Evaluation of fecal α1-proteinase inhibitor concentrations in cats with idiopathic inflammatory bowel disease and cats with gastrointestinal neoplasia.

Idiopathic inflammatory bowel disease (IBD) and gastrointestinal lymphoma are common disorders in cats. The aim of this study was to evaluate fecal α(1)-PI concentrations, a marker of gastrointestinal protein loss, in cats with histopathological evidence of gastrointestinal inflammation or gastrointestinal neoplasia. Fecal and serum samples were obtained from 20 cats with chronic gastrointestinal disease in which endoscopic biopsies were performed. Two groups of cats were assembled based on histopathology: Group A (n = 8), mild to moderate IBD; Group B (n = 12), severe IBD or gastrointestinal neoplasia. Fecal α(1)-PI concentrations and serum concentrations of total protein, albumin, globulin, cobalamin, folate, pancreatic lipase immunoreactivity, and trypsin-like immunoreactivity were determined. Nineteen of the 20 diseased cats had elevated fecal α(1)-PI concentrations, ranging from 1.9 to 233.6 µg/g compared to 20 healthy control cats (normal range: ≤1.6 µg/g). Fecal α(1)-PI concentrations were statistically significantly different between healthy cats and cats of Group A (median: 3.9 µg/g, range: 1.3-9.2 µg/g, P < 0.001) or cats of Group B (median: 20.6 µg/g, 4.3-233.6 µg/g; P < 0.001), and between cats of Groups A and B (P < 0.01). Hypoalbuminemia, hypoproteinemia, and hypocobalaminemia were detected in 88%, 83%, and 56% of the diseased cats, respectively. This study suggests that increased fecal α(1)-PI concentrations in association with low serum albumin and total protein concentrations may be a common finding in cats with IBD or gastrointestinal neoplasia. Furthermore, fecal α(1)-PI concentrations appear to be higher in cats with severe IBD or confirmed gastrointestinal neoplasia when compared to cats with mild to moderate IBD.

Comparison of endoscopic and full-thickness biopsy specimens for diagnosis of inflammatory bowel disease and alimentary tract lymphoma in cats.

OBJECTIVE: To evaluate the accuracy of endoscopic biopsy (EB) specimens for diagnosis of alimentary tract lymphosarcoma in cats. DESIGN: Prospective study. ANIMALS: 22 cats with inflammatory bowel disease (IBD) or alimentary tract lymphosarcoma. PROCEDURES: Endoscopic biopsy specimens were obtained during endoscopy of the stomach and duodenum immediately prior to laparotomy or laparoscopic surgery, during which full-thickness biopsy (FTB) specimens were obtained. Accuracy of histopathologic diagnoses was compared between EB and FTB specimens. RESULTS: Lymphosarcoma was diagnosed in 10 cats on the basis of FTB specimens. Lymphosarcoma was detected in the jejunum and ileum in all 10 cats, in the duodenum in 9 cats, and in the stomach in 4 cats. In the same 10 cats, EB findings indicated a diagnosis of lymphosarcoma in 3 cats and were suggestive but inconclusive for lymphosarcoma in 3 cats. Lymphosarcoma was correctly diagnosed via gastric EB specimens in 3 of the 4 cats with gastric lymphosarcoma but evaluation of EB specimens led to an incorrect diagnosis of IBD in 4 cats with small intestinal lymphosarcoma. CONCLUSIONS AND CLINICAL RELEVANCE: EB specimens were useful for diagnosis of gastric lymphosarcoma but were not adequate for differentiating between IBD and lymphosarcoma in the small intestine. Because the most common sites of alimentary tract lymphosarcoma in cats are the jejunum and ileum, FTB specimens of those sites should be obtained via laparotomy or laparoscopy for accurate diagnosis. Laparoscopy may be a minimally invasive alternative to endoscopy and laparotomy for obtaining diagnostic biopsy specimens.

Clinical effects of short-term oral budesonide on the hypothalamic-pituitary-adrenal axis in dogs with inflammatory bowel disease.

