Refractory Canine Protein-Losing Enteropathy: What Are the Options?

摘要

Protein-losing enteropathy (PLE) is a syndrome of excessive protein loss across the enteric mucosa. PLE has been identified as a consequence of a wide variety of disorders in the canine including infectious (parasitic enteritis, fungal enteritis), neoplastic (alimentary lymphoma, gastrointestinal adenocarcinoma), mechanical (foreign body obstruction, intussusception), miscellaneous (intestinal erosions/ulcerations, right-sided heart failure, pericarditis, portal hypertension) and inflammatory processes. In clinical practice the most commonly diagnosed disorders resulting in PLE are chronic enteropathies (CE) and intestinal lymphangiectasia (IL). As a reminder and for clarification, the use of the term "chronic enteropathy" can be applied to any dogwith chronic gastrointestinal signs in which extra-intestinal disease, infectious causes, neoplasia and intestinal disease of other etiology (e.g., mechanical obstruction) have been reasonably excluded. The use of the term CE allows for inclusion of dogsthat have not had intestinal inflammation documented (i.e., an intestinal biopsy has not been performed) and includes dogs that may ultimately be food-responsive, antimicrobial-responsive, steroid or immunosuppressant-responsive, or non-responsive.1 When an intestinal biopsy has been performed and intestinal inflammation documented, the term chronic inflammatory enteropathy (CIE) or inflammatory bowel disease (IBD) can be applied.