Juan Hernandez

Case summary: A 7-year-old neutered male Maine Coon cat was referred for an 18-month history of chronic mixed small- and large-bowel diarrhoea with tenesmus, marked weight loss and severe debilitation. Abdominal ultrasonography revealed focal ileal and colonic mural thickening with regional lymphadenomegaly, and colonoscopy identified a severe colonic stenosis precluding biopsy collection. Subtotal colectomy with ileocolic anastomosis was performed. Histopathology demonstrated severe transmural chronic inflammation of the ileum and colon, with deep ulceration, fibroplastic remodelling and a mixed lymphoplasmacytic and neutrophilic infiltrate. Surgery, dietary optimisation and cobalamin supplementation resulted in clinical improvement and weight regain, but a new colonic stenosis developed seven months later and was treated by endoscopic balloon dilation. Repeated fluorescence in situ hybridisation analyses failed to identify adherent or invasive bacteria. Immunosuppressive therapy was subsequently introduced, but clinical deterioration eventually progressed despite treatment, and the cat was euthanised following presentation in decompensated hypovolaemic shock. Relevance and novel information: This report describes an unusual fibrostenotic phenotype of feline chronic inflammatory enteropathy, characterised by recurrent intestinal strictures and transmural mixed lymphoplasmacytic–neutrophilic inflammation. The repeated absence of adherent or invasive bacteria argues against a primary bacterial-driven process. The clinicopathological features closely resemble the fibrostenosing phenotype of human Crohn’s disease, including ileocolonic involvement, deep ulceration, transmural inflammation and postoperative recurrence. This case expands the recognised spectrum of feline chronic inflammatory enteropathy and suggests that proactive monitoring may help identify disease progression earlier and guide more timely control of inflammation, even during periods of apparent clinical stability.

Background: T lymphocytes play a central role in the intestinal immune response in dogs with immunomodulator-responsive enteropathy (IRE), but the clinical relevance of mucosal T-cell infiltration remains unclear. Hypothesis/Objectives: Compare mucosal CD3+ T-cell density between dogs with IRE and healthy comparison dogs across intestinal segments, and assess associations with clinical, biochemical, and histologic severity markers. Animals: Forty-two client-owned dogs with IRE and 12 healthy research dogs. Methods: Retrospective multicenter study. Archived endoscopic biopsy samples from the duodenum, ileum, and colon were evaluated using the Simplified Histopathological Scoring System. Immunohistochemistry for CD3 was quantified by digital image analysis (QuPath) and expressed as relative CD3+ density (RCD3). Group comparisons, receiver operating characteristic curve analyses, mixed linear models, and correlation analyses were performed. Results: Relative CD3+ density was significantly higher in dogs with IRE than in comparison dogs in the duodenum (median, 6.34% vs 1.42%; P = .03), ileum (9.79% vs 0.85%; P < .001), and colon (3.88% vs 1.32%; P = .002). The area under the curve values were 0.833, 0.896, and 0.811, respectively. The RCD3 was not correlated with clinical indices, serum albumin concentration, or histologic scores, but ileal histologic score was negatively correlated with RCD3 (ρ = −0.37; P = .04). Conclusions and clinical importance: Mucosal CD3+ T-cell density is increased in dogs with IRE but is not associated with clinical or overall histologic disease severity. Quantification of CD3+ should not be used as a solitary monitoring tool but may contribute to immunophenotyping.

Rethinking response criteria of treatment of chronic enteropathy in dog is necessary, as clinical activity indices are widely used as primary endpoints despite substantial variability in how “response,” “remission,” and “relapse” are defined. Across recent studies, response thresholds range from modest relative reductions (eg, ≥25%) to stringent targets (eg, ≥75%), absolute score cut-offs, shifts between severity categories, or binary resolution of clinical signs. This methodological heterogeneity undermines comparability between trials and complicates evidence synthesis. An often-overlooked contributor to this issue is the intrinsic variability of the Canine Inflammatory Bowel Disease Activity Index and the Canine Chronic Enteropathy Clinical Activity Index, particularly their limited inter-observer reproducibility for total scores and several core items. When commonly used response thresholds overlap with expected measurement error, apparent clinical improvement might reflect scoring variability rather than true change in disease activity. We therefore propose a pragmatic framework for response classification anchored in the measurement properties of these instruments. For research endpoints, an absolute change of at least 4 points (Δ ≥ 4) is suggested as a conservative minimal detectable change to reduce misclassification of responders and non-responders. In dogs with low baseline scores driven by 1 or 2 isolated abnormalities, an item-centered approach (Δ item ≥2) might be more appropriate, particularly for variables such as stool consistency or defecation frequency. Finally, transparent reporting of scoring conditions, prioritization of evaluator consistency, and integration of complementary outcomes, including validated health-related quality-of-life measures and longitudinal symptom tracking, might help better capture clinically meaningful effects.

