Introduction
Gastrointestinal (GI) signs are common reasons for dogs to present to a veterinarian. Studies1,2 performed outside the US show that vomiting, diarrhea, anorexia, and weight loss are among the top complaints in dogs presenting for veterinary evaluation. Gastrointestinal signs might refer to primary GI disease but could also occur secondary to extra-GI disease or pharmaceutical intervention. Consequently, studies evaluating the prevalence and demographic features of specific canine GI diseases and not just clinical symptomatology are needed.
Few studies have investigated the prevalence of GI disease, and most have been limited to those easily studied through laboratory sample collection, such as the prevalence of intestinal parasites in dogs.3,4 Other gastroenterology research5,6 consists of retrospective case studies or prospective interventional studies on a specific disease. These studies are often performed at tertiary referral centers and might not represent the wider canine population. As a result, the prevalence of most GI diseases in the general companion dog population is not known but rather is estimated based on anecdotal experience. There is a need for access to large data resources holding both demographic and health information for the general population of companion dogs to gain insight on the prevalence of various diseases.7
Within the last decade, increased implementation of electronic medical record systems has led to the development of several national epidemiological projects, such as VetCompass, Banfield’s PetWare, and PetScan.4,7-12 Encompassing information from a variety of primary care practices, these programs have been identified as key resources for high-quality health information for the wider population of dogs.7 For example, a study13 using VetCompass has identified the digestive system as the second most prevalent organ system affected in dogs attending primary care practices in England. The Dog Aging Project (DAP) collects similar demographic and medical data; however, it is unique in that tens of thousands of companion dogs throughout the US are enrolled in an observational longitudinal study14 whereby dog owners complete annual health surveys and activities evaluating cognitive function and mobility. As a result, the DAP has the potential to be more informative with improved standardization than data retrospectively taken from medical records that might not include routine annual follow-up. Previous studies using DAP data have identified GI disease as the fourth most common owner-reported disease category15 and Giardia infection as the fourth most commonly reported medical condition across all disease categories.16 The present cross-sectional study aimed to describe the lifetime prevalence of owner-reported GI disorders (ORGIDs) among US-owned companion dogs enrolled in the DAP. Lifetime prevalence is defined as the proportion of individuals who have experienced a condition at any point in their lives up to the point of the study17; in this case, specifically, that is the proportion of dogs with an ORGID at any point prior to their enrollment in the DAP. In addition, we aimed to identify potential associations between dog characteristics (ie, demographics, lifestyle, and health) and owner reporting of specific GI conditions.
Methods
Study setting and data collection
The DAP is a US-based, nationwide, long-term longitudinal study of the biological and environmental determinants of healthy aging in companion dogs.15 All client-owned dogs of any age living in the US are eligible for enrollment in the DAP. Owners nominate their dog through the DAP website.14,18 As long as the approximate age of the dog is known, participants are then provided access to a password-protected online research portal hosted at the University of Washington.19 After giving informed consent, participants complete the 10-part Health and Life Experience Survey (HLES), which collects information about the dog’s signalment, behavior, environment, physical activity, diet, and health history.15 The full HLES questionnaire is publicly available online.20 Once all components of this survey have been completed, the dog becomes a member of the “DAP Pack,” meaning that all participants in the DAP have a fully complete HLES.
This cross-sectional study was performed by use of owner-completed baseline HLES data collected from dogs enrolled in the DAP Pack between December 26, 2019, and December 31, 2022. Although the HLES has a specific section for GI disease, additional GI disorders can be found in other disease categories including congenital, infectious, cancer, and pancreatic diseases. Therefore, dogs were defined as having an ORGID if the owner selected at least 1 disease or clinical sign attributable to the GI tract in any section of the HLES. In addition to asking whether a dog was diagnosed with a named disorder, the HLES questionnaire also lists persistent or recurrent clinical signs as disorders (eg, chronic diarrhea, chronic vomiting, constipation, and fecal incontinence). Acute or self-limiting clinical signs were not assessed. As each of these clinical signs could be related to a number of different disorders, they were considered as separate disorders. Gastrointestinal disorders were then grouped as described in Supplementary Table S1. To directly reflect the response choices selected by DAP Pack dog owners, ORGIDs are reported in this table with the precise terms presented in the HLES. At the time the HLES was created, chronic enteropathy was not the dominant term, and so, although included disorders may fall under the umbrella of chronic enteropathy, we chose to analyze and present the data utilizing the exact terms owners selected in the survey. Dogs with ORGIDs were further subgrouped as having an infectious ORGID (Table 1) or noninfectious ORGID (Table 2) for analysis. Noninfectious ORGID groups with more than 250 dogs were also further evaluated. For analysis, dogs were grouped on the basis of having a given ORGID (ORGID group) versus not having that ORGID at any point in their history (control group). Any dog without the specific ORGID being evaluated was considered a control dog for this study. These control dogs may or may not have had other ORGIDs or non–GI-related owner-reported conditions.
