Pet column: What is up with CIE in dogs?

Dr. Ron Carsten
Integrative Pet Vet

Inflammation in the body is beneficial, but too much of a good thing can be bad. Especially when excess, unregulated inflammation in the intestines leads to chronic diarrhea caused by a condition called chronic inflammatory enteropathy (CIE).

Diarrhea is considered chronic when it has been present for three weeks or longer. Anyone that has had the experience of helping their dog companion deal with diarrhea knows how stressful it can be. Worry, accidents in the house, frequent trips outside during the night, and occasional vomiting can be a challenge.

One report estimates that 20-30% of veterinary appointments are related to vomiting and diarrhea in dogs. This is perhaps not surprising because digestion is such a complex process, and there are numerous causes of diarrhea. Intestinal causes include parasites, viral infections, eating inappropriate things, changes in diet, food sensitivities, cancer, and inflammation. Diarrhea caused by problems outside of the intestines include liver or kidney disease, pancreatitis, adrenal dysfunction, and even heart disease. Issues like imbalance in the intestinal flora (microbiota), irregularities in autonomic nervous system control, and stress or anxiety can be contributors.

In one study of chronic diarrhea in dogs, it was determined that 90% had a problem in the intestines and not outside of the intestines like liver disease. Chronic inflammation in the intestine caused diarrhea in 79% of those dogs. These are the dogs with CIE.

Some dogs and some breeds like German Shepherds and Boxers have a genetic predisposition to an imbalanced immune reaction in the digestive tract. This combined with additional immune stressors like a disrupted intestinal flora, food sensitivities, vitamin deficiencies, and early life exposures can contribute to CIE.

Diagnosing CIE requires ruling out other causes of chronic diarrhea. This process involves a range of blood tests and stool evaluation. Abdominal ultrasound and even biopsies of the intestine are valuable. Biopsies confirm the diagnosis and provide information about the inflammatory cells. Unfortunately, obtaining intestinal biopsies is invasive and not always done.

When other causes of chronic diarrhea have been ruled out and the conclusion is that CIE is causing the diarrhea, a support plan should be initiated that addresses the contributors to the intestinal inflammation. Studies show that approximately half of dogs with CIE are triggered by food sensitivities that result in intestine inflammation. This means that a critical first step is a therapeutic food trial with a limited ingredient food or preferably a hydrolyzed diet. It can take 8-12 weeks to determine the effect or benefit of the food trial.

If the food trial does not control the diarrhea, immune suppressive drugs may be used as the next step. After a reasonable course of immune suppressive drugs, antibiotics may be used. However, antibiotic use is being discouraged. Current research indicates that antibiotics have no or minimal impact on shortening the course of the diarrhea. The antibiotics often distort the flora in ways that are difficult to recover from. Dogs that do not respond to the food trial, immune suppressive treatments, or antibiotics (if used) are considered to have idiopathic inflammatory bowel disease. This means that the cause has not been determined. Some dogs have a complicating factor where there is ongoing loss of protein from the blood into the intestine. This is known as a protein losing enteropathy.

During the feeding trial, other diarrhea contributors should be addressed. Supplementation with cobalamin, folate, and vitamin D may be indicated by test results. Keep in mind that it can take weeks to correct these deficiencies. Addressing issues with the intestinal flora is also fundamental to managing CIE. It can take 6-8 weeks or longer to effect a sustainable shift in the flora. Probiotics and prebiotics are generally necessary. In some situations, fecal transfer may be required. Abnormal intestinal motility can affect the flora in the intestine. Intestinal motility can be influenced by stress and anxiety.

Modulating stress can have important benefits. Regulation of digestion can also be impacted by spinal column alignment issues that influence the autonomic nervous system. Supplements like glutamine and arabinogalactan that support the intestinal lining may be valuable in the early support plan. Inflammation modulating herbs like boswellia and marshmallow root may play an important role in the health of the intestinal lining.

Managing chronic diarrhea in dogs can be challenging. Providing a comprehensive support plan is based on having a clear understanding of the causes. If you have questions about CIE in your dog, contact your veterinarian.

Ron Carsten, DVM, PhD, CVA, CCRT was one of the first veterinarians in Colorado to use the integrative approach, has lectured widely to veterinarians, and has been a pioneer in the therapeutic use of food concentrates to manage clinical problems. He is also the founder of Colorado Animal Rescue (CARE). In addition to his Doctor of Veterinary Medicine, he holds a PhD in Cell and Molecular Biology and is a Certified Veterinary Acupuncturist and Certified Canine Rehabilitation Therapist. He practices integrative veterinary medicine in Glenwood Springs. Dr. Carsten is the 2022 Colorado Veterinary Medical Association Distinguished Service Award recipient.

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