Fecal and Clinical Profiles of Dogs With Chronic Enteropathies Treated With Bile Acid Sequestrants for 5–47 Months: A Retrospective Case Series

Background

Bile acid (BA) malabsorption and BA diarrhea (BAD) are prevalent but underdiagnosed conditions in people with chronic diarrhea of multiple causes. Recent studies have shown BA dysmetabolism in dogs with chronic enteropathies (CE).

Objective

Describe canine inflammatory bowel disease activity index (CIBDAI), dysbiosis index (DI) and fecal BA concentrations in healthy dogs and dogs with refractory or partially immunosuppressive-responsive CE or CE dogs requiring high doses of corticosteroids, treated with BA sequestrants (BAS).

Animals

Twenty-four CE dogs and 18 healthy dogs.

Methods

Retrospective case series. Dogs with CE were treated with BAS as adjunctive treatment. Fecal BA was analyzed using liquid chromatography–tandem mass spectrometry. Fecal microbiota was assessed using DI. Response to treatment was defined as a decrease in CIBDAI category.

Results

Sixteen of 24 dogs improved clinically after BAS treatment (cholestyramine, 44–133 mg/kg q12h; colesevelam, 7–24 mg/kg q12h; colestipole, 26 mg/kg q24h). Duration of treatment was 5–47 months. Median (range) CIBDAI decreased from 6.5 (4–13) to 3 (2–5) in responders. At baseline, responders had a higher median (range) percentage of fecal unconjugated primary BAs (93 [1–100]) versus non-responders (2.5 [0–95]) and healthy dogs (1.5 [0–19]). Dysbiosis index (median [range]) was higher in responders (4.2 [−4.7 to 9.0]) versus non-responders (−0.1 [−1.5 to 5.7]) and healthy dogs (−4.5 [−6.4 to −0.2]).

Conclusions and Clinical Importance

Treatment with BAS as adjunctive treatment potentially may benefit some dogs with nonresponsive or partially immunosuppressive-responsive enteropathy or CE dogs requiring high doses of corticosteroids.