QUARTERLY BEAT / OCTOBER 2023 ///
/// QUARTERLY BEAT / OCTOBER 2023
MICROBIOME Updates if an animal has antibiotic-induced dysbiosis but the rest of the GI tract is functioning normally, the epithelial barrier of the intestine can usually tolerate a temporary disruption. But if an animal has a chronic GI disease along with inflammatory changes in the epithelium and a compromised mucus layer, that is another case. In this situation, if dysbiosis is also present, a complicated, long-lasting condition may develop that requires a number of therapeutic interventions to manage. STRATEGIES FOR RESTORING GUT HEALTH A balanced gut microbiome is critical to canine and feline health, and correcting GI dysbiosis requires a multipronged approach. This may include one or more of the following interventions: • DIET. Diet should be considered the primary strategy when managing patients with dysbiosis. An estimated 50% to 65% of dogs with chronic inflammatory enteropathies respond positively to dietary changes. 2 For canine patients with small intestinal or mixed bowel diarrhea, a highly digestible diet that allows nutrients to be readily absorbed, followed by a reevaluation of the dog’s clinical signs 10 to 14 days later, is often a good place to start.
• DIETARY FIBER. Fiber can make a big difference in stool quality in dogs and cats. Soluble fiber (e.g., psyllium or inulin) can add form to small bowel diarrhea by binding excess water in the intestine, increasing viscosity and slowing intestinal transit time. In addition, soluble fibers also serve as food for beneficial bacteria and are selectively fermented by them. This causes an increase in microbial diversity and the production of short-chain fatty acids (SCFAs) that nourish the epithelial cells of the colon (colonocytes), which can be helpful in resolving large bowel diarrhea. As these cells grow and multiply, the increased surface area helps maximize nutrient absorption across the intestinal wall. 3 Insoluble fiber (e.g., cellulose or wheat bran) acts as a bulking agent, stretching the intestinal wall and stimulating peristalsis to help push feces out of a constipated dog or cat. Most fiber sources are a blend of both soluble and insoluble fibers. • PROBIOTICS. These are live microorganisms that, when consumed in adequate amounts, confer a health benefit on the host. 4 Different probiotic strains have different effects and must be administered in specific amounts to achieve the desired outcomes. Supplementing with probiotics can help shift gut microbiota toward more beneficial bacterial species, helping maintain an optimal balance. When a patient does require an antibiotic, probiotics may help lessen some of the gastrointestinal signs associated with antibiotic administration. For example, one study showed that supplementing dogs infected with Giardia spp. the probiotic strain Enterococcus faecium SF68 for seven days during the administration of metronidazole enhanced their clinical response and resulted in a higher percentage of days with normal stools (65.6% for dogs administered dual therapy vs. 46.9% for dogs administered metronidazole alone). 5
Diet should be considered the primary strategy when managing patients with dysbiosis. An estimated 50% to 65% of dogs with chronic inflammatory enteropathies respond positively to dietary changes. 3
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Pathogens
FOCUSING IN ON GI MICROBIOME HEALTH
In this VETgirl feature article sponsored* by Purina, Dr. Raj Naik, DACVIM (Nutrition) discusses the importance of the GI microbiome. We’ve all heard about it. But do we really know the importance of it on overall global health? Here, this article is a must read for tips on managing your veterinary patients!
Microbiota
• SYNBIOTICS. A probiotic/prebiotic combination, called a synbiotic, leverages the individual benefits of each to provide complementary and/or synergistic effects. A synbiotic supports a healthy intestinal
DYSBIOSIS: WHEN MICROBIAL BALANCE GETS OFF-KILTER Because the microbiota in the gut help support overall health, achieving and preserving a balance of beneficial to potentially pathogenic bacteria is particularly important. Dysbiosis is an imbalance in the makeup of gut microbiota and can be triggered by multiple factors, including antibiotic use, stress, age, illness, diet change, and weaning. It is also associated with a variety of health conditions, ranging from irritable bowel disease (IBD), obesity, and cardiovascular disease to immune-mediated conditions and neurodevelopmental conditions. 1
When considering the GI microbiome in dogs and cats, practitioners often focus on GI health and the importance of achieving a microbial balance that is favorable to the management of patients with clinical signs such as diarrhea. As knowledge about the GI microbiome’s role expands, veterinary researchers are defining what the GI microbiome does in a more macro way. Why? Studies have shown the GI microbiome may exert significant effects on multiple body systems. Besides its digestive function, the gut works as a kind of sensory organ for the immune system. Metabolites generated by digestion travel to other parts of the body through the bloodstream, with the potential to activate or suppress inflammatory processes.
microbiome by providing a prebiotic to increase GI microbial diversity and a probiotic to promote GI microbial balance.
PRACTICING ANTIBIOTIC STEWARDSHIP It is not uncommon for owners of dogs with acute diarrhea to request antibiotics in hopes of rapid improvement. Clinicians should explain that acute diarrhea is often caused by stress or dietary indiscretion and will likely resolve on its own in about a week. Practitioners should also emphasize that a course of antibiotics may make little difference in the duration of clinical signs, 6 and ultimately do more harm than good by inducing a state of dysbiosis. Plus, diarrhea is likely to recur in the
Image courtesy of the Purina Institute.
If no improvement is noted, a diet trial using a hydrolyzed, novel protein or amino acid-based diet may be indicated. Dogs with large bowel diarrhea and some with mixed bowel diarrhea may be more responsive to a high fiber diet (see below). If improvement in clinical signs is not achieved with diet alone, an immunosuppressive medication or an antibiotic can be considered.
While disruptions to the homeostasis of the microbiome can contribute to disease, dysbiosis on its own does not always cause it. For example,
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