Cholestyramine treatment in two dogs with presumptive bile acid diarrhoea: a case report.

BACKGROUND: In people, bile acid diarrhoea is a prevalent complication of Crohn's disease and diarrhoea-associated irritable bowel syndrome. Affected patients typically respond to bile acid sequestrants, such as cholestyramine, but human gastroenterologists often fail to recognize bile acid diarrhoea. Consequently, bile acid diarrhoea is regarded as an underrecognized and undertreated condition in human medicine. Due to lack of diagnostic tools, clinical response to bile acid sequestrants is often used to confirm a diagnosis of bile acid diarrhoea in people. Several recent studies have shown that bile acid dysmetabolism also occurs in dogs with chronic enteropathies. It has further been shown that dogs with chronic enteropathies have significantly decreased expression of a bile acid transport protein in the ileum compared to healthy dogs, which correlates with faecal bile acid dysmetabolism. Consequently, in spite of the lack of reports in the literature, bile acid diarrhoea is likely to exist in dogs as well. CASE DESCRIPTIONS: Two dogs, an 8-year old Rottweiler and a 4.5-year old Siberian Husky were evaluated for chronic watery diarrhoea. Neither dog responded to dietary trials, probiotics, cyclosporine, faecal microbial transplantations or metronidazole. One of the dogs responded to high daily doses of corticosteroids, which were however associated with unacceptable side effects. The other dog was refractory to all standard treatment protocols, including cyclosporine and corticosteroids. Since none of the dogs responded satisfactorily to standard treatment or modulation of the intestinal microbiome, a suspicion of possible bile acid diarrhoea was raised. Treatment with cholestyramine, a bile acid sequestrant was initiated and resulted in marked improvement of faecal consistency, frequency of defecation and activity level in both dogs. CONCLUSION: This report presents two dogs with presumed bile acid diarrhoea that were successfully treated with cholestyramine. Therefore, bile acid diarrhoea should be considered as a possible diagnosis in dogs with treatment-refractory chronic diarrhoea.

Effects of oral versus parenteral cobalamin supplementation on methylmalonic acid and homocysteine concentrations in dogs with chronic enteropathies and low cobalamin concentrations.

The objective of this study was to compare the effects of parenteral (PE) versus oral (PO) cobalamin supplementation on serum methylmalonic acid (MMA) and homocysteine (HCY) concentrations in dogs with hypocobalaminaemia. Thirty-six dogs with serum cobalamin concentrations below 285ng/L (reference interval (RI): 244-959ng/L) were treated with PO (0.25-1.0mg daily) or PE cobalamin (0.25-1.2mg/injection) using a block-randomized schedule. Serum MMA and HCY concentrations were analysed at day 0, 28 and 90 after start of supplementation. There was no significant difference between the PO and PE group regarding serum MMA or HCY concentrations at any time point. Median (range, P comparing baseline and 28 days, P comparing 28days and 90 days) serum MMA concentrations (nmol/L; RI 415-1193) were 932 (566-2468) in the PO and 943 (508-1900) in the PE group at baseline, respectively, 705 (386-1465, P<0.0001) and 696 (377-932, P<0.0001) after 28 days, and 739 (450-1221, P=0.58) and 690 (349-1145, P=0.76) after 90 days. Serum HCY concentrations (median (range), P comparing baseline and 28 days, P comparing 28days and 90 days, µmol/L; RI 5.9-31.9) in the PO and PE groups were 12.2 (3.3-62.2) and 8.4 (3.7-34.8) at baseline, 12.5 (5.0-45.0, P=0.61) and 8.0 (3.8-18.3, P=0.28) after 28 days, and 17.7 (7.3-60.0 P=0.07) and 12.4 (6.3-33.1, P=0.0007) after 90 days, respectively. Oral and parenteral cobalamin supplementation had the same effect on serum MMA concentrations in this group of dogs.

Comparison of efficacy of oral and parenteral cobalamin supplementation in normalising low cobalamin concentrations in dogs: A randomised controlled study.