Infectious owner-reported gastrointestinal disorders (ORGIDs) from a cross-sectional owner-reported survey study of 43,517 dogs enrolled in the Dog Aging Project (DAP) between December 26, 2019, and December 31, 2022. Numbers (percentages) of dogs with infectious ORGIDs listed in the DAP Health Life and Experience Survey are provided.
| Infectious GI disease | No. (%) of dogs |
|---|---|
| All | 7,580 (17) |
| Giardia spp | 3,258 (7) |
| Roundworms | 1,288 (3) |
| Tapeworms | 1,250 (3) |
| Hookworms | 1,132 (3) |
| GI parasites (not specified) | 861 (2) |
| Coccidia | 716 (2) |
| Trichuris spp | 448 (1) |
| Parvovirus | 386 (1) |
| Campylobacter spp | 51 (0.1) |
| Distemper virus | 26 (< 0.1) |
| Neorickettsia helminthoeca | 34 (< 0.1) |
| Isospora spp | 19 (< 0.1) |
| Salmonella spp | 12 (< 0.1) |
| Histoplasma spp | 2 (< 0.1) |
| Pythium spp | 0 (0) |
| Hepatozoon spp | 0 (0) |
Data are reported as number of dogs (percentage of DAP Pack).
GI = Gastrointestinal.
Noninfectious ORGIDs from the cross-sectional owner-reported survey data described in Table 1.
| Noninfectious ORGID | No. (%) of dogs |
|---|---|
| Clinical-sign–based GI disorders | 2,097 (5) |
| Chronic diarrhea | 1,316 (3) |
| Chronic vomiting | 519 (1) |
| Constipation | 127 (0.3) |
| Fecal incontinence | 135 (0.3) |
| Bilious vomiting syndrome | 166 (0.4) |
| GI allergies | 1,241 (3) |
| Food or medicine allergies | 1,050 (2) |
| Other allergies | 191 (0.4) |
| GI foreign body | 1,086 (2) |
| Anal sac impaction | 1,031 (2) |
| Pancreatitis | 857 (2) |
| Inflammatory disorder | 615 (1) |
| Inflammatory bowel disease | 553 (1) |
| Idiopathic colitis | 68 (0.2) |
| Acute hemorrhagic diarrhea syndrome | 388 (0.9) |
| Congenital disease | 216 (0.5) |
| Atresia ani | 0 (0) |
| Cleft lip | 12 (< 0.1) |
| Cleft palate | 14 (< 0.1) |
| Esophageal achalasia | 2 (< 0.1) |
| Other congenital GI disorder | 2 (< 0.1) |
| Persistent right aortic arch | 2 (< 0.1) |
| Umbilical hernia | 184 (0.4) |
| Cancer or tumors (defined by location) | 147 (0.3) |
| Anal sac | 76 (0.2) |
| Esophagus | 4 (< 0.1) |
| GI tract (stomach, intestine) | 34 (0.1) |
| Rectum | 33 (0.1) |
| Malabsorptive or maldigestive diseases | 114 (0.3) |
| Exocrine pancreatic insufficiency | 50 (0.1) |
| Lymphangiectasia | 16 (< 0.1) |
| Malabsorptive disorder | 25 (0.1) |
| Protein-losing enteropathy | 23 (0.1) |
Data are reported as number of dogs (percentage of DAP Pack).
Statistical analysis
Descriptive statistics for noninfectious and infectious ORGID subgroups and all noninfectious ORGID categories with > 250 dogs were calculated for age at diagnosis, weight, and proportion of sex and neuter status. Age at diagnosis was calculated based on month/year of diagnosis of the ORGID. A dog’s date of birth (DOB) was then subtracted from this date to get an estimated age in year at diagnosis. For those dogs with no DOB recorded, an estimated DOB was calculated based on the owner-reported age at time of HLES completion. Control dogs were defined as dogs without an ORGID. For control dogs, age was set as the age at the time of HLES completion. Dogs that had an “impossible” age (≤ 0 or > 27 years) were removed from final analyses.
