Canine pancreatic lipase immunoreactivity concentrations associated with intervertebral disc disease in 84 dogs

Gut feelings: gastrointestinal signs in French bulldogs undergoing spinal surgery

Introduction

The French bulldog (FBD) is a brachycephalic breed prone to several neurological conditions, of which intervertebral disc herniation (IVDH) is considerably prevalent. Gastrointestinal (GI) disease is a reported complication in dogs surgically treated for IVDH. The objective of this study was to describe GI signs and their outcome in FBDs surgically treated for IVDH.

Materials and methods

Data regarding the GI signs (vomiting, diarrhoea and regurgitation), their frequency and short-term outcome in FBDs surgically treated for IVDH (cervical, thoracolumbar or lumbar) between January 2017 and April 2023 were obtained from medical records at one institution. Categorical variables were compared using Fisher exact tests, and ordinal/continuous data between categorical groups using Kruskal-Wallis or Mann-Whitney tests.

Results

Ninety-seven FBDs were included for analysis. GI signs occurred in 74/97 (76.3%) FBDs while hospitalised, with 33.8% and 66.2% developing GI signs pre- and post-operatively, respectively. FBDs that developed GI signs had a mean of 4.9 episodes. Diarrhoea was the most common GI sign encountered (51/74) compared to regurgitation (38/74) and vomiting (22/74). Resolution of GI signs occurred within a mean of 2.2 days. Mean duration of hospitalisation post-surgery was 4.6 days in FBDs that developed GI signs versus 3.7 days in FBDs that did not (p = 0.033). Anaesthesia length was associated with developing GI signs (p=0.037). Neurological severity, neuroanatomical localisation and surgical procedure were not associated with development of GI signs (p = 0.42, p = 0.794 and p = 1, respectively).

Conclusion

GI signs were commonly encountered in FBDs surgically treated for IVDH and associated with length of anaesthesia and prolonged hospitalisation.

Evaluation of Disease Spectrum in Hospitalized Cats with Hyperlipasemia: Pancreatitis Alone Is Rare, Hyperlipasemia without Suspected Pancreatitis Is Common

Histological evidence of pancreatitis is commonly found in necropsy studies in cats. A clinical diagnosis of pancreatitis is challenging due to nonspecific clinical signs, a lack of diagnostic lipase cutoffs, and frequent presence of multiple diseases. It is still unknown how often pancreatitis alone is found in sick cats and how often clinicopathological evidence of pancreatitis in sick cats does not lead to a clinical diagnosis of pancreatitis. Our aims were to evaluate the extent of comorbidities in cats with suspected pancreatitis, evaluate how often sick cats with hyperlipasemia are diagnosed only with non-pancreatic diseases, and compare their clinical findings. Medical records of 563 client-owned hospitalized cats with available lipase activity measurement (LIPC Roche) > 30 U/L (RI, 6-26) were searched and medical diagnoses recorded and grouped by organ system. Clinicopathological findings were compared between cats with pancreatitis alone (PA), pancreatitis with concurrent disease (PD), and no suspected pancreatitis (NP). We found that PA was present in 33 (6%) cats, 159 cats (28%) were in the PD group, and 371 cats (66%) had no suspected pancreatitis (NP). Clinical, laboratory, and ultrasonographic findings did not differ between PA and PD cats. Lipase activities did not differ between the three groups. The most common disease categories in PD and NP cats were gastrointestinal, hepatobiliary, renal/urinary, and endocrine, and renal/urinary, gastrointestinal, cardiac, and musculoskeletal, respectively. We conclude that cats are rarely hospitalized because of suspected pancreatitis alone, and PA cats did not differ clinically from PD cats. Hyperlipasemia in sick cats without a diagnosis of pancreatitis may be due to a reactive pancreatopathy or preexisting chronic pancreatitis.

Repeated specific canine pancreatic lipase measurements do not identify multiple acquired portosystemic shunts in dogs after extrahepatic portosystemic shunt attenuation

BACKGROUND

In dogs with portal hypertension (PH), spec cPL is suggested to be increased despite normal pancreatic histology. After attenuation of congenital extrahepatic portosystemic shunts (cEHPSS), multiple acquired portosystemic shunt (MAPSS) can develop as consequence of sustained PH. Presence of MAPSS affects future therapeutic options and prognosis.