The aim of this study was to compare the efficacies of parenteral and oral cobalamin supplementation protocols in dogs with chronic enteropathies and low cobalamin concentrations. It was hypothesised that both treatments would increase serum cobalamin concentrations significantly. Fifty-three dogs with chronic enteropathies and serum cobalamin concentrations<285ng/L (reference interval 244-959ng/L) were enrolled. Dogs were randomised to treatment with either daily oral cobalamin tablets (0.25-1.0mg cyanocobalamin daily according to body weight) or parenteral cobalamin (0.4-1.2mg hydroxycobalamin according to body weight). Serum cobalamin concentrations were analysed 28±5days and 90±15days after initiation of supplementation. After 28 days, all dogs had serum cobalamin concentrations within the reference interval or above. In the parenteral group (n=26), median (range) cobalamin concentrations were 228 (150-285) ng/L at inclusion, 2107 (725-10,009) ng/L after 28days and 877 (188-1267) ng/L after 90 days. In the oral group (n=27), median (range) serum cobalamin concentrations were 245 (150-285) ng/L at inclusion, 975 (564-2385) ng/L after 28days and 1244 (738-4999) ng/L after 90 days. In both groups, there were significant differences in serum cobalamin concentrations between baseline and 28 days, and between 28days and 90days (P<0.001). In conclusion, both parenteral and oral cobalamin supplementation effectively increase serum cobalamin concentrations in dogs with chronic enteropathies and low cobalamin concentrations.

Oral Cobalamin Supplementation in Dogs with Chronic Enteropathies and Hypocobalaminemia.

BACKGROUND: Cobalamin deficiency is commonly associated with chronic enteropathies (CE) in dogs and current treatment protocols recommend parenteral supplementation. In humans, several studies have reported equal efficacy of oral and parenteral cobalamin administration of cobalamin. OBJECTIVES: To retrospectively evaluate whether oral cobalamin supplementation can restore normocobalaminemia in dogs with CE and hypocobalaminemia. ANIMALS: Fifty-one client-owned dogs with various signs of CE and hypocobalaminemia. MATERIAL AND METHODS: Retrospective study based on a computerized database search for dogs treated at Evidensia Specialist Animal Hospital, Helsingborg, Sweden during January 2012-March 2014. Inclusion criteria were dogs with signs of CE, an initial serum cobalamin ≤270 ng/L (reference interval: 234-811 ng/L) and oral treatment with cobalamin tablets. Serum cobalamin for follow-up was analyzed 20-202 days after continuous oral cobalamin supplementation started. RESULTS: All dogs became normocobalaminemic with oral cobalamin supplementation. The mean increase in serum cobalamin concentration after treatment was 794 ± 462 ng/L. Serum cobalamin concentrations were significantly higher after supplementation (mean 1017 ± 460 ng/L; P < .0001) than at baseline (mean 223 ± 33 ng/L). CONCLUSION AND CLINICAL IMPORTANCE: Our results suggest that oral cobalamin supplementation is effective in normalizing serum cobalamin concentrations in dogs with CE. Prospective studies comparing cellular cobalamin status in dogs being treated with parenteral versus oral cobalamin supplementation are warranted before oral supplementation can be recommended for routine supplementation.

Evaluation of preputial cytology in diagnosing oestrogen producing testicular tumours in dogs.

OBJECTIVES: The purpose of this study was to evaluate the diagnostic sensitivity and specificity of preputial cytology in oestrogen producing testicular tumours in dogs. METHODS: Forty-five dogs with palpable testicular masses and 30 healthy control dogs were included. Dogs were evaluated for signs of alopecia and/or feminisation. Analyses of preputial cytology, haematology and serum oestradiol were performed. Dogs with testicular masses were neutered and the testes were submitted for histopathological examination. The dogs were divided into three groups (1) control dogs (n=30), (2) dogs with a testicular mass and serum oestradiol concentration <40 pmol/L (n=35), (3) dogs with a testicular mass and serum oestradiol concentration >40 pmol/L (n=10). RESULTS: More than 20% superficial cells in preputial smear was significantly associated with serum oestradiol concentration >40 pmol/L (P<0·001). The number of superficial cells was significantly increased (P<0·001) in preputial smears from dogs with alopecia. CLINICAL SIGNIFICANCE: It appears that the preputial cytology has a high sensitivity and specificity for the diagnosis of oestrogen producing testicular tumours in dogs.

Reducing the dilution of breath samples for breath hydrogen testing.

Breath hydrogen testing has a diagnostic potential as a gastrointestinal function test that could be performed in general practice. The purpose of this study was to improve techniques for collection of breath samples and transfer of samples to transport vessels. Breath samples from 10 dogs were collected using both a snug-fitting and a loose-fitting standard anesthetic mask attached to a reservoir bag, and a modified snug-fitting system. CO(2) was used as internal standard and mean CO(2) concentrations were 1.19+/-0.76, 2.17+/-0.66 and 2.68+/-0.92, respectively. Additional samples were saved in transport tubes for 19 days, during which the hydrogen and carbon dioxide concentrations remained stable. A reliable method for transferring the breath samples from the reservoir bag to vacuum transport tubes was also identified. Our results demonstrate less contamination of breath samples with air than previously reported, and a reproducible method to transfer breath samples to transport vessels.