Multivariate logistic regression models were used to investigate demographic and lifestyle characteristics associated with each ORGID diagnosis that was identified in more than 250 dogs. In addition to evaluating individual ORGID diagnosis categories, all dogs with noninfectious ORGIDs were grouped together for analysis to more thoroughly evaluate for associations with demographic and lifestyle characteristics. We excluded infectious ORGID diagnoses in this analysis, as they have a different etiology and pathophysiology compared to noninfectious diseases. Each individual ORGID and the combined ORGID analyses had their own multivariate logistic regression applied based on a priori specification of individual characteristics of interest. Association between demographic characteristics including age, weight, sex, and neuter status was investigated in all ORGID categories. Lifestyle factors investigated varied by ORGID category and included diet type (eg, dry, kibble, canned, freeze-dried, semidry/semimoist, raw, home prepared, or “other” [ie, any diet not encompassed by the provided response variables]), appetite (eg, normal, poor, or voracious), history of being underweight, the use of various medications or supplements (nonprescription medications for GI upset, fiber, probiotics), and exposure to toys or rawhides/bones. In the HLES, famotidine was the provided example of a nonprescription medication for GI upset, although an owner could have selected yes for any medication they thought fit in this category. Demographic and lifestyle characteristics investigated for each ORGID category were chosen before any analyses were performed based on clinical observations. As the HLES provides cross-sectional data at the time of participant enrollment, we could only determine an association between ORGIDs and lifestyle characteristics, not a temporal relationship. Dogs were only included once in the combined ORGID analysis, even if they had more than 1 ORGID reported. In these situations, the dog’s age was set to their age at the ORGID diagnosis listed first in the HLES. Prevalence ORs (PORs) and corresponding 95% CIs were calculated for each investigated characteristic, and these POR estimates were conditional on the selected a priori risk factors included in each multivariate logistic regression model. Weight was recorded in kilograms and age was analyzed in years, such that each increase in 1 POR was associated with either a 1-kg increase in weight or 1-year increase in age. As we were completing multiple logistic models from the same dataset (1 for each ORGID), we applied a Bonferroni correction for multiple comparisons based on the 9 logistic regressions evaluated in the entire analysis, setting significance at α = .0056. All analyses were completed in the program R, version 3.5.2 (The R Foundation for Statistical Computing), and graphs were made with the ggplot2 package (The R Foundation for Statistical Computing).
Results
Population
As of December 31, 2022, a total of 43,517 dogs had joined the DAP Pack, which required completion of HLES, and were included in the study. An additional 15,588 owners began the HLES but did not complete it and therefore were neither enrolled in the DAP nor included in this study. The dogs in the DAP Pack had a median age of 6.8 years (range, 0 to 25.5 years) and a median weight of 23.2 kg (range, 0.07 to 106.4 kg). The majority were neutered (38,592 of 43,517 [89%]), and 50% (21,935 of 43,517) were male.
Of the 43,517 dogs in the DAP Pack, 30,677 (70%) had no history of ORGID (control group) and 12,840 had at least 1 ORGID, translating to a lifetime prevalence, as previously defined, of 30%. Among all dogs with any ORGID, 601 dogs had an impossible calculated age at diagnosis and were removed from all analyses. The number of ORGIDs reported per dog ranged from 0 to 8. Of the DAP Pack (n = 43,517), 1,379 dogs (3%) reported more than 1 ORGID, of which the majority (1,054 of 1,379 [76%]) reported 2 disorders. Out of the 43,517 dogs in the DAP Pack, infectious ORGIDs were reported in 7,580 dogs (17%) and noninfectious ORGIDs were reported in 6,806 dogs (16%), such that 1,546 dogs (4%) had concurrent reporting of infectious and noninfectious ORGIDs in their HLES. Frequencies of infectious and noninfectious ORGIDs are reported in Tables 1 and 2, respectively. Demographic characteristics of dogs with infectious and noninfectious ORGIDs are summarized in Table 3.
Demographic characteristics of the DAP Pack and ORGID categories with > 250 dogs, December 2019 to 2022. The “any noninfectious ORGID” group includes dogs that had 1 or more of the noninfectious ORGIDs listed in Table 2. Although some dogs had more than 1 noninfectious ORGID, they were included only once in this category. Seven of the subcategories of noninfectious ORGIDs listed in Table 2 were reported in > 250 dogs and are listed after the “any noninfectious ORGID” category.
