CARDIOLOGY



Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is a gastrointestinal disorder of both dogs and cats characterized by inflammation of the lining of the stomach and/or intestines. Animals with IBD may present with a variety of symptoms, including:

A. Vomiting

B. Diarrhea

C. Loss of appetite

D. Weight loss

E. Flatulence (aka: gas)

F. Borborygmi (aka: stomach “grumbling”)

These symptoms are not specific for inflammatory bowel disease, as a wide variety of other diseases may manifest the same clinical signs.

IBD is most often termed idiopathic, a term indicating the underlying cause cannot be determined. However, scientific studies have documented genetic influences, food allergies, parasites, intestinal bacterial overgrowth, pancreatic disease, and/or foreign body ingestion may exacerbate inflammatory bowel disease. Furthermore, IBD may occur concurrently with inflammatory diseases of the liver and/or pancreas, reflux esophageal disease, and/or motility disorders of the gastrointestinal tract.

A diagnosis of inflammatory bowel disease may be suspected with a several months-to-years history of waxing/waning clinical signs. However, clinical signs may also manifest acutely (aka: all of sudden). Ultimately, a biopsy of the gastrointestinal tract is required for the definitive diagnosis of inflammatory bowel disease. However, prior to obtaining a biopsy, thorough diagnostic testing including blood/urine tests, fecal tests, abdominal radiography and/or ultrasonography, are performed to rule out other systemic diseases such as bacterial infections, pancreatic disease, and/or focal abnormalities of the gastrointestinal tract.

A biopsy of the gastrointestinal tract may be obtained by one of two methods: abdominal surgery or endoscopy. The decision as to which biopsy method is most beneficial for your pet is based upon a variety factors.

During endoscopy, an endoscope (aka: tube with a fiberoptic camera) is passed via the mouth into the patient’s stomach and/or small intestines (or via the rectum into the colon). Biopsies are obtained by feeding a small biopsy instrument into the endoscope. Although endoscopy does require general anesthesia, the procedure is relatively non-invasive and, in most cases, may be performed on an out-patient basis. Additionally, it allows the veterinarian to visually inspect the inside of the stomach, duodenum (first segment of the small intestines), and/or colon to look for ulcers, polyps, masses, and/or foreign objects.

A major disadvantage of endoscopy is the small size of the biopsy samples, and thus the biopsies may be non-diagnostic. Lymphoma, a relatively common cancer in dogs and cats, may not be detected in endoscopic biopsy samples. Additionally, the endoscopy only extends the first segment of the small intestines and colon, and therefore, some lesions may be beyond its reach.

Surgery is a more invasive method of collecting biopsies of the gastrointestinal tract. The primary advantages of surgery are that this method allows the surgeon to visually and manually inspect all of the patient’s abdominal organs (especially the gastrointestinal tract) and obtain larger (aka: full-thickness) biopsy samples. Additionally, surgery affords the option of corrective procedures, including mass/polyp removal or pyloroplasty (widening of the opening from the stomach into the small intestines) should they be indicated. Surgery is strongly recommended in the following patients:

A. Those in which lymphoma must be conclusively ruled out

B. Those that may have lesions beyond the reach of an endoscope

C. Those that may benefit from pyloroplasty

D. Those that require evaluation and/or biopsy of other organs

Your pet’s veterinarian will discuss with you the method of biopsy most suitable for your pet.

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