Gastrointestinal Ulcers in Fido?
Jeff Dennis, DVM, DACVIM
Gastrointestinal (GI) ulcerations are inflammatory lesions that extend into the deeper layers of the gastrointestinal tract, going beyond the mucosa. GI ulceration is the result of factors that alter, damage or overwhelm the normal defense and normal repair mechanisms of the GI mucosal barrier. There is no predilection for a particular age group or breed, and signs can be extremely variable from patient to patient. Some patients may have no clinical signs, while others may be in immediate need of intensive support and hospitalization, including blood transfusions.
There are many potential causes of GI ulceration ranging from drugs/medication to tumors. Some cases of ulceration are clear-cut. A prime example would be in a case of high dose aspirin administration in a dog with severe arthritis. Others, and perhaps the majority, are more difficult to determine.
Some of the more common causes of GI ulceration in our pets include
- the ingestion of certain medication (nonsteroidal and steroidal anti-inflammatory drugs)
- metabolic disorders such as kidney failure, liver disease and hypoadrenocorticism (Addison’s disease)
- stress, pain, and/or major medical illness/surgery
- dietary indiscretion or the ingestion of foreign objects
- pancreatitis (inflammation of the pancreas)
- microscopic disease of the GI tract including inflammatory bowel disease or certain types of cancer (lymphosarcoma)
- toxins such as lead
Symptoms- What to Watch For
There are a number of symptoms that patients with gastrointestinal ulceration may exhibit. The most common include any/all of the following:
- vomiting (with or without digested blood)
- abdominal pain
- decreased appetite
- pale gums
A presumptive diagnosis of GI ulceration can sometimes be made on the basis of history and clinical findings such as the previously mentioned aspirin administration or known foreign body ingestion. A full diagnostic work-up is recommend, regardless of the cause.
A complete blood cell count (CBC), biochemical profile and urinalysis should be performed in all cases. A CBC will evaluate for the presence of infections, inflammation and anemia, sometimes associated with gastrointestinal ulceration. A biochemical profile evaluates organ function, which is important to establish if there may be an underlying metabolic disorder.
Screening abdominal radiograph, although often within normal limits, may support the diagnosis of an ulcer secondary to a tumor or foreign body, although an ulcer cannot be seen. An abdominal ultrasound evaluates the abdominal organs and helps assess for the presence of tumors that may be associated with ulcers; however, ultrasound may not identify the GI ulcer itself.
A contrast upper GI study with barium may identify ulcers. It is a safe test; however, is quite time consuming, and although helpful in some patients, results are not always conclusive. Gastrointestinal endoscopy is the gold standard in diagnosing GI issues. It may facilitate the removal of foreign bodies, evaluate for ulcers, and sample tissue for the presence of inflammation or cancer, which may cause the ulcer. It does require general anesthesia in our veterinary patients; however, it is a fairly quick and safe procedure.
Other tests may be recommended on a case-by-case basis. These may include a liver function test for certain liver disorders, an ACTH stimulation test to rule out hypoadrenocorticism (Addison’s disease), and/or a blood lead level if lead exposure is a possibility.
Management of gastrointestinal ulcers centers on treatment of the primary cause and blocking excessive stomach acid production. Rarely, in severe cases control of bleeding and blood transfusions may be indicated.
Withholding all oral intake for a period of time allows the GI tract to rest and is an important part of treatment. Fasting allows the lining of the GI tract to heal. Gradual reintroduction of small amounts of bland food should then be instituted, gradually increasing the amount over several days.
Drugs that decrease acid production by the stomach expedite the resolution of GI ulcers. Examples include Pepcid® (famotidine), Cytotec® (misoprostol) and Prilosec® (omeprazole) to name a few. Gastrointestinal protectants and adsorbents sooth and coat an irritated GI lining and help bind harmful agents. A commonly used medication is Carafate® (sucralfate). Anti-emetic drugs and/or antibiotics are considered to treat some patients on a case-by-case basis. Pain medication should be considered in pets with ulcer disease. Ulcers can cause intense abdominal discomfort, and affected patients may benefit greatly.
Endoscopy or surgery may be indicated to remove foreign objects or tumors causing ulcers, biopsy associated tissue with the ulcer, or remove an area of persistent hemorrhage (surgery). Fluid therapy may be necessary in some patients with severe GI ulceration to correct dehydration. Additionally, blood transfusions may be indicated in the severely anemic patients.