OBJECTIVE

Evaluate if spec cPL concentrations increase postoperatively in dogs that develop MAPSS and can thus serve as an indicator of PH.

ANIMALS

Twenty-four dogs with cEHPSS.

METHODS

Dogs classified according to surgical outcome after cEHPSS attenuation (8 with MAPSS [group M], 9 with closed cEHPSS [group C] and 7 with patent blood flow through the original cEHPSS, without evidence of MAPSS [group P]). Spec cPL was measured in preoperative samples (T0), 4 days (T1) and 1 (T2) and 3- to 6-months (T3) after surgery.

RESULTS

Spec cPL was within reference interval (<200 μg/L) at all timepoints except at T1. At T1, 2 dogs in group M (321 and >2000 μg/L) and also 1 in group C (688 μg/L) and 1 in group P (839 μg/L) had increased spec cPL concentrations. No differences in spec cPL concentrations between groups or changes over time were identified.

CONCLUSIONS AND CLINICAL IMPORTANCE

Spec cPL is not consistently increased in dogs that develop MAPSS after cEHPSS attenuation and has no potential as a biomarker for the identification of MAPSS after cEHPSS attenuation.

Double-blinded placebo-controlled clinical trial of prophylactic omeprazole in dogs treated surgically for acute thoracolumbar intervertebral disc extrusion

BACKGROUND

Proton pump inhibitors are administered prophylactically in dogs treated surgically for acute thoracolumbar intervertebral disc extrusion (TL-IVDE). However, their efficacy in decreasing gastrointestinal (GI) complications is unknown.

HYPOTHESIS

Omeprazole does not decrease the frequency of GI complications compared to placebo in dogs treated surgically for acute TL-IVDE.

ANIMALS

Thirty-seven client-owned dogs undergoing hemilaminectomy for acute TL-IVDE.

METHODS

Randomized double-blinded placebo-controlled prospective clinical trial. Dogs received PO placebo or omeprazole at 1 mg/kg q12h for 5 days during hospitalization. Development of GI signs (e.g., diarrhea, vomiting, regurgitation, hematochezia, melena) was recorded daily. Clinicopathologic testing performed during hospitalization and at 2 and 4-week re-evaluations included: fecal occult blood, PCV, blood urea nitrogen/creatinine ratio, fecal calprotectin, canine pancreatic lipase immunoreactivity and fecal alpha-1 proteinase inhibitor concentrations. Omeprazole and placebo groups were compared using chi-squared or Fisher's exact tests.

RESULTS

Gastrointestinal signs developed in 10/20 (50%) dogs in the omeprazole group and in 7/17 (41%) dogs in the placebo group (P = .59). Diarrhea was common (8/20 omeprazole, 5/17 placebo), hematochezia was rare (1/20 omeprazole, 1/17 placebo); melena was not observed. Clinicopathologic evidence suggestive of bleeding was present in 9/20 dogs treated with omeprazole and in 11/17 dogs that received placebo (P = .23). Fecal occult blood positivity was more common in dogs with GI signs (P = .03). Canine pancreatic lipase immunoreactivity was higher during hospitalization compared to re-evaluations (P = .01).

CONCLUSIONS AND CLINICAL IMPORTANCE

Short-term, prophylactic omeprazole treatment did not decrease clinically detectable GI complications in dogs with acute TL-IVDE.

Utility of 1,2-o-dilauryl-rac-glycero glutaric acid-(6'-methylresorufin)-ester-lipase for monitoring dogs with chronic pancreatitis

BACKGROUND

The utility of 1,2-o-dilauryl-rac-glycero glutaric acid-(6'-methylresorufin)-ester-(DGGR)-lipase activity (DLA) in monitoring clinical progression of chronic pancreatitis (CP) in dogs is unknown.