| Group | No. of dogs* | Age^ or age at diagnosis (y)a | Weight (kg)a | Neutered maleb | Intact maleb | Spayed femaleb | Intact femaleb |
|---|---|---|---|---|---|---|---|
| DAP Pack | 43,491 | 6.8 (0.1–25.5) | 22.8 (0.1–106.4) | 18,925 (43.5%) | 3,002 (6.9%) | 19,651 (45.2%) | 1,913 (4.4%) |
| Dogs without any ORGID | 30,656 | 6.7 (0.1–25.5) | 23.1 (0.1–106.4) | 13,134 (42.8%) | 2,213 (7.2%) | 13,837 (45.1%) | 1,472 (4.8%) |
| Dogs with any ORGID | 12,239 | 3.6 (0.1–20.3) | 23.6 (0.3–95.5) | 5,530 (45.2%) | 752 (6.1%) | 5,539 (45.3%) | 418 (3.4%) |
| Any infectious ORGID | 7,160 | 2.3 (0.1–20.3) | 24.4 (0.3–95.5) | 3,118 (43.5%) | 495 (6.9%) | 3,241 (45.3%) | 306 (4.3%) |
| Any noninfectious ORGID | 6,806 | 5.1 (0.1–19.1) | 22.9 (1.6–87.7) | 3,248 (47.7%) | 365 (5.4%) | 3,036 (44.6%) | 157 (2.3%) |
| Chronic diarrhea | 1,290 | 4.7 (0.8–18.2) | 24.7 (0.1–80.5) | 631 (48.9%) | 86 (6.7%) | 524 (40.6%) | 49 (3.8%) |
| GI foreign bodies | 1,068 | 3.7 (3.8–17.7) | 25.7 (1.8–87.7) | 541 (50.7%) | 77 (7.2%) | 426 (39.9%) | 24 (2.2%) |
| Anal sac impactions | 1,026 | 6.2 (0.1–19.1) | 20.5 (1.5–84.1) | 454 (44.2%) | 40 (3.9%) | 518 (50.1%) | 14 (1.4%) |
| Pancreatitis | 850 | 7.8 (0.2–18.5) | 17.3 (1.6–56.3) | 387 (45.5%) | 25 (2.9%) | 432 (50.8%) | 6 (0.7%) |
| Inflammatory GI disease | 605 | 5.9 (0.1–17.3) | 22.1 (1.7–65.5) | 310 (51.2%) | 22 (3.6%) | 267 (44.1%) | 6 (1.0%) |
| Chronic vomiting | 512 | 4.8 (0.1–16.8) | 20.1 (1.6–62.7) | 250 (48.8%) | 19 (3.7%) | 234 (45.7%) | 9 (1.8%) |
| AHDS | 382 | 5.1 (0.1–15.8) | 20.8 (2.3–73.6) | 169 (44.2%) | 23 (6.0%) | 185 (48.4%) | 5 (1.3%) |
aData are reported as median and range.
bData are reported as number of dogs and percentage.
^Age for the DAP Pack and dogs without ORGID was defined as age at Health and Life Experience Survey completion.
*No. of dogs include only those dogs that were analyzed for the regression. Dogs with ages less than or equal to 0 were removed.
AHDS = acute hemorrhagic diarrhea syndrome
Characteristics associated with infectious ORGIDs
Giardia infection was the most common infectious ORGID, and the frequencies of all named infectious ORGIDs are reported in Table 1. Compared to those without a history of infectious ORGIDs, dogs with infectious ORGIDs had greater odds of being younger (POR, 0.85; 95% CI, 0.78 to 0.79), neutered (POR, 3.00; 95% CI, 2.73 to 3.30), or heavier in body weight (POR, 1.005; 95% CI, 1.002 to 1.007; P < .001 for all). Sex was not associated with infectious ORGIDs (POR, 0.99; 95% CI, 0.933 to 1.05; baseline sex, female; P = .766). Dogs with infectious ORGIDs also had greater odds of having a history of being underweight compared to those without a history of infectious ORGIDs (POR, 1.65; 95% CI, 1.52 to 1.79; P < .001). Compared to dogs in an urban environment, dogs living in suburban (POR, 0.82; 95% CI, 0.76 to 0.89) and rural environments (POR, 0.79; 95% CI, 0.72 to 0.88) had lower odds of infectious ORGIDs (P < .001 for both). Dogs with a history of visiting dog parks had lower odds of infectious ORGIDs (POR, 0.918; 95% CI, 0.863 to 0.977; P < .001).
