Chronisch-entzündliche Darmerkrankungen beim Hund – diagnostische und therapeutische Aspekte

Zusammenfassung

Als chronische Enteropathien werden über mindestens 3 Wochen andauernde gastrointestinale Symptome wie Vomitus, Diarrhö, Borborygmus, Gewichtsverlust oder abdominale Dolenz bezeichnet. Die Diagnose erfordert Labor- und Kotuntersuchungen sowie bildgebende Diagnostik zum Ausschluss infektiöser oder mechanisch-obstruktiver gastrointestinaler sowie extragastrointestinaler Ursachen. Spezifische labordiagnostische Tests wie z. B. die Bestimmung der Cobalamin- und Folsäurekonzentration im Serum geben zudem Hinweise auf das Vorliegen einer distalen bzw. proximalen Dünndarmerkrankung. Die chronische Enteropathie beinhaltet die Futtermittel-responsive (FRE), Antibiotika-responsive (ARE), Immunsuppressiva-responsive bzw. -refraktäre (IRE) und nichtresponsive Enteropathie (NRE), die retrospektiv durch ihr Ansprechen auf empirische Therapieversuche diagnostiziert werden. Eine Sonderstellung nimmt die Proteinverlust-Enteropathie (PLE) ein, die mit einer schlechteren Prognose einhergeht. Sie stellt eine Folge verschiedener Grunderkrankungen dar, wie schwergradige entzündliche oder neoplastische Darmerkrankungen oder primäre intes tinale Lymphangiektasien. Zur besseren Vergleichbarkeit des Schweregrades der Erkrankung und zur objektiveren Einschätzung einer Verbesserung der klinischen Symptomatik unter Therapie dienen numerische Bewertungssysteme (CIBDAI, CCECAI), die die Ausprägung verschiedener klinischer sowie labordiagnostischer Parameter bewerten. Die Prognose der chronischen Enteropathie ist abhängig von der zugrundeliegenden Ursache. Tiere mit FRE zeigen meist ein schnelles Ansprechen und eine gute Langzeitkontrolle ihrer Erkrankung. Bei Hunden mit IRE oder PLE besteht hingegen ein variabler Therapieerfolg und es kommt häufig zu Rückfällen.

Summary

Chronic enteropathies are characterized by persistent or recurrent gastrointestinal signs for a minimum duration of 3 weeks. Clinical signs for chronic enteropathies include vomiting, diarrhea, borborygm, weight loss, and abdominal pain. Clinicopathologic parameters, fecal examination, and diagnostic imaging findings are important to exclude other (e.g., infectious or obstructive) gastrointestinal and extragastrointestinal etiologies. Specific diagnostic tests, including the determination of the serum cobalamin and folate concentrations, can help to evaluate the patient for gastrointestinal disease and to determine the disease location (distal vs. proximal small intestine). Chronic inflammatory enteropathies are retrospectively classified as food-responsive enteropathy (FRE), antibiotic-responsive enteropathy (ARE), immunosuppressant-responsive or -refractory enteropathy (IRE), or non-responsive enteropathy (NRE), based on the response to empirical treatment. The term protein-losing enteropathy (PLE) is used for a subgroup of affected dogs with intestinal protein loss, and has been shown to display a worse prognosis. PLE can be induced by severe intestinal inflammation, neoplasia, or primary intestinal lymphangiectasia. Clinical scoring systems (CIBDAI, CCECAI) have been established in dogs, which can be applied to objectively assess the severity of clinical signs at the time of diagnosis and to monitor patient improvement during treatment. The prognosis in dogs with chronic enteropathy depends on the underlying etiopathogenesis. Dogs diagnosed with FRE typically respond favorably and display good long-term control with appropriate dietary management, whereas the response to treatment varies in dogs with IRE or PLE, with frequent relapses of clinical signs.

Schlüsselwörter

Chronische Enteropathie - Inflammatory Bowel Disease - Futtermittelresponsive Enteropathie - Immunsuppressiva-responsive Enteropathie

Key words

Chronic enteropathy - inflammatory bowel disease - food-responsive diarrhea - immunosuppressant-responsive enteropathy

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