OBJECTIVE

To examine the association of DLA with clinical signs of CP, as assessed by a CP clinical severity score (CPCSS).

ANIMALS

Twenty-four dogs.

METHODS

This is a retrospective study. Chronic pancreatitis was diagnosed based on clinical signs and DLA > 250 U/L and monitored using CPCSS and DLA.

RESULTS

The study included 134 visits (median, 10 visits/dog; range, 2-11). Mild-moderate (CPCSS, 0-3) and severe (CPCSS, ≥4) disease were documented in 94 (70%) and 40 (30%) visits, respectively. In emergency visits (n = 44; 33%) CPCSS (median, 5; range, 0-15) and DLA (median, 534 U/L; range, 63-7133) were higher (P < .001 and P = .003, respectively) than in scheduled ones (n = 90; 67%; median, 1; range, 0-6 and median, 384 U/L; range, 49-3747, respectively). DGGR-lipase activity was associated (P = .009) with the CPCSS, with a lower activity documented in mild-moderate CPCSS (median 391 U/L; range, 49-3747), compared to severe score (median, 558 U/L; range, 63-7133). DGGR-lipase activity was significantly, but weakly, correlated with CPSS (r = 0.233, P = .007). DGGR-lipase activity inefficiently discriminated mild-moderate vs severe CP (area under the receiver operator characteristics curve, 0.64; 95% confidence interval, 0.53-0.75; P = .012), with DLA cutoff of 428 U/L corresponding to sensitivity of 65% and specificity of 63%.

CONCLUSIONS AND CLINICAL IMPORTANCE

Increased DLA is associated with emergency revisits in dogs with CP, possibly reflecting acute flare-ups. DGGR-lipase activity was associated with the CPCSS over the follow-ups but could not differentiate disease severity.

Evaluation of serum miR-216a and miR-375 as biomarkers in dogs with acute pancreatitis

BACKGROUND

Serum microRNAs have emerged as biomarkers of various diseases. Overexpression of serum miR-216a and miR-375 occurs in dogs with experimentally induced acute pancreatitis (AP).

OBJECTIVES

To identify the possibility of using serum miR-216a and miR-375 as biomarkers for the diagnosis and evaluation of treatment response in dogs with naturally occurring AP.

ANIMALS

Twenty-one dogs with AP and 20 healthy dogs.

METHODS

Cross-sectional study. The relative expression of serum hsa-miR-216a-5p, cfa-miR-216a, and cfa-miR-375 were analyzed using reverse transcription and real-time PCR.

RESULTS

A significant difference in the serum expression of cfa-miR-375 was found between dogs with AP (median [interquartile range] 3.59 [1.55-24.52]-fold) and healthy dogs (0.81 [0.54-2.21]-fold, P < .001), and no significant differences were observed in hsa-miR-216a-5p and cfa-miR-216a (P > .05). The area under the receiver operating characteristic curve of serum cfa-miR-375 for differentiating between AP dogs and healthy dogs was 0.84 (95% confidence interval [CI]: 0.71-0.96). The expressions of hsa-miR-216a-5p and cfa-miR-375 were positively correlated with the concentrations of serum C-reactive protein (r_s  = .46, r_s  = .48, respectively), but not with the serum specific canine pancreatic lipase. The expression of cfa-miR-375 was significantly less after treatment in dogs with AP (P = .02).

CONCLUSIONS AND CLINICAL IMPORTANCE

Serum cfa-miR-375 could be a potential biomarker for the diagnosis and evaluation of treatment response of AP in dogs. In addition, miR-216a and miR-375 could be associated with inflammatory processes in dogs with AP.