Characteristics associated with noninfectious ORGIDs
Chronic diarrhea was the most common noninfectious ORGID, and the frequencies of all noninfectious ORGIDs are reported in Table 2. All dogs with any category of noninfectious ORGIDs were grouped together (n = 6,806) and evaluated for associated demographic and lifestyle characteristics, the results of which are summarized in Figure 1. Compared with controls, dogs with noninfectious ORGIDs had greater odds of being younger in age (POR, 0.88; 95% CI, 0.87 to 0.89), male (POR, 0.86; 95% CI, 0.81 to 0.91; baseline sex, female), castrated (POR, 2.55; 95% CI, 2.29 to 2.85), or lower in body weight (POR, 0.995; 95% CI, 0.993 to 0.998; P < .001 for all). Compared to those without, dogs with noninfectious ORGIDs also had greater odds of having a history of being underweight (POR, 1.58; 95% CI, 1.47 to 1.70) or having an appetite that was either poor (POR, 1.47; 95% CI, 1.29 to 1.67) or voracious (POR, 1.12; 95% CI, 1.06 to 1.19). When we considered the primary dietary component fed and set commercial kibble as the baseline diet group, dogs with noninfectious ORGIDs had greater odds of having a history of being fed a commercial canned (POR, 2.51; 95% CI, 2.21 to 2.85), home-prepared (POR, 1.46; 95% CI, 1.28 to 1.67), or other (POR, 1.78; 95% CI, 1.48 to 2.14) diet compared to dogs with no history of having a noninfectious ORGID (P < .001 for all). There was no association between noninfectious ORGIDs and the following diets: freeze-dried (P = .965), semidry or semimoist (P = .837), or raw (P = .453). Dogs with noninfectious ORGIDs also had greater odds of having a history of receiving a probiotic (POR, 1.69; 95% CI, 1.58 to 1.81) or nonprescription medication for GI upset (POR, 4.06; 95% CI, 3.80 to 4.33) compared to dogs with no history of noninfectious ORGIDs (P < .001 for both).
Forest plot of characteristics associated with noninfectious owner-reported gastrointestinal disorders (n = 6,806). Data are presented as prevalence ORs with 95% CIs as determined by multivariate logistic regression analysis. Weight was recorded in kilograms, and age was analyzed in years.
Citation: Journal of the American Veterinary Medical Association 262, 12; 10.2460/javma.24.05.0306
Characteristics associated with individual noninfectious ORGID categories
Eight noninfectious ORGID diagnoses were reported in > 250 dogs. Food and medication allergies were not further evaluated despite occurring in over 250 dogs, as the survey did not allow differentiation between medication allergies and food allergies; furthermore, an owner might have selected “food allergy” when their dog presented with dermatological rather than GI signs. With exclusion of food and medication allergies, 7 noninfectious ORGID categories were further evaluated. These top categories from largest to smallest were chronic diarrhea, GI foreign bodies, anal sac impactions, pancreatitis, inflammatory GI disorders, chronic vomiting, and acute hemorrhagic diarrhea syndrome (AHDS). Descriptive data of the top 7 ORGID categories are provided in Table 3, and each category’s association with studied characteristics is summarized in Supplementary Table S2.
Dogs with chronic diarrhea (POR, 2.41; 95% CI, 1.87 to 3.16), GI foreign bodies (POR, 2.91; 95% CI, 2.33 to 3.68), anal sac impactions (POR, 2.67; 95% CI, 2.04 to 3.58), pancreatitis (POR, 2.74; 95% CI, 1.93 to 4.04), inflammatory GI disorders (POR, 3.27; 95% CI, 2.20 to 5.10), chronic vomiting (POR, 3.19; 95% CI, 2.17 to 4.91), or AHDS (POR, 2.15; 95% CI, 1.47 to 3.27) had greater odds of being neutered compared to dogs that had no history of each of these respective diseases (P < .001 for all). Dogs with owner-reported chronic diarrhea (POR, 0.85; 95% CI, 0.83 to 0.86), GI foreign bodies (POR, 0.73; 95% CI, 0.71 to 0.75), anal sac impactions (POR, 0.95; 95% CI, 0.93 to 0.96), inflammatory GI disorders (POR, 0.92; 95% CI, 0.90 to 0.95), chronic vomiting (POR, 0.85; 95% CI, 0.83 to 0.87), or AHDS (POR, 0.91; 95% CI, 0.89 to 0.93), but not those with pancreatitis (P = .019), had greater odds of being younger compared to dogs without a history of these ORGID categories (P < .001 for all). Dogs with anal sac impactions (POR, 0.983; 95% CI, 0.978 to 0.988), pancreatitis (POR, 0.962; 95% CI, 0.956 to 0.968), chronic vomiting (POR, 0.977; 95% CI, 0.970 to 0.985), and AHDS (POR, 0.983; 95% CI, 0.975 to 0.991) had higher odds of having a lower body weight compared to dogs without a history of these ORGID categories (P < .001 for all). Conversely, dogs with GI foreign bodies had greater odds of having a heavier body weight compared to those without a history of a GI foreign body (POR, 1.010; 95% CI, 1.005 to 1.015; P < .001). Body weight was not significantly associated with chronic diarrhea (P = .660). Dogs with a history of chronic diarrhea (POR, 0.75; 95% CI, 0.64 to 0.87) and GI foreign bodies (POR, 0.70; 95% CI, 0.67 to 0.87) had greater odds of being male compared to those without a history of these ORGID categories (P < .001 for both), but sex was not significantly associated with any other noninfectious ORGID reported in > 250 dogs.
