Continuous radiotelemetric monitoring of intragastric pH in a dog with peptic ulceration

Abstract

CASE DESCRIPTION A 6-year-old castrated male Boxer was evaluated for a 5-week history of frequent vomiting, melena, and signs of abdominal pain following accidental ingestion of 5 to ten 15-mg meloxicam tablets (approx ingested dose, 3.1 to 6.2 mg/kg [1.4 to 2.8 mg/lb]). CLINICAL FINDINGS Clinical signs persisted despite 3 weeks of treatment with sucralfate (41.8 mg/kg [19 mg/lb], PO, q 8 h) and omeprazole (0.8 mg/kg [0.36 mg/lb], PO, q 24 h). Results of a CBC and serum biochemical analysis were unremarkable. Abdominal ultrasonography revealed peptic ulceration, and esophagogastroduodenoscopy confirmed the presence of severe proximal duodenal ulceration. TREATMENT AND OUTCOME A radiotelemetric pH-monitoring capsule was placed in the gastric fundus under endoscopic guidance for continuous at-home monitoring of intragastric pH and response to treatment. Treatment was continued with sucralfate (as previously prescribed) and omeprazole at an increased administration frequency (0.8 mg/kg, PO, q 12 h). Intragastric pH was consistently ≥ 3.0 for > 75% of the day during treatment, with the exception of 1 day when a single dose of omeprazole was inadvertently missed. Ulceration and clinical signs completely resolved. CLINICAL RELEVANCE Continuous radiotelemetric monitoring of intragastric pH in the dog of this report was useful for confirming that treatment achieved a predetermined target pH and for demonstrating the impact of missed doses. Duodenal ulceration resolved with twice-daily but not once-daily omeprazole administration. Findings suggested that twice-daily administration of omeprazole may be necessary to achieve this target pH and that a pH ≥ 3.0 for 75% of the day may promote healing of peptic ulcers in dogs.

ACVIM consensus statement: Support for rational administration of gastrointestinal protectants to dogs and cats

“…Enterohepatic recycling of NSAIDs likely plays a role whereby high concentrations of NSAIDs in bile are secreted into the duodenum in close proximity to the major duodenal papilla. Some of the most serious intestinal lesions in dogs caused by NSAIDs occur in this region . Small intestinal injury may be caused by increased numbers of gram‐negative facultative anaerobic bacteria that flourish in the SI of patients treated with PPIs.…”

“…The ability to accurately and noninvasively measure intragastric pH with catheter‐less radiotelemetric pH monitoring devices (Bravo pH monitoring system, Medtronic Inc., Minneapolis, MN) in recent years has advanced our understanding of the effects of acid suppressants and dosing protocols on intragastric pH in animals and humans . Unfortunately, critical assessment of acid suppressants in experimental models and dogs and cats with spontaneous disease is sparse, and most of the studies evaluating the efficacy of acid suppressants were performed in healthy animals.…”

Prospective Randomized Controlled Clinical Trial of the Long-Term Effects of Omeprazole on Healthy Dogs

“…In dogs and cats, PPIs, including omeprazole, have demonstrated efficacy in increasing gastric pH, prescribed for managing dyspepsia, peptic ulceration, and gastroesophageal reflux disease [1,9]. Short-term administration of PPIs is generally well-tolerated in dogs and cats, with minor adverse effects, primarily self-limiting diarrhea and intestinal dysbiosis [4,7,10].…”

Aspirin eugenol ester ameliorates LPS-induced inflammatory responses in RAW264.7 cells and mice

“…Although the inflammatory response is necessary for keeping the body healthy, when the inflammatory response is too intense, it can cause a large number of tissue rejection reactions and a series of knock-on effects. At present, non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids are widely used in the treatment of inflammatory diseases ( Lane et al, 2017 ). Research has revealed that NSAIDs have the advantage of fast onset of action and are more commonly used in clinical practice, but pharmacokinetic and pharmacodynamic tests have shown that these drugs have side effects such as gastrointestinal mucosal damage ( Saganuwan and Orinya, 2016 ).…”