animals. The clinical application of a simple scoring index (e.g., canine IBD activity index [CIBDAI]) for measurement of canine IBD activity is also reviewed.     

A scoring index for disease activity in canine inflammatory bowel disease

The clinical course of inflammatory bowel disease (IBD) in dogs is characterized by spontaneous exacerbations and remissions, which makes assessment of disease burden difficult. The objectives of this study were to develop a scoring system for evaluation of canine IBD activity and to validate this scoring method by correlating it to objective laboratory and histologic indices of intestinal inflammation. Fifty-eight dogs with IBD were evaluated prospectively and compared to 9 disease-free control dogs. Clinical disease activity was quantified by a simple scoring system, the canine IBD activity index (CIBDAI), and compared to serum concentrations of C-reactive protein (CRP), haptoglobin (HAP), alpha-acid glycoprotein (AGP), and serum amyloid A (SAA), as well as histology scores derived from endoscopic biopsy specimens. Forty-six dogs were available for a reevaluation of the CIBDAI, CRP HAP, and AGP, and 34 dogs had repeat analysis of SAA performed after medical therapy. Serum concentrations of CRP were significantly (P < .02) increased in dogs with CIBDAI scores > or = 5 (mild disease activity or greater) compared to controls. Among IBD dogs, the CIBDAI showed good correlation (r = 0.82, P < .0001) to both histology and HAP scores, but CRP also was a strong co-correlate of disease activity. The IBD dogs showed significantly (P < .0001) decreased CIBDAI and CRP values but significantly (P < .0001) increased HAP concentrations after medical therapy compared to pretreatment values. We conclude that the CIBDAI is a reliable measure of inflammatory activity in canine IBD and that CRP is suitable for laboratory evaluation of the effect of therapy in these patients.     

Evaluation of disease activity markers in dogs with idiopathic inflammatory bowel disease

OBJECTIVES: To evaluate the clinical utility of serum tumour necrosis factor-alpha, C-reactive protein and microalbuminuria as disease activity markers in canine idiopathic inflammatory bowel disease. METHODS: Dogs with chronic gastrointestinal disease for which no underlying cause could be identified were considered to have idiopathic inflammatory bowel disease and were included in the study. Serum tumour necrosis factor-alpha was assessed using a canine-specific ELISA, C-reactive protein by immunoturbidometric assay and quantitative microalbuminuria was analysed using a monoclonal antibody directed against canine albumin. The canine inflammatory bowel disease activity index and histopathologic grade were used to assess disease severity; biologic markers were then compared with the canine inflammatory bowel disease activity index and histopathologic grade. RESULTS: Sixteen dogs were included in the study. C-reactive protein level was mildly elevated in 15 dogs. Microalbuminuria was elevated in two of 15 dogs, and tumour necrosis factor-alpha was not detected in any dog tested. No correlation was found between the canine inflammatory bowel disease activity index and C-reactive protein or microalbuminuria or between histopathologic grade and C-reactive protein or microalbuminuria. There was no correlation between histopathologic grade and the canine inflammatory bowel disease activity index. CLINICAL SIGNIFICANCE: Although only a small number of dogs were evaluated, this study does not support the use of serum tumour necrosis factor-alpha measured by canine-specific ELISA or microalbuminuria in the evaluation of disease activity in dogs with idiopathic inflammatory bowel disease. Although mildly elevated in most dogs, C-reactive protein did not reflect disease severity as assessed by the canine inflammatory bowel disease activity index or histopathologic grade.     

Evaluation of lymphocyte apoptosis in dogs with inflammatory bowel disease

Objective-To determine whether lymphocyte apoptosis in intestinal mucosae is more common in healthy dogs than dogs with inflammatory bowel disease (IBD) and whether numbers of apoptotic cells increase after successful treatment of affected dogs. Animals-8 dogs with IBD (IBD dogs) and 8 healthy control dogs. Procedures-Biopsy specimens of the duodenum and colon were obtained via endoscopy from dogs with IBD before and after 10 weeks of standard treatment and compared with specimens obtained from control dogs. Expression of activated caspase 3 (Casp3), caspase-cleaved fragment p85 from poly-ADP-ribose polymerase (PARP), and B-cell leukemia/lymphoma 2 (Bcl-2) was measured in the duodenal (villous tip and base) and colonic mucosae. Results-Expression of Casp3 was greater in the duodenal villous tips of control dogs, compared with expression in similar tissues from dogs with IBD before or after treatment. Despite clinical improvement of dogs with IBD, expression of Casp3 did not increase after treatment. Expression of PARP did not differ between groups at any time point. Expression of Bcl-2 was greater at all 3 tissue sites in control dogs, compared with expression at the same sites in dogs with IBD. Furthermore, Bcl-2 expression in duodenal villous tips was higher in dogs with IBD after treatment but was not higher elsewhere. In control dogs, expression patterns for all 3 markers were similar between sites (villous tip > villous base > colon). Conclusions and Clinical Relevance-Expression of Casp3 in lymphocytes in duodenal villous tips was significantly reduced in dogs with IBD, compared with expression in healthy dogs, but no increase was detected following successful treatment of IBD. Increased expression of Bcl-2 may be a potential marker of the success of treatment.     

Immunology of inflammatory diseases of the bowel.