Retrospective analysis of association between hepatopathy and serum DGGR lipase activity in dogs: a pilot study

1,2-o-dilauryl-rac-glycero-3-glutaric acid-(6′-methylresorufin) ester (DGGR) lipase assays are used to measure lipase activity in the diagnosis of pancreatitis. The effect of hepatic lipases released from damaged hepatocytes on serum DGGR lipase activity has not been reported, to our knowledge. We identified dogs with histologically confirmed liver lesions and concurrent unremarkable pancreatic histology, and dogs with no histologic evidence of hepatic or pancreatic disease. Dogs with relevant comorbidities were excluded. The hepatopathy group (n = 7) included 4 dogs with inflammatory hepatopathies, 2 with hepatic neoplasia, and 1 with unspecified (non-inflammatory, non-neoplastic) hepatopathy. The control group (n = 5) included one dog each with enteritis, subcutaneous hemangiosarcoma, hydrocephalus, myelomalacia, and tetanus. A Mann–Whitney U test compared selected biochemical parameters including serum DGGR lipase, alkaline phosphatase, alanine aminotransferase, and amylase activities, with statistical significance defined as p ≤ 0.05. Data are presented as median and range. Serum DGGR lipase activity (RI: <44 IU/L) was not different between the hepatopathy (52 IU/L; range: 27–85 IU/L) and control (37 IU/L, 25–105 IU/L; p = 0.947) groups. Serum amylase activity (RI: 256–1,610 IU/L) was significantly higher in the hepatopathy group (830 IU/L; 711–1,210 IU/L) than the control group (541 IU/L, 336–695 IU/L; p = 0.028). No association or correlation between serum DGGR lipase activity and hepatic lesions (based on histologic or biochemical findings) was identified, suggesting that clinically relevant changes in serum DGGR lipase activity may not be expected secondary to hepatopathy alone.

Bayesian clinical reasoning in the first opinion approach to a dog with suspected thoracolumbar pain

Whilst multi-planar imaging has allowed advances in diagnosis and treatment of canine spinal cord disorders, it is sometimes inaccessible to pet owners leading to a reliance on imaging modalities and ancillary tests that are more readily available. For this reason, this essay considers how Bayesian clinical reasoning may aid in deciding which tests, if any, are most useful for the diagnosis of spinal disease in clinical practice and choosing reasonable empiric therapies.

New insights into the etiology, risk factors, and pathogenesis of pancreatitis in dogs: Potential impacts on clinical practice

While most cases of pancreatitis in dogs are thought to be idiopathic, potential risk factors are identified. In this article we provide a state‐of‐the‐art overview of suspected risk factors for pancreatitis in dogs, allowing for improved awareness and detection of potential dog‐specific risk factors, which might guide the development of disease prevention strategies. Additionally, we review important advances in our understanding of the pathophysiology of pancreatitis and potential areas for therapeutic manipulation based thereof. The outcome of pathophysiologic mechanisms and the development of clinical disease is dependent on the balance between stressors and protective mechanisms, which can be evaluated using the critical threshold theory.

Clinical Features and Risk Factors for Gastrointestinal Complications in Dogs Treated Surgically for Thoracolumbar Intervertebral Disc Extrusion

Gastrointestinal (GI) complications and their clinical implications are poorly characterized in dogs treated surgically for acute thoracolumbar intervertebral disc extrusion (TL-IVDE). The objective of this retrospective study was to characterize GI signs (including vomiting, diarrhea, melena, and hematochezia) in dogs undergoing hemilaminectomy for acute TL-IVDE. One-hundred and sixteen dogs were included. Frequency, type and severity of GI signs during hospitalization, duration of hospitalization and outcome were obtained from the medical record. Potential risk factors for the development of GI signs were explored using univariable and multivariable analyses. Gastrointestinal signs occurred in 55/116 dogs (47%); 22/55 dogs (40%) had one episode and 21/55 (38%) had ≥5 episodes. Diarrhea was the most common (40/55, 73%) while melena was rare (1/55, 2%). GI signs developed in 8/11 dogs (73%) treated perioperatively with both non-steroidal anti-inflammatories and corticosteroids with or without a washout period and in 25/52 dogs (48%) treated prophylactically with proton pump inhibitors. Median hospitalization was 7 days (4-15 days) vs. 5 days (4-11 days) in dogs with or without GI signs, respectively. Duration of hospitalization was associated with development of any GI signs, diarrhea and more severe GI signs (p = 0.001, 0.005, 0.021, respectively). Pre-operative paraplegia with absent pain perception was identified on univariable analysis (p = 0.005) and longer anesthetic duration on multivariable analysis to be associated with development of more severe GI signs (p = 0.047). In dogs undergoing surgery for acute TL-IVDE, GI signs were common and associated with duration of hospitalization and anesthesia. The influence of specific medications and neurologic severity on development of GI signs requires further investigation.

