VOLUME 2:
TIPS FOR SUCCESSFUL
MANAGEMENT OF
GASTROINTESTINALDISEASE
Nutritional Managementof Acute Gastroenteritis
Alison Manchester

DVM, MS, Diplomate ACVIM (SAIM)

Dietary Strategies forDogs and Cats withChronic Enteropathies
Aarti Kathrani

BVetMed (Hons), PhD, Diplomate
ACVIM (SAIM, Nutrition), FHEA,
MRCVS

Nutrition andPancreatitis in Cats
Cecilia Villaverde

BVSc, PhD, Diplomate ACVIM(Nutrition), Diplomate ECVCN

Purina Institute Digest

Nutritional Management of Acute Gastroenteritis
Alison Manchester, DVM, MS, DACVIM (SAIM)
Colorado State University, Fort Collins, Colorado, USA
Acute gastroenteritis is one of the most common
reasons for pets to be presented to their veterinarian.
Vomiting, change in stool form and/or frequency,
and reduced appetite are the typical clinical signs
but more severe signs, such as hypovolemic shock,
may also be present. There are many causes ofacute vomiting and gastroenteritis in dogs and cats,
many of which will not be definitively diagnosed.
The therapeutic approach to patients with acutegastroenteritis is multimodal and includes
treating the underlying cause, correcting fluid
deficits, and controlling nausea +/- pain.
Nutritional therapy should also be included in
the treatment strategy. Recent studies refute theonce widely accepted practice of withholding foodfrom acute gastroenteritis patients. Fasting has
been associated with reduced villus height andincreased risk of bacterial translocation in dogs
and humans.1,2 Using antiemetics and waiting 2 to
4 hours after the last episode of vomiting to feed
until may help prevent recurrence of signs.
For patients with recent vomiting, it is prudent
to initially offer small amounts of food (e.g., 25%of resting energy requirements if hospitalized,divided throughout the day). Division of daily
calories over 3 to 6 small meals may be continued
during the recovery period. Patients can graduallytransition back to their normal feeding regimen
as their clinical signs subside. Palatability is an
important consideration, particularly for finicky
eaters. Strategies for encouraging food intake canbe found in Box 1.
No single diet will be appropriate for all patients.
The ideal macronutrient blend of protein, fat, andcarbohydrate for dogs with acute gastroenteritis
is yet to be determined. Fiber is a nutrient to pay
attention to and tailor to the individual patient.
In some cases, supplemental fiber may help withdiarrhea3,4 and provide beneficial prebiotic effects.
However, fiber reduces digestibility and may delay
gastric emptying, which may be undesirable invomiting patients.
Volume 2 • September 2023

Of Note■ Acute gastroenteritis is a diverse
syndrome encompassing patientswith mild, self-limiting to severe,life-threatening disease.
■ Nutrition is a key component oftreatment, along with addressing theunderlying cause of illness, hydrating
the patient, and controlling nausea
and pain.
■ Clear communication with the client
is key to treatment success.
Ultimately, there are many diets that can be effectivein acute gastroenteritis. These include commercial(e.g., gastroenteric formulas) and home-cooked
diets. Commercially available gastroenteric diets
are complete and balanced and contain nutrientssuch as prebiotics that may support gastrointestinal
health. Home-cooked diets will be more labor
intensive for clients and should be formulated
by a board-certified veterinary nutritionist to becomplete and balanced. The veterinary healthcare team should work together with the client toevaluate each patient as an individual and develop
an appropriate nutrition plan.
Optimizing positive outcomes in these patients
involves providing realistic expectations toclients. Provided the diagnostic workup did notreveal a specific cause for gastroenteritis andno red flags (e.g., hypovolemic shock, anemia,hypoalbuminemia) were encountered, clientscan be counseled that most causes of acutegastroenteritis are self-limiting. However, it may
take several days for things to normalize. Clientsshould be provided with specific instructions
regarding feeding, including what diet to offer,
how much of the diet to offer and how often, andsigns that their pet could need further evaluation.
2Purina Institute Digest

Box 1. Strategies for encouraging food intake
in patients with acute gastroenteritis■ Avoid offering a diet intended for long-term

use in the hospital, as this may result inaversion to that diet, especially in cats

■ Warm the food■ Mix in flavored broth (without added

harmful ingredients such onions or garlic)■ Place the food bowl where the pet

can access it without interruption orcompetition■ Hand feed the patient■ Clean the food bowl regularly

References
1. Hernandez, G., Velasco, N., Wainstein, C., Castillo,L., Bugedo, G., Maiz, A., Lopez, F., Guzman, S.,& Vargas, C. (1999). Gut mucosal atrophy after ashort enteral fasting period in critically ill patients.