During the past century, research on animal diseases has focused on the characterization of specific etiologies and disease control strategies. Many diseases affecting domestic animals have been successfully controlled using various methods, including vaccination, management, vector control, or antimicrobial agents. A number of microorganisms have proven resistant to these efforts. Control of these organisms requires the development of new strategies. As practitioners and researchers, we need to consider approaches that encompass the entire realm of disease expression from molecular to immune responses and interactions with other functional systems (e.g., endocrine, neurologic, and vascular systems). We need a basic understanding of effective immune responses enabling the tailoring of vaccines to produce the desired response. This tailoring of host responses is augmented by the use of vaccines that use host growth factors, cytokines, or costimulatory molecules to bias the ensuing response. Intestinal microbial flora of food-producing animals can be managed to optimize health and minimize colonization by pathogenic organisms, especially zoonotic agents. New systems for the delivery of cytokines and other factors that favor optimal intestinal health and homeostasis need to be researched and evaluated. With time, it is likely that our clients and the consumers will be less tolerant of antibiotic usage. They will be more aware of the zoonotic potential of many microbes that colonize food animals. Food safety issues will be a continuing concern, as will the protection of our water supply from contamination from feedlots and pasture runoff. We are in the dawn of a new century, and, it is hoped, a new era of discovery of enteric disease pathogenesis and control.     

Hypovitaminosis D in dogs with inflammatory bowel disease and hypoalbuminaemia

Objectives : To compare serum vitamin D metabolites and plasma parathyroid hormone concentrations in dogs with inflammatory bowel disease and normal albumin concentration, dogs with inflammatory bowel disease and hypoalbuminaemia, healthy dogs and hospitalised ill dogs with non‐gastrointestinal illness. Methods : Serum 25 hydroxyvitamin D and 1,25 dihydroxyvitamin D concentrations were measured in 36 healthy dogs, 49 hospitalised ill dogs with non‐gastrointestinal illnesses, 21 dogs with inflammatory bowel disease and normoalbuminaemia and 12 dogs with inflammatory bowel disease and hypoalbuminaemia. Plasma parathyroid hormone and ionised calcium concentrations were measured in a subset of these dogs. Results : Concentrations of serum 25 hydroxyvitamin D were lower in hypoalbuminaemic dogs with inflammatory bowel disease than in the healthy dogs (P<0·001), hospitalised ill dogs (P<0·001) and normoalbuminaemic dogs with inflammatory bowel disease (P<0·001). Dogs with inflammatory bowel disease and hypoalbuminaemia had a higher plasma concentration of parathyroid hormone (P<0·01) and lower plasma concentration of ionised calcium (P<0·001) than hospitalised ill dogs. Dogs with inflammatory bowel disease had a positive correlation between serum 25 hydroxyvitamin D concentrations and serum albumin (P<0·0001), serum calcium (P<0·0001) and plasma ionised calcium (P<0·0005) concentrations. Clinical Significance : Dogs with inflammatory bowel disease and hypoalbuminaemia frequently have ionised hypocalcaemia, high parathyroid hormone and low serum 25 hydroxyvitamin D concentrations. Further studies are indicated to establish the pathogenesis of this disease complication as well as therapeutic strategies to reverse this state.     

Treatment of inflammatory bowel disease (IBD) in dogs and cats

The treatment of inflammatory bowel disease (IBD) possesses numerous difficulties owing to the unclear etiology of the disease. This article overviews the drugs used in the treatment of IBD depending on the intensity of clinical symptoms (Canine Inflammatory Bowel Disease Activity Index and Canine Chronic Enterophaty Clinical Activity Index). Patients demonstrating mild symptoms of the disease are usually placed on an appropriate diet which may be combined with immunomodulative or probiotic treatment. In moderate progression of IBD, 5-aminosalicylic acid (mesalazine or olsalazine) derivatives may be administered. Patients showing severe symptoms of the disease are usually treated with immunosuppressive drugs, antibiotics and elimination diet. Since the immune system plays an important role in the pathogenesis of the disease, the advancements in biological therapy research will contribute to the progress in the treatment of canine and feline IBD in the coming years.     

Simultaneous occurrence of inflammatory bowel disease and trichomonosis in a Maine coon cat

A 2-year-old, 4.2 kg, spayed female, Maine coon cat was referred to the veterinary hospital for evaluation of hyporexia, slow growth, and chronic, intermittent, mucoid, bloody, voluminous, and fetid diarrhea. The diarrhea had been observed since the cat was acquired from a cattery at 4 months of age; with acute worsening in the 5 d before presentation. Abdominal palpation revealed moderate pain. Ultrasonographic examination showed thickening of the jejunal wall and ileal loops, increased echogenicity of the jejunal mucosa, and enlargement of the jejunal and ileocolic lymph nodes. Histopathology of full-thickness intestinal biopsies showed moderate, diffuse, lymphoplasmacytic, erosive enteritis with hemorrhage and edema. Diffuse, lymphoplasmacytic, erosive colitis with mild, interstitial fibrosis and hemorrhage was also noted. The ileocecal lymph node biopsy showed eosinophilic lymphadenitis. Based on the immunohistochemical evaluation of intestinal samples with CD3 and CD79a antibodies, a diagnosis of lymphoma was ruled out. Fecal polymerase chain reaction testing was positive for Tritrichomonas foetus. Based on these results, inflammatory bowel disease and trichomonosis were diagnosed. Treatment for the cat included a hypoallergenic diet and an oral omega-3 fatty acid supplement, in conjunction with prednisolone, to manage the inflammatory bowel disease. Ronidazole was administered to target the Tritrichomonas foetus. The cat was clinically normal during a follow-up examination after 6 months of treatment.