Small Animal Referral Hospital Chronic Inflammatory Enteropathies (CIE)

• CIEs are diagnosed when other causes of intestinal inflammation have been excluded
• Common clinical signs include vomiting, diarrhoea, inappetence, lethargy and weight loss
• The most common cause is a food intolerance
• Dietary modification is the cornerstone of management
• Long term therapy is often required; intermittent ‘flares’ in disease are common

Chronic inflammatory enteropathies (CIE) are a group of diseases characterised by inflammation in the lining of the stomach and intestines. This inflammation can be caused by various factors including food intolerances, alterations in the intestinal microbiome (the bacterial population that usually live in the gastrointestinal tract) or immune system disorders. In some patients, multiple of these factors will be contributing to their CIE.

Typical clinical signs in patients with CIE are variable, but include inappetence, vomiting, diarrhoea, weight loss, poor coat quality and lethargy. A working diagnosis is usually made by a combination of clinical history, physical examination and diagnostic testing including laboratory (blood, urine, faecal) tests and imaging studies - which rule out other possible causes of the clinical signs.

The majority (approximately two thirds) of CIEs are caused by food intolerance - therefore, following initial investigation, then next appropriate diagnostic and therapeutic step is a diet trial. Patients whose clinical signs resolve with a diet trial are classified as having a Food Responsive Enteropathy (FRE).

If clinical signs are resolved by a diet trial, your pet will be classified as having a Food Responsive Enteropathy (FRE).

Please see our handout on diet trials for more information.

For patients not responding to diet trials, then next diagnostic step is usually endoscopy (camera assessment and biopsies of the stomach and intestines under anaesthesia) - to provide further information on the type of CIE present, to evaluate for other diseases in the lining of the intestinal tract, and to guide ongoing treatment.

Steroids are drugs that suppress inflammation and the immune system. Steroid Responsive Enteropathies (SRE) describe CIEs that improve with steroid therapy - sometimes this is able to be discontinued over weeks to months, whereas some patients require longer term (or life-long) steroid therapy. Where long term steroid therapy is needed, often alternative immunomodulatory drugs are used (to avoid longer term side effects which are often associated with steroids).

Sadly some patients (approximately 10%) with CIEs are classified as having a Non-Responsive Enteropathy (NRE) where they do not improve despite dietary modification, steroids/immunomodulatory therapy or other management options.

• Vitamin B9/B12 supplementation – these essential vitamins are often low in patients with intestinal disease as they cannot be absorbed adequately across the diseased intestine

It is common for patients with CIEs to have intermittent ‘flares’ in their signs. Where these persist for more than a few days, additional temporary symptomatic treatment may be required for a few days to a week, to improve their clinical signs - these can include:

• Pre, pro or synbiotics - these are supplements that contain live bacteria (probiotics), ingredients to support recovery of the gastrointestinal microbiome (prebiotics) or both (synbiotics)
• Supplemental dietary fibre (either commercial supplements or primary ingredients such as psyllium husk or chia seeds)
• Anti-nausea medications (e.g. maropitant, ondansetron) or appetite stimulants (e.g. capromorelin, mirtazapine)