Eosinophilic enteritis

Re: Eosinophilic enteritis

Kate Richardson — Tue, 20 Sep 2011 13:03:43 GMT

I think gut biopsies are probably most useful for ruling out neoplasia, especially if you are going to be using corticosteroids, as you this could lead to an initial improvement if you have intestinal lymphoma for example, and then a relapse, after which chemotherapy is less likely to be effective. I tend to make my decision whether to biopsy or not based a bit on whether the client is likely to pursue chemotherapy if neoplasia is diagnosed. If they are not, then I don't feel biopsies really change what I am going to do and become a bit academic.

Re: Eosinophilic enteritis

Mark Holmes — Tue, 20 Sep 2011 12:52:43 GMT

[quote user="David Mills"]

gut biopsies are almost uniformly useless imo - always come back as mixed inflammation, could be LPE could be hypersensitivity etc etc. Given the treatment options are food or limited numbers of drugs the complication rates published mean I've stopped doing them completely. anyone else in the same boat?

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I wouldn't go as far as stopping them completely but I find I rarely need them. Usually bloods and faecal analysis (x2 or 3) and giardia elisa testing. Then exclusion diet. At that point if there has been no improvement I am going to be looking at probably long term medication, and I generally feel if long term mediactaion will needed evry attempt should be made at a diagnosis. Particularly as that medication may involve steroids after which any further histological diagnosis is impossible

Re: Eosinophilic enteritis

Richard Fox — Tue, 20 Sep 2011 11:49:54 GMT

You need to ask yourself why you are taking the biopsy - I see GI biopsies the same as skin biopsies - you need to rule out differentials using non-invasive diagnostics first. A biopsy is there to confirm a differential not for a fishing trip. A lot of the time biopsies may not help you any further than you have already achieved - It is there to help confirm or to identify those diseases that maybe are rare with similar presenting signs such as epitheliotropic lymphoma of the SI etc.

Many GI biopsies are normal or reactive but this isn't a waste of time in my opinion - it suggests that a profound inflammatory condition is not evident and rules out neoplasia etc? Its all useful? Unfortunately many GI and skin biopsies are AETIOLOGICALLY non-specific.

Re: Eosinophilic enteritis

Martin Atkinson — Tue, 20 Sep 2011 11:01:51 GMT

[quote user="David Mills"]

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Depends on whether you're doing endoscopic or full thickness biopsies on ex. lap., I certainly think the former yield limited information and although full thickness biopsies can occasionally give equivocal results they are more often than not useful plus you can also biopsy mesenteric lymph nodes, liver, pancreas etc which will increase the confidence of your diagnosis

Re: Eosinophilic enteritis

David Mills — Mon, 19 Sep 2011 22:29:07 GMT

Re: Eosinophilic enteritis

Mark Holmes — Mon, 19 Sep 2011 16:23:25 GMT

Sorry but I would assume that if you have gone to the extent of gut biopsies then you have already done a food trial? I usually do the food trial before picking up the knife. Just so I don't have to say "well we've done all these tests now have you tried changing its diet"

Re: Eosinophilic enteritis

Martin Atkinson — Mon, 19 Sep 2011 14:54:10 GMT

[quote user="eddapb"]

Have discussed with owner - all other tests were done. Interestingly, the dog never had diarrhoea. Will definitely do exclusion diet - will bear any spare trout in mind for needy vets!

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I haven't see many dogs in which I have diagnosed IBD definitively. Seen loads in cats and vomiting is most often the only symptom.

Re: Eosinophilic enteritis

eddapb — Fri, 16 Sep 2011 21:38:52 GMT

Have discussed with owner - all other tests were done. Interestingly, the dog never had diarrhoea. Will definitely do exclusion diet - will bear any spare trout in mind for needy vets!

Re: Eosinophilic enteritis

Martin Atkinson — Fri, 16 Sep 2011 17:57:01 GMT

[quote user="Richard Fox"]

Anyhow the presence of eosinophils does not imply a hypersensitivity like it does in the skin - I have seen a case of eosinohpilic enteritis in camplylobacter infections which have resolved on Ab's? So I would be careful in suggesting this IS due to a dietary problem - as you say a dietary trial would def. be indicated

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I made the assumption that if someone had gone as far as taking intestinal biopsies that they would have tested the faeces and eliminated parasitic and microbiological causes first. Novel protein dietary trial is definitely the next step. Plus I would suggest some sucralphate if vomiting is a primary symptom.

PS I'm sure trout would be an adequate substitute for salmon, if there's any left can I have some please?!

Re: Eosinophilic enteritis

Richard Fox — Fri, 16 Sep 2011 15:40:03 GMT

The term adverse food reaction I think is now used for dietary responsive enteritis?

Re: Eosinophilic enteritis

eddapb — Fri, 16 Sep 2011 14:11:08 GMT

Thank you for advice re allergy testing. I advised Wafcol Salmon and Potato as exclusion. Trout is an easy novel protein for this owner - anyone know if trout would create any problems instead of salmon?

Re: Eosinophilic enteritis

Utlendigur — Fri, 16 Sep 2011 14:03:29 GMT

I suppose it depends what is meant by "food allergy testing" - blood sample or diet trial? As far as I understand the blood sample version isn't considered reliable for food allergies. Gold standard would be an exculsion diet +/- rechallenge. Prognosis would probably depend on the underlying cause eg underlying chronic IBD or recent development to gut parasites, severity/extent of lesions and any other problems eg EPI, hypoproteinaemia, but if it has responded to treatment so far that bodes well. I'd certainly be inclined to try some sort of hypoallergenic diet to be on the safe side especially if there is a history of the dog being a picky eater (does that equate with being underweight, or any previous intermittent GI signs?) and long course of preds.

Re: Eosinophilic enteritis

Kate Richardson — Fri, 16 Sep 2011 13:51:09 GMT

I would agree to get him/her onto an exclusion diet and not bother with allergy testing. I would also consider giving pred for a bit longer as well (for about 4-6 weeks until the diet is well and truly on board) especially as he/she is a picky eater, as this will treat the inflammation which may be the underlying reason that they are picky in the first place and an increased appetite as a side effect of the pred could be a positive side effect in this case

Re: Eosinophilic enteritis

Clive Ansell — Fri, 16 Sep 2011 13:32:47 GMT

I had a similar case about a year ago in a rough collie, gut biopsies showed the same thing. Started off with preds and dietary trials, and she has done fantastically well on Wafcol Salmon and Potato diet. Been off preds several months now and no further vomiting or clinical signs.

I've not found food allergy testing useful, and go straight for exclusion diets.

Re: Eosinophilic enteritis

Martin Atkinson — Fri, 16 Sep 2011 13:27:52 GMT

[quote user="eddapb"]

I have had a Border diagnosed on git biopsy (pylorus, duodenum and jejunum) with eosinophilic enteritis - some plasmacytes and lymphocytic infiltration. History was 2 weeks vomition off and on. The dog was given Preds and praziquantal/fenbendazole (Quantel) for 5 days and has settled fine - has anyone got any experience with long term prognosis. The dog is 2 years old and always been a picky eater. Is it worth food allergy testing? Any info welcome. Thanks

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Surely this is a nailed on food allergy/hypersensitivity so an exclusion diet is the firstthing to try. Food allergy testing is a waste of time and the client's money.