Six dogs were entered into a 30-day, prospective, nonrandomized, uncontrolled clinical trial evaluating the effects of an oral preparation of budesonide on the hypothalamic-pituitary-adrenal (HPA) axis during therapeutic management of active inflammatory bowel disease. Oral budesonide, at a dose of 3 mg/m(2), was administered once daily. Upon entry and completion of the trial, serum basal cortisol, adrenocorticotropic (ACTH)-stimulated cortisol, endogenous ACTH concentration, serum alkaline phosphatase (SAP) activity, and urine specific gravity were evaluated, as well as owner assessment of glucocorticoid-associated side effects. Significant suppression of the HPA axis occurred. No significant differences in SAP activity, urine specific gravity, or owner-subjective assessments were detected.

Use of a 13C-aminopyrine blood test: first clinical impressions.

The purpose of this study was to collect initial data to determine the potential clinical usefulness of a 13C-aminopyrine demethylation blood test, and whether additional clinical investigation is warranted. Six dogs, initially suspected of having hepatic disease based on their history, physical examination, imaging studies, general laboratory parameters, or any combination of the above, were enrolled in the study. A baseline blood sample was collected, 2 mg/kg 13C-aminopyrine was administered intravenously, and another blood sample was collected 45 min afterwards. Carbon dioxide was extracted from the blood samples and analyzed using fractional mass spectrometry. Results from the 13C-aminopyrine demethylation blood test were compared to clinical data and histologic findings. Intravenous administration of 13C-aminopyrine leads to a decrease in the percent dose of 13C recovered from dogs with histologically confirmed liver disease. Based on our results, a full-scale investigation of the potential clinical usefulness of a 13C-aminopyrine demethylation blood test for assessment of hepatic function in dogs is warranted.

A comparison of owner management and complications in 67 cats with esophagostomy and percutaneous endoscopic gastrostomy feeding tubes.

Esophagostomy feeding tubes were placed in 46 cats. Percutaneous endoscopic gastrostomy (PEG) feeding tubes were placed in 21 cats. Owner management and complications and facility of use were evaluated retrospectively by review of medical records and owner survey. Both tube types were equally effective for maintenance of body weight, ease of owner management, and complication rates. All of 12 owners surveyed were comfortable with PEG tube management. Ninety-six percent of 24 owners surveyed were comfortable with esophagostomy tube management. The esophagostomy tube can be placed less invasively, without specialized equipment, making it an excellent alternative to the PEG tube.

Optimal fecal assessment.

Fecal testing is a common component of most gastrointestinal work-ups. A multitude of diagnostic techniques are available for identifying parasites and pathogens, or showing abnormalities of flora. Optimal fecal assessment involves careful formulation of a differential list based on signalment, history, and clinical signs. Tests should be selected and interpreted based on their relative sensitivity and specificity for specific conditions. It is essential to use effective testing methods for the etiologies of concern. This article reviews the plethora of diagnostic techniques available for fecal assessment. Indications, limitations, and issues of specimen handling for each technique are discussed. The optimal approach to the diagnosis of some common parasites, pathogens, abnormalities of flora, and metabolic conditions are covered.

Maintenance of gastrointestinal endoscopes.

Endoscopes are used for visualization and biopsy of gastrointestinal lesions, as well as therapeutic procedures, such as foreign body retrieval. In the past, they were primarily used in large institutional settings where specialized personnel could focus on their maintenance. Today, they are becoming increasingly common in general practice. The maintenance of gastrointestinal endoscopes in the veterinary setting involves many challenges, including safe handling, reprocessing, and storage. Meeting these challenges requires well-trained personnel and strict protocols. Reprocessing, which includes cleaning and disinfection, offers the greatest challenge. The complex structure of flexible endoscopes, particularly the long, narrow channels, makes them difficult to clean. Gastrointestinal endoscopes operate in a contaminated environment, exposing them to high levels of organic matter and bacteria. High-level disinfection is necessary for infection control, but liquid germicides available for endoscope disinfection can be toxic to medical personnel and patients.