Volume 2 • September 2023

Journal of Critical Care, 14(2), 73-77. doi: 10.1016/
s0883-9441(99)90017-5
2. Qin, H. L., Su, Z. D., Gao, Q., & Lin, Q. T. (2002).
Early intrajejunal nutrition: Bacterial translocationand gut barrier function of severe acute pancreatitis
in dogs. Hepatobiliary and Pancreatic Diseases
International, 1(1), 150-154.
3. Lappin, M. R., Zug, A., Hovenga, C., Gagne, J., &Cross, E. (2022). Efficacy of feeding a diet containinga high concentration of mixed fiber sources formanagement of acute large bowel diarrhea in dogs
in shelters. Journal of Veterinary Internal Medicine,36(2), 488-492. doi: 10.1111/jvim.16360
4. Rudinsky, A. J., Parker, V. J., Winston, J., Cooper,E., Mathie, T., Howard, J. P., Bremer, C. A., Yaxley,P., Marsh, A., Laxalde, J., Suchodolski, J., & Perea,
S. (2022). Randomized controlled trial demonstrates
nutritional management is superior to metronidazole
for treatment of acute colitis in dogs. Journal of theAmerican Veterinary Medical Association, 260(S3),S23-S32. doi: 10.2460/javma.22.08.0349

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Purina Institute Digest

Dietary Strategies for Dogs and Cats with
Chronic Enteropathies
Aarti Kathrani, BVetMed (Hons), PhD, DACVIM (SAIM, Nutrition), FHEA,MRCVSRoyal Veterinary College, North Mymms, UKChronic enteropathies (CE) describe a group of
diseases resulting in persistent or intermittent
chronic gastrointestinal signs. Food-responsive
enteropathy represents the largest subgroup ofCE, comprising approximately two-thirds of all CE
cases presenting to a secondary or tertiary referral
hospital in dogs1 and likely also in cats.
Response to specific dietary therapeutic strategies
in dogs and cats with CE is highly variable.
Therefore, nutrition should be treated as anindividualized therapeutic intervention. Multiple
diet trials may be needed to determine the mosteffective strategy for each animal with CE. The
possible pros and cons of different dietary options
are shown in Table 1.

Highly digestible gastrointestinal dietHighly digestible therapeutic gastrointestinal
diets may help with clinical signs of CE in bothdogs and cats. However, it is important to note thatone study showed that while a highly digestible
therapeutic gastrointestinal diet was able toinduce remission in dogs with CE, the dogs wereless likely to remain asymptomatic at subsequent
rechecks when compared to dogs managed with ahydrolyzed diet.2

Hydrolyzed protein diet
Hydrolyzed protein diets may help influence theimmune system and have high digestibility. Dueto the scientific evidence supporting the use ofhydrolyzed protein diets in canine and feline CE
and the finding that some dogs that failed anelimination diet trial with a novel protein diet
responded to a hydrolyzed protein diet,3 these dietsshould likely be trialed first. If the animal does
not consume the diet or the gastrointestinal signs

Volume 2 • September 2023

Of Note■ There are multiple different dietary
options for dogs and cats withchronic enteropathies.
■ Nutrition for pets with chronicenteropathies should be tailored tothe individual dog or cat.
■ The new diet should be fed
exclusively for at least two weeks todetermine the response.
do not improve, then a commercial therapeutic
limited-ingredient novel protein diet can be tried.

Limited-ingredient novel protein diet
Nearly 50% of cats and 60% of dogs with chronic
gastrointestinal signs respond positively to a novel
protein diet.4,5 Well-pet novel protein diets should
be avoided for the treatment of CE.

