Gastro Intestinal Ulcers
Gastro intestinal ulcers, or gastric ulcers, are the disruption and ulceration of the gastric and intestinal mucosa. Most of these are sequelae of gastritis or an underlying disease.
The recent introduction of endoscopy in canine practice has revealed an increased incidence of this disorder.
The incidence is higher in adult dogs. Females are more prone than males, there is no breed predilection for gastro intestinal ulcers.
Etiology
- Indiscriminate use of non-steroidal anti inflammatory drugs like phenylbutazone, ibuprofen, corticosteroids, etc.
- Renal or hepatic insufficiency, neoplasm, pancreatitis, hypoadrenocorticism, and stress have systemic causes.
- Helicobacter pylori has also been reported as an isolate from a canine gastric ulcer. (common isolate in human cases).
- Inflammatory bowel disease causes gastrointestinal ulcers.
Pathogenesis
The gastric mucosal barrier consists of a thick mucous layer and epithelial cells, which constitute an important anatomical barrier to acid. Prostaglandins play an important role in maintaining the integrity of the gastric mucosa. Damage to the mucosal barrier by irritants increases the mucosal permeability, allowing the diffusion of acid back into the mucosa. Degradation of mast cells in the submucosa on contact with the acid results in the release of histamine, which stimulates parietal cells to secrete more HCl, which leads to mucosal erosion and ulceration.
Decreased cell turnover and mucous production in corticosteroid therapy, retention of uremic toxins in renal failure, decreased mucosal blood flow leading to a loss of the mucosal barrier in liver failure, or some other mechanism contributing to ulcer formation.
Clinical Signs
Vomition (recurrent) is the chief sign. Vomitus contains frank or digested blood; melena may be an associated clinical sign. Persistent weight loss, progressive anaemia, and signs of abdominal pain. Try to sit in the cooler places, and inappetence is seen. Some of the dogs die instantly due to perforation and internal haemorrhage.
Diagnosis
Diagnosis of gastro intestinal ulcers is based on followings:
- History and clinical signs
- Endoscopy and abdominal ultrasound
- Continuous radiography with the barium meal
- Exploratory laparotomy
Treatment
- Changing of the diet: the Bland diet is introduced.
- Oral antacid: magnesium hydroxide containing preparations are better.
- H2 blockers (Ranitidine) and proton pump inhibitors (Pantoprazole, Omeprazole, Rabeprazole, etc.) are used.
- Cytoprotective like sucralfate at 0.5–1 g as a total dose 2-3 times by oral route, it forms a complex with the proteinous exudate, which is abundant in ulcers, and provides a barrier for the action of acids.
- Prostaglandin analogues like misoprostol 2.5 mcg/kg body weight 2-3 times daily by oral route also reduce secretion and cytoprotective action.
In general, anti-ulcerative therapy should be continued for a minimum of 6–8 weeks with a periodical review of the case.