Dogs with chronic diarrhea (POR, 1.98; 95% CI, 1.65 to 2.36), chronic vomiting (POR, 2.28; 95% CI, 1.85 to 2.79), and inflammatory GI disorders (POR, 2.80; 95% CI, 2.33 to 3.35) had greater odds of having a history of being underweight compared to dogs without these ORGID categories (P < .001 for all). Documentation of a poor appetite in the HLES was associated with all categories in which it was evaluated (P < .001 for all), which included chronic diarrhea (POR, 1.96; 95% CI, 1.43 to 2.63), inflammatory GI diseases (POR, 2.85; 95% CI, 2.14 to 373), and chronic vomiting (POR, 1.97; 95% CI, 1.38 to 2.73). Although a voracious appetite was positively associated with a noninfectious ORGID when all subcategories were combined (n = 6,806), it was not significantly associated with the noninfectious ORGID subcategories of chronic diarrhea (P = .30), chronic vomiting (P = .171), or inflammatory GI disease (P = .357). Dogs with chronic diarrhea had greater odds of having a history of receiving probiotics (POR, 2.55; 95% CI, 2.15 to 3.03; P < .001) but not fiber supplementation (P = .842). Dogs with owner-reported pancreatitis had greater odds of having a history of receiving medications for GI upset in the HLES (POR, 3.46; 95% CI, 3.00 to 4.00; P < .001).
Dogs with a history of a GI foreign body had lower odds of having a history of receiving rawhides/bones (POR, 0.72; 95% CI, 0.63 to 0.82; P < .001) or toys (POR, 0.46; 95% CI, 0.39 to 0.56; P < .001). Of note was the finding that of the 1,087 dogs diagnosed with a GI foreign body, 467 (43%) required no treatment, 339 (31%) required surgery and hospitalization, 189 (17%) required hospitalization alone, and 92 (8%) required surgery alone.
Discussion
To our knowledge, the present study reported the lifetime prevalence of GI disease in the largest sample yet evaluated of companion dogs living in the US and represented a demographically diverse group of owners (eg, including rural environments) that are often underrepresented in studies conducted at secondary or tertiary veterinary referral facilities. Defined as the proportion of individuals in a population that have experienced a particular condition at any point of their lives up to the time of the survey,21 the lifetime prevalence of ORGIDs in this study approached 30%, which was essentially the same as the prevalence of digestive system diseases reported in dogs presenting to primary care practices in England.14 Among ORGID diagnoses, infectious GI disease was most common, with Giardia infection being the most commonly reported infectious disease. The prevalence of Giardia spp in dogs within North America based on pooled data has been reported to be 17%22; however, the prevalence is lower when excluding studies performed on shelter dogs or only symptomatic dogs. For example, the prevalence of Giardia spp in stool samples from pet dogs presenting to a veterinary teaching hospital was reported to be 7.2%, which is similar to our findings (7.5%).23
With the exception of pancreatitis, dogs with ORGIDs were younger at the time of their ORGID diagnosis than control dogs were at the time of survey completion. Since they did not have an ORGID diagnosis date, the age used for the analysis of control dogs was the time of survey completion, which might have favored older ages in the control group. However, the most common age (mode) within the DAP Pack was between 2 and 3 years old, and with such a young population overall, we would not have expected that dogs with ORGIDs would be younger. In addition, our findings were consistent with previous results; AHDS,24 anal sac disease,25 and inflammatory bowel disease26,27 have been shown to be more common in middle-aged dogs, and GI foreign bodies occur most commonly in young to middle-aged dogs.28,29 In contrast, pancreatitis has been reported to be common in older dogs.30 In the current study, male dogs were more likely to have noninfectious ORGIDs, a finding that was also observed for the specific noninfectious ORGID categories of GI foreign bodies and chronic diarrhea. Foreign body ingestion has previously been reported to be more common in male dogs.28,29 In 1 study6 evaluating chronic diarrhea in dogs, male dogs were overrepresented, with a male-to-female ratio of 1.3 for chronic enteropathies and 2.3 for extra-GI causes of diarrhea. Similar to prior studies,27,31,32 we did not find a difference by sex in the lifetime prevalence of owner-reported noninfectious inflammatory GI disease.
