Delayed gastric emptying in a 8 year old Bull Terrier

RE: Delayed gastric emptying in a 8 year old Bull Terrier

Andrew Kent — Thu, 08 Apr 2021 13:08:08 GMT

[quote userid="9239" url="~/001/veterinary-clinical/small-animal/medicine/f/expert-help/29761/delayed-gastric-emptying-in-a-8-year-old-bull-terrier/229596#229596"]We only took abdominal radiographs, not thoracic. What would you look for in thoracic radiography? [/quote]

I guess I would make sure no megaoesophagus - more detailed evaluation about function would require fluoroscopy.

[quote userid="9239" url="~/001/veterinary-clinical/small-animal/medicine/f/expert-help/29761/delayed-gastric-emptying-in-a-8-year-old-bull-terrier/229596#229596"]

For a month now.

Omeprazole 1mg/kg BID

Prednisolone: 0.5mg/kg SID

Cisapride: Started 0.5mg/kg TID and after two weeks decreased to 0.3mg/kg TID

[/quote]

I might taper down and stop the steroid (mindful you might want to biopsy etc). You could move to a wet ultra low-fat diet alongside the meds (eg RCW GI low fat tins).

[quote userid="9239" url="~/001/veterinary-clinical/small-animal/medicine/f/expert-help/29761/delayed-gastric-emptying-in-a-8-year-old-bull-terrier/229596#229596"]We tried Purina HA first and she was worse followed by sweet potato only and she was better.[/quote]

Could encourage us there will be a dietary solution with a bit of tinkering.

[quote userid="9239" url="~/001/veterinary-clinical/small-animal/medicine/f/expert-help/29761/delayed-gastric-emptying-in-a-8-year-old-bull-terrier/229596#229596"]Would you go for full thickness or endoscopic?[/quote]

We would favour endoscopic for invasiveness but ideally would need duodenal and ileal biopsies (the latter via colonoscopy) - the B12 level would be helpful to evaluate the requirement for this.

Andy

RE: Delayed gastric emptying in a 8 year old Bull Terrier

Dinu Catilina — Wed, 07 Apr 2021 22:31:14 GMT

Hi Andy, thank you very much for your input.

[quote userid="2451" url="~/001/veterinary-clinical/small-animal/medicine/f/expert-help/29761/delayed-gastric-emptying-in-a-8-year-old-bull-terrier/229545#229545"]

Have you seen the bloating or is this owner observed? Has it been documented on imaging?

[/quote]

It is owner observed and they video it. The cranial abdomen does seem larger than normal but it is difficult to assess how much in an overweight Bull Terrier. They are rather tubular most of the time anyway.

[quote userid="2451" url="~/001/veterinary-clinical/small-animal/medicine/f/expert-help/29761/delayed-gastric-emptying-in-a-8-year-old-bull-terrier/229545#229545"]So the stomach was small? And motility appeared normal? Ever any thoracic imaging? In an older labrador may be worth just making sure the oesophagus looks normal.[/quote]

The stomach was small and empty when we saw her but she was starved for 24 hours for gastroscopy.

We only took abdominal radiographs, not thoracic. What would you look for in thoracic radiography?

The oesophagus looked normal on endoscopy. The pancreas unremarkable on ultrasound and macroscopic during exlap.

[quote userid="2451" url="~/001/veterinary-clinical/small-animal/medicine/f/expert-help/29761/delayed-gastric-emptying-in-a-8-year-old-bull-terrier/229545#229545"]I'm not sure how well this performs with chronic pancreatitis. Did the pancreas look normal on ultrasound? Ever had a DGGR lipase or cPLI? Cortisol? B12/folate?[/quote]

None of the above, I will speak to the owners and do them. Because she never had any diarrhoea I didn't investigate too much in this direction.

[quote userid="2451" url="~/001/veterinary-clinical/small-animal/medicine/f/expert-help/29761/delayed-gastric-emptying-in-a-8-year-old-bull-terrier/229545#229545"]

Dinu Catilina said:
Started treatment with Omeprazole/Prednisolone/Cisapride

What dose/frequency and for how long?

[/quote]

For a month now.

Omeprazole 1mg/kg BID

Prednisolone: 0.5mg/kg SID

Cisapride: Started 0.5mg/kg TID and after two weeks decreased to 0.3mg/kg TID

[quote userid="2451" url="~/001/veterinary-clinical/small-animal/medicine/f/expert-help/29761/delayed-gastric-emptying-in-a-8-year-old-bull-terrier/229545#229545"]With the suspicion of GORD you could consider a trial of omeprazole (dosed BID), metoclopramide or cisapride and an ultra low-fat wet diet for a month or so to see if it helps.[/quote]

We tried Purina HA first and she was worse followed by sweet potato only and she was better. This food trial was done while on the above treatment.

