Selecting appropriate diets for management of chronic enteropathies

Abstract

Gastrointestinal signs including inappetence, vomiting, diarrhoea and weight loss that persist for more than 3 weeks are described as chronic enteropathy. Chronic enteropathies are further classified as food-responsive enteropathy, antimicrobial-responsive enteropathy, immunosuppressant-responsive enteropathy and non-responsive enteropathy. Diagnosis of each type of enteropathy relies on the exclusion of other causes, along with the response to various therapeutic interventions including diet trials, use of therapies directed towards the microbiome and/or immunosuppressant medications. Chronic inflammatory enteropathy is a diagnosis based on the chronicity of clinical signs while inflammatory bowel disease can only be confirmed by obtaining tissue biopsy demonstrating histopathological evidence of intestinal mucosal inflammation. Diet may play a role in the pathogenesis of chronic enteropathies, but it is critical to the management of these patients. Since between 50% and 66% of cases are food responsive, diet trials are essential in the management of these patients. The selection of appropriate therapeutic diets relies on thorough patient nutritional assessment, detailed dietary history (including both historical diets and current diet) and inventory of feeding management practices and the patient's environment.