Advances in the diagnosis of acute pancreatitis in dogs

In the last 20 years, the diagnosis of pancreatitis has become more frequent as a result of improved diagnostic modalities such as abdominal ultrasound examination, advanced imaging, and immunoassays for the measurement of pancreatic lipase. Our aim is to provide a state‐of‐the‐art overview of the clinical diagnosis of acute pancreatitis (AP) in dogs with a particular focus on pancreatic lipase assay validation and clinical performance, in addition to advanced imaging modalities. We also discuss the potential indications for cytology and histopathology in dogs with suspected AP.

Serum C-reactive protein in dogs with paraplegia secondary to acute intervertebral disc extrusion

BACKGROUND

Apart from the absence of nociception, there is no readily available prognostic test for dogs presenting with paraplegia secondary to acute intervertebral disc extrusion (IVDE).

OBJECTIVE

To assess if serum C-reactive protein (CRP) can predict the postoperative outcome in paraplegic dogs undergoing surgery for IVDE and to assess the association between serum CRP and presence/absence of nociception on admission, and serum CRP and presence/absence of intramedullary changes seen on magnetic resonance imaging (MRI).

ANIMALS

One hundred dogs that underwent surgery at our hospital between 2018 and 2020 because of acute paraplegia secondary to IVDE and in which serum CRP was measured.

METHODS

Retrospective observational cohort study. Dogs were classified as 4 or 5 according to the modified Frankel score (MFS) depending on presence/absence of nociception, respectively. MRI images were reviewed and the T2-weighted hyperintensity: L2 vertebral body length was measured. Postoperative outcome was defined as positive if nociception, ambulation or both returned after decompressive surgery.

RESULTS

The median (95% CI) serum CRP was 4 (4-5) and 6 (4-7) mg/L in MSF4 and MSF5, respectively (P = .03). A weak linear relationship (R²  = 0.049, P = .03) was found between CRP and the T2-weighted hyperintensity: L2 vertebral length. Outcome data was available for 85 dogs: CRP was 4 (4-5) and 5 (4-10) mg/L in positive and negative outcome dogs, respectively (P = .32).

CONCLUSION AND CLINICAL IMPORTANCE

Serum CRP did not predict outcome after surgery in dogs with paraplegia secondary to IVDE.

Increased canine pancreatic lipase immunoreactivity (cPLI) and 1,2-o-dilauryl-rac-glycero-3-glutaric acid-(6'-methylresorufin) ester (DGGR) lipase in dogs with evidence of portal hypertension and normal pancreatic histology: a pilot study

The clinical presentations of both liver disease and pancreatitis are nonspecific and overlapping, which may cause difficulty in diagnosis. In our retrospective pilot study, we assessed whether dogs with evidence of portal hypertension and absence of pancreatitis on pancreatic histology have increases in canine pancreatic lipase immunoreactivity (cPLI) and 1,2-o-dilauryl-rac-glycero-3-glutaric acid-(6'-methylresorufin) ester (DGGR) lipase. We included dogs that had been presented between 2008 and 2019 if they had normal pancreatic histology, histologically confirmed hepatopathy, and if canine pancreas-specific lipase (Spec cPL; Idexx) or DGGR lipase had been measured. Only dogs with portal hypertension were included. Six dogs fulfilled the inclusion criteria. Four of 6 and 2 of 6 dogs had Spec cPL and DGGR lipase exceeding the upper reference limit, respectively. From the 4 dogs with increased Spec cPL, 2 had concentrations of 200-400 µg/L and 2 had concentrations ≥ 400 µg/L. Our results suggest that canine portal hypertension might lead to increased Spec cPL and DGGR lipase values in the absence of pancreatitis on histology. Until more evidence in a larger number of dogs with portal hypertension is available, both tests should be interpreted cautiously in the presence of portal hypertension.

