Chronic enteropathy

Quick Anchor

Recognize the pattern first.

Chronic enteropathy is a syndrome, not a single diagnosis. The classic dog has chronic small bowel diarrhea, intermittent vomiting, weight loss, altered appetite, or borborygmi. Some cases look more colitic, but pure large bowel signs should still keep parasites, dietary issues, and primary colitis on the list.

• Signalment is variable; German Shepherd Dogs, Boxers, French Bulldogs, and some terriers appear often in stems.
• Low body condition, chronic waxing and waning signs, and poor response to random diet changes are common clues.
• Hypocobalaminemia is common and can worsen mucosal disease, weight loss, and poor response to treatment.

Exam Core

Core concepts the exam expects.

The workup starts by excluding disorders that can look identical from the outside. That means a minimum database, repeated fecal assessment or empiric deworming, consideration of Giardia, and a deliberate search for endocrine, pancreatic, infectious, and infiltrative disease.

• Do not label the case too early. Chronic enteropathy remains a diagnosis of exclusion until the basics are addressed.
• Diet-responsive disease is common. A strict novel-protein or hydrolyzed diet trial is often the best early next step in a stable dog.
• Antibiotic-response is a weak exam endpoint. Modern management de-emphasizes reflex metronidazole or tylosin use unless there is a specific reason.
• Biopsy matters when the dog is sick enough. Severe hypoalbuminemia, marked weight loss, melena, suspicious ultrasound changes, or failure of appropriate trials justify endoscopy or full-thickness biopsy.

Decision Core

Best-next-step logic.

Stable dogs with chronic GI signs usually move through a structured sequence rather than straight to immunosuppressants. The key is to match the next step to severity.

• First pass: CBC, chemistry, urinalysis, fecal testing, parasite control, and dietary history.
• Add targeted tests when clues appear: cTLI for marked weight loss or polyphagia, cobalamin and folate for malabsorptive disease, bile acids if liver disease is plausible, pancreatic testing if pancreatitis overlaps.
• Use imaging to look for structural disease: ultrasound helps screen for layering changes, lymphadenopathy, masses, intussusception, or severe mural disease.
• Diet trial before drugs in stable patients: feed only the prescribed diet for an adequate interval and avoid treat contamination.
• Escalate when unstable or refractory: severe hypoalbuminemia, GI bleeding, or persistent failure after a proper diet trial should trigger biopsy planning and more aggressive therapy.

High-Yield Traps

Where exam stems try to fool you.

• Not every chronic diarrhea case is inflammatory bowel disease; some resolve with diet alone.
• Normal or mildly abnormal abdominal radiographs do not rule out clinically important chronic intestinal disease.
• Low albumin is not automatically hepatic failure; GI protein loss is a major alternative.
• A dog with weight loss, voluminous stool, and polyphagia deserves cTLI testing before steroids.
• Empiric antibiotics are not a substitute for an organized diet trial and differential diagnosis.

Rapid Revision

Last-minute recall.

• Chronic enteropathy = chronic GI signs after basic symptomatic care, with other causes still excluded.
• Diet trial is high yield and often early.
• Hypocobalaminemia is common and should be corrected.
• Biopsy becomes important when the dog is severe, hypoalbuminemic, or refractory.
• Protein loss, lymphoma, EPI, and Addison disease are the major misses to avoid.

Practice

Board-style checks.