The prevalence of castration in our study (89%) was found to be higher than the reported national average (64%).33 In addition, being neutered was associated with all types of ORGIDs. This is in contrast to previous studies31,32,34 of inflammatory bowel disease or chronic enteropathy in dogs where intact males and, to a lesser extent, spayed females tended to be overrepresented. However, it is important to note that these studies were conducted in Europe, where the prevalence of gonadectomy is much lower.33,35-38 Gonadectomy has been reported to be a risk factor for intervertebral disc herniation in Dachshunds,39 joint disease,40 immune-mediated diseases including inflammatory bowel disease,41 and certain cancers.40,42 However, to date, there has been no association reported between gonadectomy and non–immune-mediated GI diseases. The finding of all ORGID categories being associated with neutering, although interesting, should be interpreted with caution. A previous study43 found that gonadectomy increases life expectancy by 14% in male dogs and 26% in female dogs. It is possible that the association of neutering with all types of ORGID in the current study might represent reporting bias, as owners who choose to neuter their pets might be more likely to take their dog to a veterinarian for other reasons as well, thereby increasing the opportunity for a diagnosis to be made. These owners could also be more attuned to their pet’s medical history and thus more likely to recall a specific diagnosis.
Consistent with previous literature, we found that lower body weight (ie, smaller body size) was associated with anal sac impactions and AHDS,24,44 whereas a larger body size was associated with GI foreign bodies.28 In addition, dogs with infectious ORGIDs were more likely to be larger than control dogs. A previous study45 found toy-breed dogs to have a decreased risk of infectious disease, which is suspected to be due to the popularity of these dogs in urban settings. However, in the current study, dogs living in urban areas were more likely to have an infectious ORGID, which argues against the explanation for the lower risk of infectious GI disease among toy-breed dogs. We also found that a smaller size was associated with pancreatitis; due to limitations of our HLES, we could not distinguish between acute versus chronic pancreatitis.
Within the current study, dogs reported to have received probiotics were more likely to have chronic diarrhea and the use of medications for GI upset was associated with noninfectious ORGIDs. In the HLES, the brand name of the acid suppressant famotidine was listed as an example of a medication for GI upset. For both probiotics and medications given for GI upset, we could neither confirm what product was given nor could we discern whether these medications were recommended under the direction of a veterinarian. Furthermore, we were not able to evaluate a temporal relationship, as the diagnosis of a given disease could have occurred at any point in the dog’s life, whereas owners were instructed to select yes for a medication or supplement category only if they were used within the year of HLES completion. Proton pump inhibitors are commonly prescribed or recommended for GI-related diseases or clinical signs (eg, vomiting, diarrhea, inappetence), even when there may be no support for their use.46,47 This might explain why the use of medications for GI upset was associated with a 4-fold chance of noninfectious ORGIDs in our study. Unexpectedly, dogs with a history of receiving toys or rawhides/bones were less likely to have a diagnosis of a GI foreign body. One possible explanation is that dog owners who are aware of pica or previous GI foreign bodies in their dogs avoid providing toys and bones to their dogs, particularly given that a temporal relationship cannot be established with this cross-sectional data. Alternatively, environmental enrichment in the form of toys or rawhides and bones might prevent dogs from eating other foreign material.
An important limitation of our study was that the cross-sectional nature of the analysis precluded the ability to determine causal relationships from these observations. For example, dogs with noninfectious ORGIDs were more likely to have been fed canned food, but we cannot determine whether the canned food was introduced before or after the diagnosis of the ORGID. As control dogs were included on the basis of not having a given ORGID and therefore did not have an “age at diagnosis,” their age was based on the time of HLES completion. This limitation could have favored dogs in the control group being older at the time of inclusion. However, our results were similar to other reported aged effects of ORGIDs, as previously discussed, so this limitation most likely did not contribute to significant bias in our results. In addition, as a survey-based study, the data were subject to recall and response bias. An owner may enroll their dog at any age, and therefore, they might remember past events incorrectly or fail to report them at the time of the survey. Dog owners might also provide inaccurate answers if they are unfamiliar with the disease categories provided in the survey. Finally, owners who tend to participate in surveys or have the resources (eg, time, internet access) to complete an online survey are more likely to contribute to the DAP, which may impact the ability to extrapolate this data to the larger population.
Despite these limitations, compared to veterinary electronic medical record (VEMR) data collection, data from health-related surveys have important benefits including standardization and ease and speed of data acquisition. Veterinary electronic medical record data are often incomplete due to fragmentation of care across multiple care institutions.48,49 Furthermore, owner-completed survey data allow the assessment of what dog owners find relevant in their dog’s medical and lifestyle history. Unlike VEMR data, survey-based data can also capture health problems for which a dog might not have presented to their veterinarian. For example, in the current study, 43% of dogs with GI foreign bodies required no treatment and might not have presented to their veterinarian. Most prior studies28,29 on GI foreign bodies in dogs have only reported on those that necessitated presentation to a veterinary clinic or required surgical or endoscopic intervention. Health survey data, such as the HLES used in the DAP, can complement VEMRs.50 The DAP does request submission of VEMRs from all participants, and work to compare owner-reported information to information extracted from VEMRs is ongoing.