Home-cooked diet
There is a subset of dogs and cats with CE that
may respond positively to a home-cooked dietrather than a commercial diet. Consultation witha board-certified veterinary nutritionist should besought if the dog or cat fails trials with commercial
therapeutic diets, so that a complete and balanced
home-cooked diet can be formulated.
Possible reasons for failure to respond to atherapeutic diet include owner non-compliancewith feeding, the need for a different dietary
strategy, comorbidities, the patient requires
medication to help control clinical signs, ormisdiagnosis of chronic enteropathy.
4Purina Institute Digest

Table 1. Possible pros and cons of different dietary options for chronic enteropathies
DietProsCons

Therapeutic
gastrointestinal• High digestibility• High palatability• Multiple formulas available• Potentially less able to maintain remission

Therapeutichydrolyzed protein• Limited diet history required• Some formulas are lower in fat• Possible issues with palatability• Limited canned options for cats

Therapeutic limited
ingredient• Increased likelihood ofpalatability for finicky pets
• Canned formulas often
available• Some formulas are higherin fiber• Full diet history required• Anecdotal concern for increased relapse or
cross reactivity• Potential previous exposure withwell-pet diets

Home-cooked• High digestibility• High palatability• Flexibility with nutrient
composition when properly
formulated• Higher expense• Labor intense• Board-certified veterinary nutritionist
needed• Potential sourcing issues for novel
ingredients• Recipe drift

References
1. Allenspach, K., Culverwell, C., & Chan, D.
(2016). Long-term outcome in dogs with chronicenteropathies: 203 cases. The Veterinary Record,178(15), 368. doi: 10.1136/vr.103557
2. Mandigers, P. J., Biourge, V., van den Ingh, T. S.,
Ankringa, N., & German, A. J. (2010). A randomized,open-label, positively-controlled field trial of ahydrolyzed protein diet in dogs with chronic small
bowel enteropathy. Journal of Veterinary InternalMedicine, 24(6), 1350-1357. doi: 10.1111/j.19391676.2010.0632.x
3. Marks, S. L., Laflamme, D. P., & McAloose, D. (2002).
Dietary trial using a commercial hypoallergenic
diet containing hydrolyzed protein for dogs

Volume 2 • September 2023

with inflammatory bowel disease. VeterinaryTherapeutics, 3(2), 109-118.
4. Guilford, W. G., Jones, B. R., Markwell, P.
J., Arthur, D. G., Collett, M. G., & Harte, J. G.
(2001). Food sensitivity in cats with chronic
idiopathic gastrointestinal problems. Journalof Veterinary Internal Medicine, 15(1), 7-13. doi:
10.1892/0891-6640(2001)015<0007:fsicwc>2.3.co;2
5. Luckschander, N., Allenspach, K., Hall, J., Seibold,F., Grone, A., Doherr, M. G., & Gaschen, F. (2006).
Perinuclear antineutrophilic cytoplasmic antibodyand response to treatment in diarrheic dogs with food
responsive disease or inflammatory bowel disease.
Journal of Veterinary Internal Medicine, 20(2), 221-227.
doi: 10.1892/0891-6640(2006)20[221:pacaar]2.0.co;2

