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  • Author or Editor: Elias Westermarck x
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Abstract

Objective—To study progression of autoimmunemediated atrophic lymphocytic pancreatitis from the subclinical to the clinical phase (exocrine pancreatic insufficiency [EPI]) and determine whether progression of the disease could be halted by treatment with immunosuppressive drugs.

Design—Randomized controlled trial.

Animals—20 dogs with subclinical EPI.

Procedure—Diagnosis of subclinical EPI was determined on the basis of repeatedly low serum trypsin like-immunoreactivity (TLI) in dogs with no signs of EPI. Laparotomy was performed on 12 dogs with partial acinar atrophy and atrophic lymphocytic pancreatitis. A treatment group (7 dogs) received an immunosuppressive drug (azathioprine) for 9 to 18 months, and a nontreatment group (13) received no medication.

Results—During the subclinical phase, serum TLI was repeatedly low (< 5.0 µg/L). Although a few dogs had nonspecific gastrointestinal tract signs, they did not need diet supplementation with enzymes. While receiving immunosuppressive medication, treated dogs had no clinical signs of EPI, but within 2 to 6 months after treatment was stopped, 2 dogs had signs of EPI, and diet supplementation with enzymes was started. Five of the 13 untreated dogs needed diet supplementation with enzymes within 6 to 46 months. During follow-up of 1 to 6 years, 3 of the 7 treated dogs and 8 of the 13 untreated dogs did not need continuous diet supplementation with enzymes.

Conclusions and Clinical Relevance—Progression of atrophic lymphocytic pancreatitis varied widely. The subclinical phase may last for years and sometimes for life. The value of early treatment with an immunosuppressive drug was questionable and, because of the slow natural progression of the disease, cannot be recommended. (J Am Vet Med Assoc 2002;220:1183–1187)

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in Journal of the American Veterinary Medical Association

Abstract

Objective—To assess the effects of dietary modification on clinical signs of exocrine pancreatic insufficiency (EPI) in dogs.

Design—Blinded randomized crossover study.

Animals—21 dogs with EPI.

Procedure—Dogs were fed the diet they received at home for 2 weeks. Thereafter, they received 3 special diets (a high-fat diet, a high-fiber diet, and a highly digestible low-residue diet) for 3 weeks each. Owners scored dogs daily for the last 2 weeks of each 3-week period for severity of 6 clinical signs including appetite, defecation frequency, consistency of feces, borborygmus, flatulence, and coprophagia. An EPI index was calculated for each dog by adding the daily scores for each clinical sign.

Results—Significant differences in daily EPI indices among diets were observed in 20 dogs. The original diet appeared to be the most suitable in 8 dogs, whereas the high-fat diet was most suitable in 5 dogs, the high-fiber diet was most suitable in 4 dogs, and the low-residue diet was most suitable in 2 dogs. In 1 dog, the lowest EPI index score was the same during the original diet and the high-fat diet feeding periods. One dog did not complete the feeding period for the high-fiber diet. Differences in mean EPI indices among diets were not significant.

Conclusions and Clinical Relevance—Results indicated that responses to different diets varied among individual dogs. Because responses to the feeding regimens were unpredictable, it is suggested that feeding regimens be individually formulated for dogs with EPI.

Full access
in Journal of the American Veterinary Medical Association

Objective

To study response to long-term enzyme replacement treatment in dogs with exocrine pancreatic insufficiency (EPI).

Design

Cross-sectional study.

Animals

76 German Shepherd Dogs or rough-coated Collies with EPI and 145 clinically normal dogs of the same breeds.

Procedure

Questionnaires were sent to owners of dogs with EPI and owners of clinically normal dogs. Dogs with EPI had been given dietary enzyme supplements for at least 4 months. Relative frequency distributions of gastrointestinal tract and dermatologic signs, prevalences of typical signs of EPI (eg, weight loss, ravenous appetite, yellow and pulpy feces, high fecal volume), feeding regimens, and dietary intolerances were compared between dogs with EPI and clinically normal dogs.

Results

Gastrointestinal tract signs considered typical for dogs with EPI were almost completely controlled with dietary enzyme supplements in half of the dogs with EPI, and their general health was similar to that of clinically normal dogs. A poor treatment response was found in a fifth of dogs with EPI that had several signs that were typical of EPI. Signs most often persisting were high fecal volume, yellow and pulpy feces, and flatulence. Dermatologic problems were common, especially in German Shepherd Dogs with EPI. Treatment response was irrespective of breed. Nonenteric-coated enzyme supplements, powdered enzyme, and raw chopped pancreas were equally effective in controlling clinical signs. Although dietary sensitivities were common, use of adjunctive dietary treatment was minimal. Antibiotics were occasionally administered to half of the dogs with EPI.

