Chronic Diarrhea in Dogs - Retrospective Study in 136 Cases

Abstract

Background: Chronic diarrhea (CD) is common in dogs, and information on frequency and distribution of primary and secondary causes is lacking.

Objectives: To evaluate underlying causes and predictors of outcome in dogs with CD.

Animals: One hundred and thirty-six client-owned dogs with CD (≥3 weeks duration).

Methods: Retrospective review of medical records (Small Animal Clinic, Freie Universität Berlin, Germany, 09/2009-07/2011). Quantification of final diagnoses and comparison of clinical aspects including disease severity and clinicopathological abnormalities among dogs with clinical remission (either complete [gastrointestinal signs absent] or partial [clinical improvement of gastrointestinal signs and reduced episodes with shortened duration]), and those without recovery.

Results: Ninety percent of dogs were diagnosed with a primary enteropathy: inflammatory (71%; of those 66% dietary responsive, 23% idiopathic, 11% antibiotic responsive), infectious (13%), neoplastic (4%), and in one dog each mechanical disease or systemic vasculitis. Secondary causes were diagnosed in 10% of dogs: exocrine pancreatic (6%), endocrine (2%), and in one dog each hepatic, renal, and cardiac disease. In total, 87% of dogs had clinical remission, whereas 13% died or did not respond to treatment: Lack of recovery was frequently recorded for dogs with primary inflammatory (idiopathic) or neoplastic disease and was significantly associated with increased disease severity scores (P = .005), anemia (hematocrit < 40%, P < .001), severe hypoalbuminemia (serum albumin <2.0 g/dL, P = .008), and severe hypocobalaminemia (serum cobalamin concentration <200 pg/mL, P = .006).

Conclusions and clinical importance: Inflammatory enteropathies and particularly those of dietary origin were the most common causes of CD in dogs. Findings support the usefulness of hematocrit, and serum albumin and cobalamin concentration as prognostic markers in dogs with CD.

Keywords: Enteropathy; Epidemiology; Inflammatory bowel disease; Outcome.

Figure 1

Questionnaire to define outcome groups in dogs with chronic diarrhea. *There was no dog that fulfilled these criteria.

Figure 2

Distribution of primary and secondary causes and frequencies of underlying causes of chronic diarrhea in 136 dogs. Bar graphs representing frequencies of total. PE, primary enteropathy; SE, secondary enteropathy; FRE, food responsive enteropathy (n = 64); ARE, antibiotic responsive enteropathy (n = 11); IBD, idiopathic inflammatory bowel disease (n = 22).

Figure 3

Disease severity in dogs with chronic diarrhea according to outcome (A) and predominant site of disease (B). Box‐and‐whiskers plots showing median, range, and 25th to 75th percentiles. *P < .05 and **P < .01 for Kruskal‐Wallis comparison of differences among medians followed by Mann‐Whitney U‐tests and Bonferroni adjustment for multiple comparisons. CIBDAI, canine inflammatory bowel disease activity index; CR, complete recovery; PR, partial recovery; NR, no recovery; SI, small intestinal disease; LI, large intestinal disease; DI, diffuse intestinal disease.

Figure 4

Comparison of predominance of clinical signs between groups of dogs with either primary or secondary enteropathy (A) and among outcome in dogs with chronic diarrhea (B). Pearson chi‐square or Fisher's exact tests were used to compare categorical variables. Statistical significance was set at P < .05. PE, primary enteropathy; SE, secondary enteropathy; CR, complete recovery; PR, partial recovery; NR, no recovery; SI, small intestinal disease; DI, diffuse intestinal disease; LI, large intestinal disease.

Figure 5

Comparison of clinicopathological abnormalities among outcome groups. Box‐and‐whiskers plots showing median, range and 25th to 75th percentiles for hematocrit (A), serum albumin (B), total serum calcium (C), and cobalamin (D). *P < .05 and ***P < .001 for Kruskal‐Wallis comparison of differences among medians followed by Mann‐Whitney U‐tests and Bonferroni adjustment for multiple comparisons. CR, complete recovery; PR, partial recovery; NR, no recovery.