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Purina Institute Digest

Nutrition and Pancreatitis in Cats
Cecilia Villaverde, BVSc, PhD, DACVIM (Nutrition), DECVCN
Expert Pet Nutrition, Fermoy, County Cork, Ireland
Feline pancreatitis can be difficult to diagnose andmanage. The treatment plan is usually adjusted
depending on the presence of complications andcomorbidities. Treatment includes managementof any comorbidities, nausea, and analgesia. In
all cases, nutritional support is a central part ofmanagement.
While there are no specific nutrient requirements
described in cats with pancreatitis compared tohealthy cats, and the best macronutrient profile forthese patients is yet unknown, providing adequate
calories and nutrients in the form of a complete
and balanced, highly digestible and palatablediet is important to prevent malnutrition and its
associated negative effects.1
A complete nutritional assessment, including diethistory, is important to assess risk of malnutritionand establish a tailor-made feeding plan foreach patient. Factors that impact the feedingplan include body condition score (BCS), muscle
condition score, and the presence of comorbidities.
There are several key nutrients for management of
feline pancreatitis, including protein and fat. As
opposed to dogs, there has been no association
described between pancreatitis and dietaryindiscretion or hyperlipidemia in cats. Therefore,
fat moderation or restriction is not a common
recommendation in cats. One retrospective studyof cats with suspected pancreatitis concluded thata diet with 45% fat (on a metabolizable energy –ME – basis) was well tolerated in these cases.2 It
may be wise to select a diet lower in fat if higher
fat diets have not been well tolerated. It is also
important that all essential nutrients be provided
in the form of a complete and balanced diet.
Nutritional management should be implemented
as soon as possible, and assisted feeding should
be used if needed to ensure adequate energy
intake. Using a highly digestible complete andbalanced therapeutic gastrointestinal diet is agood starting point for feline pancreatitis withVolume 2 • September 2023

Of Note■ The best nutritional profile for catswith pancreatitis has not been yetestablished.
■ Cats with pancreatitis should be fed
as soon as feasible, and assisted
feeding is required if voluntary intake
is insufficient.
■ Veterinary therapeutic
gastrointestinal diets are adequate
choices for cats with pancreatitis
given their high digestibility andpalatability, but comorbidities willaffect diet choice.
the current knowledge of the disease. These diets
provide nutrients in an easily assimilable manner,are usually high in energy density, and tend tohave good palatability.
In cats with comorbidities, the specific disease(s)will also affect diet choice (Table 1). For example,
the use of limited ingredient or hydrolyzed protein
diets, commonly recommended for chronicenteropathies, can be used in cats with bothdiseases.3 The patient’s nutritional assessment,
especially BCS, may also impact diet selection; forexample, choosing a diet higher in energy density
than the current diet is indicated in underweightcats.
For patients eating voluntarily, multiple small
meals might be better tolerated.4 It is especially
important to provide specific feeding amounts forobese or obese-prone patients. The feeding planshould be adjusted according to the repeatednutritional assessment (including body weight,BCS, muscle condition, and food intake), clinicalevolution, and other diagnostics.

6

Purina Institute Digest

Table 1. Comorbidities commonly associated with pancreatitis in cats and typical dietary strategies
DiseaseTypical dietary strategies

Chronic enteropathy• Highly digestible, elimination diet (with hydrolyzed protein or limited
ingredients)

Cholangitis• Highly digestible diet• Protein moderation might be required if there is hepatic encephalopathy
although uncommon

Diabetes mellitus• Low carbohydrate/high fat/high protein diets are commonly recommended• In overweight cats, weight management is indicatedReferences
1. Brunetto, M. A., Gomes, M. O., Andre, M. R., Teshima,E., Gonçalves, K. N., Pereira, G. T., Ferraudo, A. S.,& Carciofi, A. C. (2010). Effects of nutritional support
on hospital outcome in dogs and cats. Journal ofVeterinary Emergency and Critical Care, 20(2), 224231. doi: 10.1111/j.1476-4431.2009.00507.x
2. Klaus, J. A., Rudloff, E., & Kirby, R. (2009).
Nasogastric tube feeding in cats with suspected
acute pancreatitis: 55 cases (2001-2006). Journal ofVeterinary Emergency and Critical Care, 19(4), 337346. doi: 10.1111/j.1476-4431.2009.00438.x

Volume 2 • September 2023

3. Kathrani, A. (2021). Dietary and nutritional
approaches to the management of chronicenteropathy in dogs and cats. The Veterinary Clinics
of North America: Small Animal Practice, 51(1), 123136. doi: 10.1016/j.cvsm.2020.09.005
4. Taylor, S., Chan, D. L., Villaverde, C., Ryan, L., Peron,F., Quimby, J., O’Brien, C., & Chalhoub, S. (2022).
2022 ISFM consensus guidelines on managementof the inappetent hospitalised cat. Journal ofFeline Medicine and Surgery, 24(7), 614-640. doi:
10.1177/1098612X221106353

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