Clinical Implications

Results of this study indicate that, with basically similar treatment regimens, response to long-term enzyme treatment in dogs with EPI varied considerably. (J Am Vet Med Assoc 1998;213:86-90)

Free access
in Journal of the American Veterinary Medical Association

SUMMARY

The main objective of the study reported here was to determine whether signs typical of exocrine pancreatic insufficiency (epi) are alleviated when affected dogs are fed a diet with low fat content, compared with feeding ordinary commercial dog food or food prepared by the owner. The most cost-effective amount of enzyme supplement also was estimated. The study consisted of 6 test periods. Duration of the first and third periods was 4 weeks, and that of the others was 2 weeks. During the first 2 periods, the dogs were fed their original diet. The amount of enzyme supplement was reduced by half between the first and the second period. During the last 4 periods, the dogs were fed only the low-fat diet, and amount of the enzyme supplement was reduced stepwise. During the entire study, owners were asked to assess daily the severity of 9 signs typical of epi. A new index was established by adding the daily scores of each individual epi sign. This index was designated the epi index and was used as a measure of the general well-being of the dog. When the mean epi indexes of the original diet periods were compared with those of the corresponding low-fat diet periods, there were no statistically significant differences by use of Tukey's test or the paired t-test. There was considerable variability between dogs, however. The fat content of the original diet did not correlate with the difference in epi signs when the dogs were fed the low-fat diet. According to our study, feeding a low-fat diet to dogs with epi did not significantly alleviate clinical signs of the disease.

Decreasing the enzyme supplementation by 50% of the recommended dose did not significantly increase severity of the cumulative epi score. Decreasing the enzyme supplement by three-fourths of the recommended dose was excessive, and the severity of the clinical signs increased significantly (P < 0.05). The cost of the low-fat diet, compared with that of the original diet, was high.

Free access
in American Journal of Veterinary Research

Summary

Sequential assessments of pancreatic structure and function were performed on a female German Shepherd Dog bred from parents with exocrine pancreatic insufficiency (epi), to monitor development of pancreatic acinar atrophy in this breed. Determinations of serum trypsin-like immunoreactivity (tli), results of N-benzoyl-l-tyrosyl-p-aminobenzoic acid test, fecal soy bean stimulation test (sst), and gross and histologic examinations of the pancreas did not provide evidence of exocrine pancreatic disease up to 13 months of age. However, electron microscopy revealed degenerative abnormalities of acinar cells that were already apparent at 6 weeks and became more extensive with age. Examination of the pancreas at 22 months of age also indicated no gross or histologic abnormalities, but electron microscopy revealed widespread degenerative changes, including dilatation of the rough endoplasmic reticulum and extensive fusion of zymogen granules affecting most of the acinar cells. Serum tli concentration was markedly reduced at that time, indicative of epi, but the dog remained healthy and results of the sst were normal. Within 1 month, the dog had developed clinical signs of epi, and not only serum tli concentration, but also results of the N-benzoyl-l-tyrosyl-p-aminobenzoic acid test and sst were compatible with severe loss of exocrine pancreatic tissue. This loss was confirmed by gross and histologic examination of the pancreas at 25 months, which revealed typical features of pancreatic acinar atrophy, including scattered and disorganized exocrine cells in the small remnants of pancreatic tissue. These findings indicate that in German Shepherd Dogs, pancreatic acinar atrophy may involve interference with normal intracellular processing of zymogen granules, which precedes progressive and eventual rapid loss of exocrine pancreatic tissue.

Free access
in American Journal of Veterinary Research

Abstract

Objective—To assess the safety of endoscopic retrograde pancreatography (ERP) in dogs by performing repeated clinical examinations and laboratory analyses of serum amylase, lipase, canine trypsin-like immunoreactivity (cTLI), and canine pancreatic elastase 1 (cE1) after the procedure.

Animals—7 healthy Beagles.

Procedure—Clinical examinations were performed and blood samples obtained for serum enzyme determinations before and at intervals (10 minutes; 2, 4, and 6 hours; and 1, 2, and 3 days) after ERP.