Les Maladies Inflammatoires Chroniques de l’Intestin (MICI) sont fréquentes chez le chien. Leur origine n’est pas connue mais une réaction immunitaire inadaptée est suspectée. Nous avons recruté 50 chiens atteints d’entéropathie chronique (4 répondants au changement alimentaire, 5 répondants au métronidazole, 27 MICI et 14 entéropathies avec pertes de protéines-PLE). Le score d’activité clinique CCECAI est significativement plus élevé dans le groupe PLE par rapport aux autres types d’entéropathies. L’analyse histologique et immunohistochimique conduite sur 22 chiens atteints de MICI et 14 chiens témoins a montré une différence significative entre les 2 groupes du score histologique global à l’étage colique alors qu’aucune différence n’est observée à l’étage duodénal et iléal. Le nombre de lymphocytes CD3+ est significativement plus faible dans la muqueuse iléale et colique du groupe MICI par rapport aux témoins. MCP-1 et CXCL1 sont significativement plus élevés, respectivement dans l’iléon et le côlon des malades par rapport aux témoins. La mesure des IgA pariétales montre une quantité moindre dans le duodénum des chiens malades par rapport aux témoins. L’expression protéique des TLR2, 4, 5 et 9 évaluée par immunohistochimie ne montre pas de différence entre les 2 groupes. L’analyse sérologique montre une augmentation significative des quantités d’IgG anti-flagelline et anti-LPS dans le groupe malade par rapport aux témoins. Nos résultats remettent en question la nosographie actuelle des entéropathies chroniques canines et placent la réaction immunitaire humorale dirigée contre des éléments du microbiote au cœur du processus physiopathologique. Ces données ouvrent la porte au développement de nouveaux marqueurs sanguins.

Background: Chronic enteropathies (CEs) in dogs substantially impact the quality of life (QoL) for both patients and owners. Existing clinical indices do not capture the broader burden of disease, and no validated health-related QoL (HRQoL) tool exists for CE. Hypothesis/Objectives: Develop and validate a psychometrically sound HRQoL questionnaire for dogs with CE. Animals: A total of 351 client-owned dogs: 141 with CE, 126 healthy, and 84 with other chronic diseases (OCD), based on owner classification. Methods: A multi-phase psychometric study was conducted to create and validate the instrument. Items were generated from literature and expert input, refined using cognitive debriefing and statistical filtering, and tested for internal consistency, construct validity, and discriminative validity. The HRQoL scores were compared among groups and analyzed for demographic factors. Results: The final Canine Chronic Enteropathy QoL (CCEQoL) questionnaire included 33 items. Internal consistency was excellent (Cronbach’s α = 0.91). The median total score (TS) was higher in CE dogs (129; interquartile range [IQR], 73.5–181.5) than in OCD dogs (62; IQR, 31.3–105.4) and healthy dogs (15.3, IQR, 6–34; P < .001). The total score was inversely correlated with owner-rated overall QoL (ρ = −0.61; P < .001). In CE dogs, the TS was weakly and inversely correlated with age but was not significantly associated with breed size, comorbidities, or country of residence. Conclusions and clinical importance: The CCEQoL is the first validated HRQoL tool for dogs with CE. It provides a structured, multidimensional assessment of disease burden and may enhance patient-centered care, owner–veterinarian communication, and clinical research.

This report describes a case of peritoneal splenosis in a dog, identified following the discovery of multiple peritoneal nodules on computed tomography (CT) performed for the evaluation of a compressive myelopathy. Histopathologic analysis confirmed the presence of ectopic splenic tissue without evidence of malignancy. In dogs, splenosis results from autotransplantation of splenic tissue within the peritoneal cavity, following splenic injury or surgery. Although most cases are incidental findings, nodule enlargement or rupture may occasionally lead to clinical consequences. This case emphasizes the importance of considering splenosis in the differential diagnosis of peritoneal nodules, particularly when they are not associated with peritoneal effusion and in animals with a history of splenic disease or abdominal trauma.

The Canine Inflammatory Bowel Disease Activity Index (CIBDAI) and Canine Chronic Enteropathy Clinical Activity Index (CCECAI) are key tools for monitoring chronic enteropathies (CE) in dogs. Despite their widespread use, concerns persist regarding their intra-observer repeatability and inter-observer reproducibility, which may impact clinical and research applications. This study evaluated the reliability of these indices through a two-phase approach using anonymized clinical records. In Phase 1, two observers independently scored 41 consultation forms twice, one month apart, to assess repeatability and reproducibility. Phase 2 involved four observers with varying expertise who scored 59 forms using a standardized guide addressing Phase 1 inconsistencies. Statistical methods included Lin's concordance correlation coefficient and Bland-Altman plots. High intra-observer repeatability was observed for most variables, but inter-observer reproducibility was limited for CIBDAI, CCECAI, and fluctuating parameters like stool consistency and defecation frequency. The standardized guide marginally improved consistency but did not resolve discrepancies. Expert evaluators did not consistently outperform non-experts. Reproducibility declined in more clinically severe cases. These findings highlight the need for standardized training, dynamic scoring systems, and digital tools to enhance reliability. Addressing these limitations is critical to improve clinical decision-making and research outcomes in canine CE.

Chronic inflammatory enteropathies (CIEs) in dogs are currently classified based on response to sequential treatment trials into food-responsive (FREs); antibiotic-responsive (AREs); immunosuppressant-responsive (IREs); and non-responsive enteropathies (NREs). Recent studies have reported that a proportion of NRE dogs ultimately respond to further dietary trials and are subsequently misclassified. The FRE subset among CIEs is therefore probably underestimated. Moreover, alterations in the gut microbiota composition and function (dysbiosis) have been shown to be involved in CIE pathogenesis in recent research on dogs. Metronidazole and other antibiotics that have been used for decades for dogs with AREs have been demonstrated to result in increased antimicrobial resistance and deleterious effects on the gut microbiota. As a consequence, the clinical approach to CIEs has evolved in recent years toward the gradual abandonment of the use of antibiotics and their replacement by other treatments with the aim of restoring a diverse and functional gut microbiota. We propose here to refine the classification of canine CIEs by replacing the AREs category with a microbiota-related modulation-responsive enteropathies (MrMREs) category.