Many of the ultra low-fat commercial diets contain increased dietary fiber, which is potentially detrimental to PLE dogs because
the fiber will reduce the availability and digestion of proteins and carbohydrates in the small intestine. One ultra low-fat
diet (less than 3 g/100 kcal) that does not contain high dietary fiber is Royal Canin/Waltham's Low Fat. This diet is a good
choice in many dogs with mild to moderate PLE. Alternatively, two other highly digestible diets are reasonable choices because
of their low-fat content (e.g., Purina EN, and Eukanuba Adult Low Residue); however, these diets may not be low enough in
fat to be as effective.
The commercially available hypoallergenic diets designed for treatment of dietary intolerance or allergy may seem like reasonable
options for dogs with PLE; however, the primary drawback is that they are not ultra low-fat diets. In fact, most have only
modest reductions in fat content compared to normal diets. Thus, if a novel protein diet is needed for management of the disease
(based on the histopathology), a homemade diet (using lean meat sources) or hydrolyzed diet is recommended, and they are highly
digestible, low-fat and contain proteins in their peptide forms, which are more easily absorbed, even in the presence of significant
GI disease.
In addition to dietary therapy for PLE, specific therapy is required to treat the primary cause (e.g., steroids for IBD, chemotherapy
for lymphoma). In many cases of lymphangiectasia or idiopathic PLE, steroid therapy is initiated to reduce the immunologic
component suspected to contribute to the ongoing clinical deterioration. Most dogs have some component of antibiotic responsive
diarrhea and require metronidazole, tetracycline, tylosin or other long-term antibiotic therapy to control signs and prevent
bacterial overgrowth. Supplementation with calcium, magnesium and fat-soluble vitamins often is required and should be used
in cases where dietary therapy alone does not correct the imbalances.
Serum cobalamin levels should be measured, because cobalamin levels often decrease in animals with severe GI disease, and
cobalamin is essential for growth and repair of the gut epithelium. However, in most cases, the most important aspect of therapy
is finding an appropriate diet and providing the necessary additional supplementation.
Johnny D. Hoskins
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For dogs with PLE that can be controlled with specific dietary and pharmacologic therapy, the long-term prognosis is fair
to good. Nevertheless, the most severely affected dogs may not respond to therapy or relapse soon after the initial treatment
and succumb to either complications or worsening PLE.
Dr. Hoskins is owner of DocuTech Services. He is a diplomate of the American College of Veterinary Internal Medicine with
specialities in small-animal pediatrics. He can be reached at (225) 955-3252, fax: (214) 242-2200 or e-mail:
jdhoskins@mindspring.com
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