Results—Repeated clinical examinations revealed no signs of ERP-induced complications in the 7 dogs. Results of repeated laboratory tests indicated a transient increase in serum values of amylase, lipase, and cTLI but not cE1. Mean ± SD lipase activity increased from 120.7 ± 116.4 U/L to 423.4 ± 243.1 U/L at 4 hours after ERP. Median serum cTLI concentration increased from 16.2 µg/L (range, 7.7 to 26.5 µg/L) to 34.9 µg/L (range, 16.6 to 68.3 µg/L) 10 minutes after ERP. Enzyme values returned to baseline levels at the latest on day 2 in 6 of 7 dogs. Highest values for serum amylase, lipase, and cTLI and their delayed return to baseline values were detected in 1 dog with contrast filling of the pancreatic parenchyma.

Conclusions and Clinical Relevance—Results indicated that ERP appears to be a safe imaging technique of pancreatic ducts in healthy dogs, although it induced a transient increase in serum values of pancreatic enzymes. In dogs, repeated clinical examinations and serum enzyme determinations can be used to monitor ERP-induced complications such as acute pancreatitis. ( Am J Vet Res 2004;65:616–619)

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in American Journal of Veterinary Research

Abstract

Objective—To provide values for gastrointestinal permeability and absorptive function tests (GIPFTs) with chromium 51 (51Cr)-labeled EDTA, lactulose, rhamnose, d-xylose, 3-O-methyl-d-glucose, and sucrose in Beagles and to evaluate potential correlations between markers.

Animals—19 healthy adult male Beagles.

Procedures—A test solution containing 3.7 MBq of 51Cr-labeled EDTA, 2 g of lactulose, 2 g of rhamnose, 2 g of d-xylose, 1 g of 3-O-methyl-d-glucose, and 8 g of sucrose was administered intragastrically to each dog. Urinary recovery of each probe was determined 6 hours after administration.

Results—Mean ± SD (range) percentage urinary recovery was 6.3 ± 1.6% (4.3% to 9.7%) for 51Cr-labeled EDTA, 3.3 ± 1.1% (1.7% to 5.3%) for lactulose, 25.5 ± 5.0% (16.7% to 36.9%) for rhamnose, and 58.8% ± 11.0% (40.1% to 87.8%) for 3-O-methyl-d-glucose. Mean (range) recovery ratio was 0.25 ± 0.06 (0.17 to 0.37) for 51Cr-labeled EDTA to rhamnose, 0.13 ± 0.04 (0.08 to 0.23) for lactulose to rhamnose, and 0.73 ± 0.09 (0.60 to 0.90) for d-xylose to 3-O-methyl-d-glucose. Median (range) percentage urinary recovery was 40.3% (31.6% to 62.7%) for d-xylose and 0% (0% to 0.8%) for sucrose.

Conclusions and Clinical Relevance—Reference values in healthy adult male Beagles for 6 of the most commonly used GIPFT markers were determined. The correlation between results for 51Cr-labeled EDTA and lactulose was not as prominent as that reported for humans and cats; thus, investigators should be cautious in the use and interpretation of GIPFTs performed with sugar probes in dogs with suspected intestinal dysbiosis.

Full access
in American Journal of Veterinary Research

Objectives

To determine prevalence, colonization density, and distribution of helicobacters and gastric histologic findings in healthy dogs and dogs with signs of gastritis; to evaluate association of colonization density and gastric inflammation; and to compare the number of Helicobacter spp with degree of inflammation.

Design

Cross-sectional prevalence survey.

Animals

25 healthy dogs and 21 dogs with signs of gastritis.

Procedure

During endoscopy, gastric mucosal biopsy specimens were obtained from healthy and affected client-owned dogs. Histologic and cytologic evaluation and results of a urease test were used for detecting helicobacters, which were identified definitively by use of transmission electron microscopy and bacterial culture.

Results

Helicobacters were detected in all 25 healthy and 20 of 21 affected dogs. Cytologic examination was a more sensitive method than histologic examination or the urease test. Helicobacters were found least frequently and in fewest number in the antrum in both groups of dogs. Gastric inflammation was evident in both groups of dogs and did not differ significantly between groups. A significant association was not detected between colonization density or the number of Helicobacter spp and degree of gastric inflammation. In both groups, H bizzozeronii, H felis, and H salomonis were cultured.

Clinical Implications

Histologically verified chronic gastritis is common in dogs with signs of gastritis as well as in healthy dogs. Colonization density of helicobacters was not associated with degree of gastric inflammation in the dogs of our study. It remains to be determined whether certain strains of Helicobacter spp can induce gastritis in dogs. (J Am Vet Med Assoc 1998;213:1767–1774)

Free access
in Journal of the American Veterinary Medical Association