Overall, the present study showed a high lifetime prevalence (30%) of GI disorders among a large and diverse population of companion dogs distributed throughout the US. Because these data were collected from surveys completed by dog owners, our findings indicate that dog owners recognize GI disease as a problem in their dogs. The finding of a consistently high prevalence of disorders affecting the GI system indicates that student education, research programs, and clinical management should focus on the identification, prevention, diagnosis, and treatment of GI disease.
Supplementary Materials
Supplementary materials are posted online at the journal website: avmajournals.avma.org.
Acknowledgments
The authors would like to thank the Dog Aging Project participants, their dogs, and community veterinarians for their important contributions to the Dog Aging Project.
The Dog Aging Project Consortium comprises Dr. Creevy and the following authors of this report: Joshua M. Akey, PhD (Lewis-Sigler Institute for Integrative Genomics, Princeton University, Princeton, NJ); Brooke Benton, MPH (Department of Laboratory Medicine and Pathology, School of Medicine, University of Washington, Seattle, WA); Elhanan Borenstein, PhD (Department of Clinical Microbiology and Immunology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel); Marta G. Castelhano, DVM, MVSc (Cornell Veterinary Biobank, College of Veterinary Medicine, Cornell University, Ithaca, NY); Amanda E. Coleman, DVM, DACVIM (Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA); Kyle Crowder, PhD (Department of Sociology, University of Washington, Seattle, WA); Matthew D. Dunbar, PhD (Center for Studies in Demography and Ecology, University of Washington, Seattle, WA); Virginia R. Fajt, PhD, DVM, DACVCP (Department of Veterinary Physiology and Pharmacology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX); Annette L. Fitzpatrick, PhD (Department of Family Medicine, University of Washington, Seattle, WA); Unity Jefrey, PhD, VetMB, DACVP (Department of Veterinary Pathobiology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX); Erica C. Jonlin, PhD (Department of Laboratory Medicine and Pathology, School of Medicine, University of Washington, Seattle, WA; and Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA); Matt Kaeberlein, PhD (Department of Laboratory Medicine and Pathology, School of Medicine, University of Washington, Seattle, WA); Elinor K. Karlsson, PhD (Bioinformatics and Integrative Biology, Chan Medical School, University of Massachusetts, Worcester, MA; and Broad Institute of MIT and Harvard, Cambridge, MA); Kathleen F. Kerr, PhD (Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA); Jonathan M. Levine, DVM, DACVIM (Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, TX); Jing Ma, PhD (Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA); Robyn L. McClelland, PhD (Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA); Daniel E. L. Promislow, PhD (Department of Laboratory Medicine and Pathology, School of Medicine, University of Washington, Seattle, WA; and Department of Biology, University of Washington, Seattle, WA); Audrey Ruple, DVM, PhD (Department of Population Health Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, VA); Stephen M. Schwartz, PhD (Department of Epidemiology, University of Washington, Seattle, WA; and Epidemiology Program, Fred Hutchinson Cancer Research Center, Seattle, WA); Sandi Shrager, MSW (Department of Biostatistics, Collaborative Health Studies Coordinating Center, University of Washington, Seattle, WA); Noah Snyder-Mackler, PhD (School of Life Sciences, Arizona State University, Tempe, AZ; and School for Human Evolution and Social Change, Arizona State University, Tempe, AZ); M. Katherine Tolbert, DVM, PhD (Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX); Silvan R. Urfer, DMV (Department of Laboratory Medicine and Pathology, School of Medicine, University of Washington, Seattle, WA); and Benjamin S. Wilfond, MD (Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, WA; and Division of Bioethics and Palliative Care, Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA).
Disclosures
The authors have nothing to disclose. No AI-assisted technologies were used in the generation of this manuscript.
Funding
The Dog Aging Project is supported by a National Institute on Aging grant (No. U19AG057377; Principal Investigator: Dr. Promislow) and private donations. Dr. Hoffman is funded by R00AG059920. This content is solely the responsibility of the authors and does not necessarily reflect the official views of the NIH.
ORCID
S. M. Schmid https://orcid.org/0000-0002-9383-3591
K. E. Creevy https://orcid.org/0000-0003-4169-374X
E. N. Gould orcid.org/0000-0002-2961-2452
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