Helicobacter significance and trial treatment?

RE: Helicobacter significance and trial treatment?

Evelyn Barbour-Hill — Tue, 14 Jun 2016 11:51:06 GMT

Thank you.

RE: Helicobacter significance and trial treatment?

Andrew Kent — Tue, 14 Jun 2016 07:23:28 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Andrew Kent"] Would referral for intestinal biopsies be an option?[/quote]

Andrew, what's the "best" kind of intestinal biopsy? Endoscopic mucosal biopsy? Full-thickness? Jejunal, ileal, duodenal, some of each?

[/quote]

Good question! I think everybody probably has different views on that and it also depends on your definition of best - the reality is that it is often a balance between invasiveness and sample size/quality.

Full thickness biopsies give the best chunks but its an invasive procedure that is not without risk and doesn't necessarily allow samples to be collected from as widespread an area. Endoscopy is minimally invasive and allows sampling along the entire accessible length of intestine.

The reality in most dogs/cats with chronic enteropathies is that the disease is diffuse and therefore endoscopic biopsies are likely to be representative of the disease in the deeper layers but ideally endoscopic biopsies would be taken from everywhere you can get to (which ideally means gastric, duodenal, ileal and colonic biopsies), and use decent biopsy forceps (largest possible for scope).

My approach is to use ultrasound and blood indicators (like folate/cobalamin) to guide me and unless I see a reason not to (predominantly jejunal disease, focal jejunal disease, isolated muscular disease etc) would tend to go for endoscopic mucosal biopsies.

Andy

RE: Helicobacter significance and trial treatment?

Evelyn Barbour-Hill — Mon, 13 Jun 2016 23:43:45 GMT

[quote user="Andrew Kent"] Would referral for intestinal biopsies be an option?[/quote]

Andrew, what's the "best" kind of intestinal biopsy? Endoscopic mucosal biopsy? Full-thickness? Jejunal, ileal, duodenal, some of each?

RE: Helicobacter significance and trial treatment?

Andrew Kent — Mon, 13 Jun 2016 23:17:35 GMT

[quote user="Beats"]There's two different z/d diets (http://www.hillspet.co.uk/en-gb/skin-health/z-d-dog-food.html), just to check Andy it doesn't matter which one you would still think of a new diet trial?[/quote]

I generally don't use either ZD diets in dogs (occasionally in cats if need wet option). The reason is that hydrolysing protein sources is only part of the story and in people (work never been done in animals) 30-40% of them will still react to a protein if it is hydrolysed. So I use the hydrolysed diets that are based on novel protein sources rather than common protein (like chicken) which means HA (soy based) or anallergenic (feather based).

In dogs less than 1 year of age, diet or infection are common, so I would potentially try more than one diet (usually alone, sometimes with antibiotics if concurrent diarrhoea), you will usually see a response within a few weeks.

[quote user="Beats"]Would a novel protein/carb diet be a reasonable alternative diet trial or is hydrolysed best for these?[/quote]

I think novel can work well if you can get a good food history and find something suitable, either commercial or short-term home cooked.

[quote user="Beats"]I like the idea of exhausting non-antibacterial attempts first. If diet trial unsuccessful, is it reasonable to try steroids (+/- vitB12) before anything else?[/quote]

I don't think you really have the evidence of inflammation to support steroid use - that again doesn't mean they won't work but we just don't have anything to say they will. Would referral for intestinal biopsies be an option?

With the waxing and waning history may also be worth a basal cortisol to rule out an atypical addisons.

Andy

RE: Helicobacter significance and trial treatment?

Emily Rainbow — Mon, 13 Jun 2016 21:48:52 GMT

Have you tried omeprazole BID rather than the licenced SID? I've had 2 chronic waxing/waning vomiters improve drastically by that simple change following a discussion at BSAVA:

RE: Helicobacter significance and trial treatment?

Beats — Mon, 13 Jun 2016 20:16:41 GMT

Glad I posted!

Really helpful thoughts

No intestinal biopsies I'm afraid (couldn't get scope through pylorus). No faecal analysis either.

There's two different z/d diets (http://www.hillspet.co.uk/en-gb/skin-health/z-d-dog-food.html), just to check Andy it doesn't matter which one you would still think of a new diet trial?

I've used RC Anallergenic before and might be able to persuade owner to trial of it prior to any medical therapy attempts. Would you literally just try the diet on its own (if so for how long)? Would a novel protein/carb diet be a reasonable alternative diet trial or is hydrolysed best for these?

I like the idea of exhausting non-antibacterial attempts first. If diet trial unsuccessful, is it reasonable to try steroids (+/- vitB12) before anything else?

There has been no clear improvement noted on administration of antacids before.

RE: Helicobacter significance and trial treatment?

Glenn Hodgson — Mon, 13 Jun 2016 17:56:57 GMT

Have you got faecal results? Lots of dogs in out area with clinical campylobacter that erythromycin fixes well.

RE: Helicobacter significance and trial treatment?

Andrew Kent — Mon, 13 Jun 2016 17:21:24 GMT

Personally I wouldn't treat this, I only consider treatment for helicobacter if its associated with inflammatory changes.

Its possible you would see an improvement if you treated but I would put money on that being a non-specific response to antacids rather than due to resolving helicobacter.

Did you get intestinal biopsies? I wonder if the problem is in there as I don't think these biopsies offer an explanation.

In a young dog I might try another diet trial - I don't rate Z/D so perhaps Purina HA or RC Anallergenic.

Andy

RE: Helicobacter significance and trial treatment?

Hannah Wynne Richards — Mon, 13 Jun 2016 16:00:38 GMT

Given the biopsy results I'd treat and see if symptoms disappear. Give amoxycillin and metronidazole at 20mgs/kg bid and omeprazole at 0.7 to 1 mg/kg vid Treat for 14 days. The metronidazole dose is near the toxic limit, so err on the side of caution with this.

Wynne