Gastric ulcer disease in dogs and cats (Proceedings) - Veterinary Healthcare
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Gastric ulcer disease in dogs and cats (Proceedings)


CVC IN KANSAS CITY PROCEEDINGS


Definitive diagnosis

Definitive diagnosis of gastric ulcers is made by visualization of the ulcer, usually by endoscopic examination, or during gastrotomy. An advantage to endoscopic or surgical diagnosis is the potential for biopsy of tissue in and around the ulcer to examine for primary gastric diseases, especially neoplasia, when other risk factors for gastric ulcers do not exist. Strongly supportive findings for ulcers can be generated from contrast radiography or abdominal ultrasonography. Filling defects, gastric wall thickening, and prolonged retention of contrast material in the stomach are features that can be seen in some, but not all, patients with gastric ulcers during contrast radiography. Ultrasonographic findings supportive of gastric ulcers include gastric wall thickening, which is often focal, the detection of a mucosal crater that may have tiny bubbles within it, disruption of the normal layering of the gastric wall, and gastric hypomotility. Several of these ultrasonographic findings can be seen with other gastric diseases (e.g. gastric neoplasia) and aren't specific for gastric ulcers.

Treatment

Key to treatment of gastric ulcers is identification and elimination, whenever possible, of underlying diseases or risk factors. In the majority of patients, treatment will also entail administration of drugs that reduce gastric acid secretion, and that provide mucosal protection in the face of an ulcer. The most commonly used class of drugs to reduce acid secretion is the H2 receptor blockers which include famotidine, ranitidine and cimetidine. Proton pump inhibitors such as omeprazole are also appropriate for treatment of gastric ulcers, but have been more favored for patients with difficult to treat ulcers or with difficult to treat primary causes (e.g. some gastrinomas). Administration of synthetic PGE2 analogs such as misoprostol can also be of benefit, particularly for patients with NSAID-induced ulcers. Sucralfate is an appropriate medication to give to patients with confirmed, or suspected ulcers. In an acid environment, sucralfate attains a gel-like consistency that fosters drug binding to ulcer beds protecting them from additional acid-injury. Sucralfate can also promote local production of prostaglandins and enhance the protective properties of mucus. Coupled with the fact that sucralfate carries a low risk of drug-induced side effects (occasional constipation), it is recommended for virtually all ulcer patients. One does need to be aware that sucralfate can interfere with the absorption of other drugs.

Patients with life-threatening hemorrhage, or medically intractable ulcers, are candidates for surgical resection of ulcers. Excised tissue should be submitted for histopathological examination to exclude gastric neoplasia as a primary cause of the ulcer.

Prevention of ulcers

For patients with unavoidable risk factors, administration of PGE2 analogs can be helpful in reducing the risk of developing gastric ulcers. Several studies in dogs document the protective benefits of misoprostol administration to prevent NSAID-induced ulcers. H2 blockers are commonly given to patients with mast cell tumors, renal failure or hepatic disease to prevent gastric ulcers. Because cimetidine can alter the metabolism of other drugs, and usually requires administration every 8 hours, the author favors other H2 blockers for patients with liver disease, or that are receiving other drugs.

Prevention of glucocorticoid-induced ulcers remains problematic in small animal practice. While it seems common to administer H2 blockers to patients receiving high-doses glucocorticoids, H2 blockers have not been proven to prevent the development of gastric ulcers in dogs or cats.

The prognosis for patients with gastric ulcers varies with the underlying etiology. The prognosis is good for patients that have correctable underlying risk factors or diseases (e.g. drug-induced ulcers, hypoadrenocorticism), but can be poor if the underlying disease cannot be reversed (e.g. chronic renal failure or unresectable neoplasia).

References

Fox LE, Rosenthal RC, Twedt DC et al. Plasma histamine and gastrin concentrations in 17 dogs with mast cell tumors. Vet Intern Med. 1990;4:242-246.

Liptak JM, Hunt GB, Barrs VRD, et al. Gastroduodenal ulceration in cats: eight cases and a review of the literature. J Feline Med Surgery 2002; 4:27-42.

Penninck D, Matz M, Tidwell A. Ultrasonography of gastric ulceration in the dog. Vet Radiol Ultrasound 1997; 38:308-312.

Schubert ML. Gastric secretion. Current Opinion Gastroenterol 2005; 21:636-643.


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