Difference between revisions of "Antibiotic Responsive Diarrhoea"
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'''Antibiotic responsive diarrhoea (ARD)''' used to be termed as small intestinal bacterial overgrowth (SIBO). It is a sign of an underlying disease rather than a diagnosis. The aetiology and pathogenesis of this disease is unknown. Few studies have documented the scale of increase in bacterial numbers or whether the growth is responsible for the clinical signs. | '''Antibiotic responsive diarrhoea (ARD)''' used to be termed as small intestinal bacterial overgrowth (SIBO). It is a sign of an underlying disease rather than a diagnosis. The aetiology and pathogenesis of this disease is unknown. Few studies have documented the scale of increase in bacterial numbers or whether the growth is responsible for the clinical signs. | ||
| − | ARD can be claasified as '''idiopathic''' or '''secondary'''. In cases of idiopathic ARD, the only consistent finding is response and remission on antimicrobial therapy. In contrast, there is usually an underlying intestinal disease in cases of secondary ARD. Diseases which affect any of the following functions of the intestines can cause secondary ARD: | + | ARD can be claasified as '''idiopathic''' or '''secondary'''. In cases of idiopathic ARD, the only consistent finding is response and remission on antimicrobial therapy. This has been found to be relatively common, but not exclusively, in young German Shepherd Dogs. This is suggested to be associated with IgA defiency or dysregulation, although the true underlying mechanism could be far more complex and numerous other hypotheses have been proposed. In contrast, there is usually an underlying intestinal disease in cases of secondary ARD. Diseases which affect any of the following functions of the intestines can cause secondary ARD: |
*decreased gastric acid production | *decreased gastric acid production | ||
*increased small intestinal substrate | *increased small intestinal substrate | ||
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==Diagnosis== | ==Diagnosis== | ||
===Clinical Signs=== | ===Clinical Signs=== | ||
| + | *Chronic small intestinal diarrhoea | ||
| + | *Weight loss | ||
| + | *Failure to thrive | ||
| + | *Vomiting | ||
| + | *Variable appetite | ||
| + | *Borborygmi | ||
| + | *Abdominal discomfort | ||
| + | If no localising findings are obvious, a full investigation is recommended. This includes a full routine haematology, biochemistry, urinalysis, faecal bacteriology and parasitologym diagnostic imaging and gastroduodenoscopy. Trypsin-like immunoassay (TLI) can be used diagnose exocrine pancreatic insufficiency (EPI)However, the findings are usually unremarkable in cases of idiopathic ARD. In these instances, a trial treatment with antimicrobial therapy is warranted. If these animals are responsive to the antimicrobial, but the clincal signs relapses upon withdrawal of treatment, a true idiopathic diagnosis can then be made. | ||
| − | + | Currently, the gold standard direct test for diagnosing ARD is duodenal juice culture. However, this is an expensive test and it is rarely availble. | |
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Revision as of 15:07, 17 August 2009
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This article is still under construction. |
Signalment
- Common in young German Shepherd Dogs
Description
Antibiotic responsive diarrhoea (ARD) used to be termed as small intestinal bacterial overgrowth (SIBO). It is a sign of an underlying disease rather than a diagnosis. The aetiology and pathogenesis of this disease is unknown. Few studies have documented the scale of increase in bacterial numbers or whether the growth is responsible for the clinical signs.
ARD can be claasified as idiopathic or secondary. In cases of idiopathic ARD, the only consistent finding is response and remission on antimicrobial therapy. This has been found to be relatively common, but not exclusively, in young German Shepherd Dogs. This is suggested to be associated with IgA defiency or dysregulation, although the true underlying mechanism could be far more complex and numerous other hypotheses have been proposed. In contrast, there is usually an underlying intestinal disease in cases of secondary ARD. Diseases which affect any of the following functions of the intestines can cause secondary ARD:
- decreased gastric acid production
- increased small intestinal substrate
- partial obstructive disorders
- anatomical disorders
- motility disorders
The consequence of ARD are:
- interferance with fluid and nutritional absorption due to dysfunction of the enzymes located at the microvillous.
- disturbance in mucosal permeability.
- deconjugation of bile acids.
- hydroxylation of fatty acids.
Diagnosis
Clinical Signs
- Chronic small intestinal diarrhoea
- Weight loss
- Failure to thrive
- Vomiting
- Variable appetite
- Borborygmi
- Abdominal discomfort
If no localising findings are obvious, a full investigation is recommended. This includes a full routine haematology, biochemistry, urinalysis, faecal bacteriology and parasitologym diagnostic imaging and gastroduodenoscopy. Trypsin-like immunoassay (TLI) can be used diagnose exocrine pancreatic insufficiency (EPI)However, the findings are usually unremarkable in cases of idiopathic ARD. In these instances, a trial treatment with antimicrobial therapy is warranted. If these animals are responsive to the antimicrobial, but the clincal signs relapses upon withdrawal of treatment, a true idiopathic diagnosis can then be made.
Currently, the gold standard direct test for diagnosing ARD is duodenal juice culture. However, this is an expensive test and it is rarely availble.
Diagnostic Imaging
Histopathology
Treatment
Prognosis
References
- Ettinger, S.J. and Feldman, E. C. (2000) Textbook of Veterinary Internal Medicine Diseases of the Dog and Cat Volume 2 (Fifth Edition) W.B. Saunders Company.
- Hall, E.J, Simpson, J.W. and Williams, D.A. (2005) BSAVA Manual of Canine and Feline Gastroenterology (2nd Edition) BSAVA
- Nelson, R.W. and Couto, C.G. (2009) Small Animal Internal Medicine (Fourth Edition) Mosby Elsevier.