Association between abdominal ultrasound findings, the specific canine pancreatic lipase assay, clinical severity indices, and clinical diagnosis in dogs with pancreatitis

Background

A clinical diagnosis (CDx) of pancreatitis includes evaluation of clinical signs, abdominal ultrasound (AUS), and pancreatic lipase. However, practitioners are using AUS to diagnose pancreatitis and are using AUS severity to guide decisions. The validity of this is unknown.

Objectives

To determine whether (1) there is a correlation between AUS, specific canine pancreatic lipase (Spec cPL) assay, and CDx; (2) individual AUS abnormalities correlate more closely with CDx than others; (3) AUS severity mirrors clinical severity indices; (4) changes in AUS can be used as a marker for changes in Spec cPL or CDx; and (5) the sensitivity and specificity of AUS for pancreatitis.

Animals

One hundred fifty‐seven dogs.

Methods

In this retrospective case study, inclusion criteria were signs of gastrointestinal, pancreatic disease, or both, in addition to having a Spec cPL and AUS performed within 30 hours. Information extracted from the records included bloodwork, Spec cPL, AUS images/clips, and severity of ultrasonographic findings.

Results

AUS was weakly correlated with Spec cPL (r_s = .0178, P = .03) and moderately correlated with CDx (r_s = .379, P = <.001). Pancreatic size (r_s = .285, P = <.001), echogenicity (r_s = .365, P = <.001), and mesenteric echogenicity (r_s = .343, P = <.001) were correlated with CDx. Change in AUS was not correlated with Spec cPL or CDx changes. When pancreatic enlargement, echogenicity, or altered mesenteric echogenicity were required for a diagnosis, the sensitivity and specificity were 89% (95% confidence interval [CI] 71.8, 97.7) and 43% (95% CI 34.0, 51.6). When all 3 criteria were required, the sensitivity and specificity were 43% (95% CI 24.5, 62.8) and 92% (95% CI 85.3, 95.7).

Conclusions

AUS should not be used in isolation to diagnose pancreatitis and is a poor indicator of severity.

Neuter status as a risk factor for canine intervertebral disc herniation (IVDH) in dachshunds: a retrospective cohort study

BACKGROUND

Intervertebral disc herniation (IVDH) involves displacement of the intervertebral disc secondary to disc degeneration and is extremely common in dachshunds. Clinical signs include pain with or without paresis or paralysis. Mortality rate is high and some cases are left with permanent disability even after treatment. Aims of this study were twofold: Firstly, to investigate whether neutering, i.e. gonadectomy, is associated with increased risk of IVDH in dachshunds, and secondly to investigate whether age of neutering alters risk of IVDH in this breed.Information was obtained for 1964 dachshunds from the owner survey, "Dachslife 2015". For dachshunds that were ≥ 3 years and < 10 years old at the time of the survey (1073 individuals) incidence of IVDH was compared between early-neutered (< 12 months), late-neutered (> 12 months) and entire animals of each gender.

RESULTS

Neutered females were at significantly higher risk of IVDH than entire females (risk ratio 1.81, 95% CI 1.28-2.54). For males, incidence of IVDH in neutered as compared with entire dachshunds was increased but this difference was not quite statistically significant (risk ratio 1.38, 95% CI 0.96-1.99).For both genders, this study demonstrated significantly increased risk of IVDH in early-neutered dachshunds (before 12 months old) as compared with those neutered late (after 12 months old). For early neutered males, risk ratio was 1.54 (95% CI 1.07-2.22). For early-neutered females, risk ratio was 2.12 (95% CI 1.44-3.11).

CONCLUSION

Results from this retrospective study suggest that gonadectomy, especially if performed before 12 months old, increases risk of IVDH in this breed. Decisions regarding neutering should be made on an individual basis, taking a range of pros and cons into account. Considering the high prevalence, morbidity and mortality of IVDH in dachshunds, increased IVDH risk associated with neutering is a key factor to consider in deciding whether and when to neuter.