Effect of Early Enteral Nutrition on Intestinal Permeability, Intestinal Protein Loss, and Outcome in Dogs with Severe Parvoviral Enteritis

Abstract

A randomized, controlled clinical trial investigated the effect of early enteral nutrition (EN) on intestinal permeability, intestinal protein loss, and outcome in parvoviral enteritis. Dogs were randomized into 2 groups: 15 dogs received no food until vomiting had ceased for 12 hours (mean 50 hours after admission; NPO group), and 15 dogs received early EN by nasoesophageal tube from 12 hours after admission (EEN group). All other treatments were identical. Intestinal permeability was assessed by 6-hour urinary lactulose (L) and rhamnose (R) recoveries (%L, %R) and L/R recovery ratios. Intestinal protein loss was quantified by fecal alpha1-proteinase inhibitor concentrations (alpha1-PI). Median time to normalization of demeanor, appetite, vomiting, and diarrhea was 1 day shorter for the EEN group for each variable. Body weight increased insignificantly from admission in the NPO group (day 3: 2.5 +/- 2.8%; day 6: 4.3 +/- 2.3%; mean +/- SE), whereas the EEN group exhibited significant weight gain (day 3: 8.1 +/- 2.7%; day 6: 9.7 +/- 2.1%). Mean urinary %L was increased, %R reduced, and L/R recovery ratios increased compared to reference values throughout the study for both groups. Percent lactulose recovery decreased in the EEN group (admission: 22.6 +/- 8.0%; day 6: 17.9 +/- 2.3%) and increased in the NPO group (admission: 11.0 +/- 2.6%; day 6: 22.5 +/- 4.6%, P = .035). Fecal alpha1-PI was above reference values in both groups and declined progressively. No significant differences occurred for %R, L/R ratios, or alpha1-PI between groups. Thirteen NPO dogs and all EEN dogs survived (P = .48). The EEN group showed earlier clinical improvement and significant weight gain. The significantly decreased %L in the EEN versus NPO group might reflect improved gut barrier function, which could limit bacterial or endotoxin translocation.

Biomarkers in canine parvovirus enteritis

“…Puppies receiving early enteral nutrition via a nasoesophageal tube, compared to puppies that received nil per os until vomiting cease, show earlier clinical improvement, significant weight gain, as well as improved gut barrier function, which could limit bacterial or endotoxin translocation (Mohr et al 2003).…”

Early enteral nutrition in puppies with parvovirus enteritis

“…However, early enteral nutritional support has been shown to be associated with more rapid clinical improvement (Mohr et al, 2003). Puppies fed via nasoesophageal feeding tubes from 12 hours after admission showed earlier improvement of clinical signs and had significant weight gain compared to puppies that were not fed until vomiting had stopped.…”

“…Puppies fed via nasoesophageal feeding tubes from 12 hours after admission showed earlier improvement of clinical signs and had significant weight gain compared to puppies that were not fed until vomiting had stopped. Parameters reflecting improved intestinal barrier function were also observed, suggesting that early enteral nutrition may limit bacterial or endotoxin translocation from the intestines decreasing the potential resultant coliform septicaemia and SIRS (Mohr et al, 2003). Another study in puppies with haemorrhagic gastroenteritis showed that enteral nutrition could result in vomiting shortly after initiation of feeding, but this is probably not significant because tolerance to the food soon developed in these patients (Will et al, 2005).…”

“…Survival of infected puppies ranges from 9% if left untreated to more than 90% in those treated in tertiary veterinary facilities (Kalli et al, 2010). At the authors' facility survival rates between 80 and 84% have been recorded in consecutive studies during the past decade (Goddard et al, 2008, Schoeman et al, 2007, McClure et al, 2013 Enteral nutrition was shown to be one of the supportive treatments that played a significant role in the clinical improvement of these puppies (Mohr et al, 2003) Pathogenesis and clinical manifestations of CPV enteritis In CPV enteritis, infection with parvovirus is acquired by the faecal-oral route of transmission (Goddard and Leisewitz, 2010). By the 3 rd to 5 th day viraemia is marked, with CPV preferentially targeting tissues with rapid turnover including the intestinal epithelium, lymphoid tissue and bone marrow.…”

Development and analytical validation of a radioimmunoassay for the measurement of alpha1-proteinase inhibitor concentrations in feces from healthy puppies and adult dogs

“…11 The concentration of canine α 1 -PI in feces (Fcα 1 -PI) has been shown to be clinically useful as a marker for GI protein loss in dogs ( Fig. 1), 13,14 and to be increased before the onset of clinical signs and/or hypoalbuminemia or panhypoproteinemia in Soft Coated Wheaten Terrier dogs with familial PLE (Vaden SL -PI/g feces. Observed-to-expected ratios for the serial dilution and spiking recovery of 9 and 6 fecal extracts ranged from 90.4 to 152.0% and from 71.3 to 112.3%, respectively.…”