References
Chronic inflammatory enteropathy: faecal microbiota transplantation in clinical practice
Abstract
Chronic inflammatory enteropathy is an umbrella term that encompasses various inflammatory disorders of the gastrointestinal tract. In the absence of identifiable underlying infectious, neoplastic or metabolic causes, chronic or recurrent signs of gastrointestinal disease and histopathological evidence of mucosal inflammation are the hallmarks of chronic inflammatory enteropathy. Subgroups of chronic inflammatory enteropathy are retrospectively categorised as food-responsive, immunosuppression-responsive, small intestinal dysbiosis or non-responsive based on the selective response to therapeutic trials. Small intestinal dysbiosis is an overarching term used to describe derangement of the small intestinal microbiota caused by an abnormal proliferation of bacteria and/or change in bacterial species present in the small intestinal lumen. The pathogenesis of chronic inflammatory enteropathy remains elusive, although current hypotheses emphasise the role of adverse immune responses to dietary and microbial antigens thought to arise from immune system dysregulation, genetic susceptibility and intestinal dysbiosis. The gastrointestinal tract of dogs is colonised by a vast population of microorganisms, known as the intestinal microbiota, which is composed of viruses, fungi, bacteria and protozoa. Clinical use of faecal microbiota transplantation in promoting normobiosis has been gaining popularity within the field of canine gastroenterology. This modifies the intestinal bacterial microbiota and has shown promise as an adjunctive treatment of enteric disease, associated with a faster resolution of diarrhoea and enhanced clinical recovery.
Chronic inflammatory enteropathy is a collective term that typifies disorders of the gastrointestinal tract (small intestinal and/or large intestinal) distinguished by recurrent or persistent gastrointestinal signs (defined as longer than 3 weeks' duration) and histopathological evidence of primary intestinal mucosal inflammation. Clinical signs such as hyporexia, nausea, weight loss, abdominal pain, vomiting and diarrhoea result from uncontrolled inflammation that may be constant or periodic in nature. Inflammatory enteropathies have been found in up to 70% of dogs with chronic diarrhoea (Volkmann et al, 2017), and are deemed to be the most common cause of gastrointestinal disease.
Classifications of chronic inflammatory enteropathy have historically been described in accordance with the clinical response to various therapies involving dietary manipulation (food-responsive enteropathy), empiric treatment with antibiotics (antibiotic-responsive enteropathy) and immunomodulatory therapies (immunosuppression-responsive enteropathy). Although the use of antimicrobials in chronic inflammatory enteropathy is considered out-dated to modern advancements in veterinary practice and has largely been replaced by an attempt to manipulate bacterial populations in small intestinal dysbiosis. A subset of dogs with immunosuppression-responsive enteropathy that respond to prednisolone are aptly categorised as a separate phenotype of chronic inflammatory enteropathy, known as steroid-responsive enteropathy. By the same token, non-responsive or refractory chronic idiopathic enteropathy consists of patients that fail these therapies (Figure 1).
Register now to continue reading
Thank you for visiting The Veterinary Nurse and reading some of our peer-reviewed content for veterinary professionals. To continue reading this article, please register today.