Journal Club: "Long-term evaluation of the initial response to therapy in 60 dogs with chronic inflammatory enteropathy" by Hodel et al.

Quick Clinical Takeaways

1. Repeating a diet trial can be valuable even if it has failed before -> This study demonstrates that a positive response to a diet trial is still possible even after failing an initial diet trial, as evidenced by the large shift from the immunomodulator responsive enteritis group to the food responsive enteritis group after 1 year. A diet trial is valuable as food responsive enteritis dogs respond better clinically to therapy than immunomodulator responsive enteritis dogs.
2. On a whole, dogs with chronic inflammatory enteropathy can achieve a good quality of life with the right therapy

Short Introduction:

This retrospective cross sectional study evaluated the long-term outcome of dogs with chronic inflammatory enteropathy (CIE) and investigated if they still belonged to the same category one year after diagnosis. Dogs that have been diagnosed with CIE are often classified into either the food responsive enteropathy (FRE), antibiotic responsive enteropathy (ARE), immunomodulator-responsive enteropathy (aka steroid responsive enteropathy) (IRE), or non-responsive enteropathy (NRE) based on response to their initial therapy. However, the long-term outcome of dogs with CIE has not been extensively studied.

Study Design

This was a retrospective cross sectional study that gathered clinical information from 3 time points; Time point of initial response to therapy or intestinal biopsy (TD), Time point of first notable clinical improvement (TIR) and time point of an interview at least one year after biopsy (T>=1y). The interviews were done either by questionnaire or over the telephone.

Inclusion Criteria

60 dogs met inclusion criteria and were investigated. They had:

• More than 3 weeks of gastrointestinal signs and had historical evidence of intestinal inflammation from January 2018 and October 2021 were included
• Had workup done including bloodwork, faecal float or smear or had evidence of regular parasite prevention and had an abdominal ultrasound
• Been treated by internists
• Dogs that had been alive for at least 1 year after biopsy but died by the time of the interview were included as well

Exclusion criteria

• Dogs with specific diagnoses for intestinal inflammation such as histiocytic ulcerative colitis, mycobacteria granulomatous enteritis

Key Findings:

• At time of diagnosis (TD), the median Canine Inflammatory Bowel Disease Activity Index (CIBDAI) was 9 (range 3 -17) but it significantly decreased to 1 (range 0-7) after at least a year (T>=1y), with the only exception being the NRE group.
• At time of diagnosis (TD), the median quality of life score (out of 10) was 4 and it increased to 10 after at least a year (T>=1y).
• Dogs in the FRE group had significantly lower CIBDAI scores and higher QOL than dogs in the IRE and NRE groups
• From time of initial response to therapy (TIR) to after at least a year (T>=1y), 40% of dogs changed group categories which was a significant change; 79% of dogs in IRE changed to FRE, 8% of FRE and 8% of NRE changed to IRE group, and 4% of IRE group changed to NRE group.

Key Limitations:

• Dogs only needed to fail a diet trial once to be placed into the other categories. The ACVIM consensus statement states that at least 3 diet trials should be attempted before a dog can be declared unresponsive to diet [1]. Thus, there is a possibility that the noted changes may not be truly effective as it could just be a dog positively responding to a second diet trial.
• The compliance or quality of the diet trials were not assessed. There is some uncertainty as to whether dogs that have failed the diet trial are truly unresponsive to it or whether it is due to poor compliance.
• Hospital policies could influence recruitment-> No ARE dogs in this study as antibiotics were used as a last resort in the author's hospital.
• The referral influence -> clients may be expecting some form of treatment upon referral and may be less willing to "take a step back" and do a diet trial. Thus, there is a possibility of initially doing immunomodulatory treatment alongside a diet trial before gradually weaning immunomodulators out and this could have influenced the study.
• Dogs in the immunomodulator group received different medications which may have influenced clinical response (Prednisolone, azathioprine, budesonide, cyclosporine or a combination of drugs)
• Interview bias

Thoughts

This is one of my favourite papers as I feel like it's key findings are easy to understand and it can be used as evidence to try to convince clients to remain compliant with a dietary trial or to repeat a dietary trial. The fact that dogs in the other categories (especially IRE) were allocated there despite only failing a dietary trial once highlights the difficulty in trying to get clients to do repeat dietary trials. The key finding of FRE dogs responding better than IRE and NRE dogs would hopefully make it more convincing to repeat a dietary trial in dogs that have had a single unsuccessful dietary trial thus far.

Note: The information provided is for educational and informational purposes only and does not constitute professional medical advice, diagnosis, or treatment. Please seek a veterinarian if your pet is unwell.

References:

1. Heilmann, Romy M., et al. ‘ACVIM–Endorsed Statement: Consensus Statement and Systematic Review on Guidelines for the Diagnosis and Treatment of Chronic Inflammatory Enteropathy in Dogs’. Journal of Veterinary Internal Medicine, vol. 40, no. 1, Jan. 2026, p. aalaf017. DOI.org (Crossref), https://doi.org/10.1093/jvimsj/aalaf017.
2. Hodel, Susan, et al. ‘Long-Term Evaluation of the Initial Response to Therapy in 60 Dogs with Chronic Inflammatory Enteropathy’. Journal of Veterinary Internal Medicine, vol. 38, no. 5, Sept. 2024, pp. 2444–53. DOI.org (Crossref), https://doi.org/10.1111/jvim.17161.