[quote userid="2451" url="~/001/veterinary-clinical/small-animal/medicine/f/expert-help/29761/delayed-gastric-emptying-in-a-8-year-old-bull-terrier/229545#229545"]You likely wouldn't get that on gastric biopsies (delayed gastric emptying is often more to do with poor proximal intestinal motility) so you may need to investigate for intestinal disease as above.[/quote]

I feel like an idiot not for not taking biopsies from the intestine as well.

I'll speak to the owner and see if they are willing to check the cPLI ( the pancreatic screen we did with Finn should in theory be the equivalent), folate, DGGR lipase and see if we can biopsy the intestine as well. Would you go for full thickness or endoscopic?

[quote userid="2451" url="~/001/veterinary-clinical/small-animal/medicine/f/expert-help/29761/delayed-gastric-emptying-in-a-8-year-old-bull-terrier/229545#229545"]You could also consider referral for a fluoroscopic swallow study to see if you can document reflux.[/quote]

I will speak to them but I'm not sure referral is financially an option.

Thank you very much again, please let me know if you have any other suggestions.

RE: Delayed gastric emptying in a 8 year old Bull Terrier

Andrew Kent — Mon, 05 Apr 2021 06:39:39 GMT

Hi Dinu,

Some of these cases can be a real challenge!

[quote userid="9239" url="~/001/veterinary-clinical/small-animal/medicine/f/expert-help/29761/delayed-gastric-emptying-in-a-8-year-old-bull-terrier"]I saw this case as a second opinion with a history of bloat and being unwell for over 12 months, initially rare episodes that became more frequent. She was diagnosed with pancreatitis and received symptomatic treatment each time. The episodes became more frequent and by the time I saw her she was on cerenia tablets daily and pain relief in the night. No diarrhoea. No vomiting but gulping and lip smacking in the night. [/quote]

Have you seen the bloating or is this owner observed? Has it been documented on imaging?

The clinical signs sound more suspicious for gastro-oesophageal reflux +/- oesophagitis...

[quote userid="9239" url="~/001/veterinary-clinical/small-animal/medicine/f/expert-help/29761/delayed-gastric-emptying-in-a-8-year-old-bull-terrier"]Clinical examination unremarkable. The only abnormality on abdominal ultrasound - smaller kidneys with irregular cortices. I sent a urine for UPC which came back as 1.7.[/quote]

So the stomach was small? And motility appeared normal? Ever any thoracic imaging? In an older labrador may be worth just making sure the oesophagus looks normal.

[quote userid="9239" url="~/001/veterinary-clinical/small-animal/medicine/f/expert-help/29761/delayed-gastric-emptying-in-a-8-year-old-bull-terrier"]Pancreatic screen Finn - negative, no suspicion of pancreatitis. [/quote]

I'm not sure how well this performs with chronic pancreatitis. Did the pancreas look normal on ultrasound? Ever had a DGGR lipase or cPLI? Cortisol? B12/folate?

[quote userid="9239" url="~/001/veterinary-clinical/small-animal/medicine/f/expert-help/29761/delayed-gastric-emptying-in-a-8-year-old-bull-terrier"]Started treatment with Omeprazole/Prednisolone/Cisapride [/quote]

What dose/frequency and for how long?

There is nothing very exciting in the gastric biopsies, but then in dogs it is uncommon to see significant pathology in the stomach so its more likely you would see change in the intestine. Gastric sampling is rarely helpful in isolation.

With the suspicion of GORD you could consider a trial of omeprazole (dosed BID), metoclopramide or cisapride and an ultra low-fat wet diet for a month or so to see if it helps. You could also consider referral for a fluoroscopic swallow study to see if you can document reflux.

If this is more of a GI and we feel these are episodes of poor motility then most commonly that relates to underlying chronic enteropathy - any diet trials been performed? You likely wouldn't get that on gastric biopsies (delayed gastric emptying is often more to do with poor proximal intestinal motility) so you may need to investigate for intestinal disease as above.

Often these come down to trial and error - particularly with diet. So, as before, initially consider wet and ultra low-fat as it will empty from the stomach more quickly. if that doesn't help consider novel protein/hydrolysed.

Hope that helps!

Andy