Redefining Hemorrhagic Gastroenteritis

Hemorrhagic gastroenteritis (HGE) syndrome in dogs is characterized by the acute onset of bloody diarrhea and vomiting. Histopathology performed at necropsy has shown superficial mucosal hemorrhagic necrosis in the intestines of dogs with HGE. While the syndrome’s exact cause is unknown, Clostridium perfringens has been a previously associated pathogen. Previous histologic and microbiologic studies of dogs with HGE have only evaluated postmortem GI tissues. This prospective study was the first to perform intra vitam histologic and microbiologic evaluations in dogs with HGE.

Ten dogs with HGE and 11 dogs with non-HGE intestinal disease were included. Endoscopic biopsies were taken from the stomach, duodenum, ileum, and colon and examined for endoscopic and histologic changes, and the first duodenal biopsy sample obtained with sterile forceps was submitted for bacterial culture. Lesions of the mucosa were only identified in the intestines and not in the stomach of dogs with HGE. In addition, all of the dogs with HGE had Clostridium spp identified by culture or histopathology in the small intestine. There is an association between C perfringens and acute hemorrhagic diarrhea, and it was recommended that HGE be renamed to acute hemorrhagic diarrhea syndrome, as the study found no evidence of gastritis in dogs with HGE.

Commentary

This study’s results were somewhat surprising in that the stomach does not appear to be primarily involved despite the common clinical sign of vomiting in many of these patients. Also, the major histologic finding within the small and large intestines involves necrosis rather than inflammation, thereby invalidating the nomenclature of the disease. Finally, the suspicion of Clostridium spp factoring into the pathogenesis supports the need for appropriate therapeutic antibiotic coverage in these cases.—Dara Zerrenner, MS, VMD, DACVIM

Source

Endoscopically visualized lesions, histologic findings, and bacterial invasion in the gastrointestinal mucosa of dogs with acute hemorrhagic diarrhea syndrome. Unterer S, Busch K, Leipig M, et al. JVIM 28:52-58, 2014.