Pathophysiology, Diagnosis, and Management of Canine Intestinal Lymphangiectasia: A Comparative Review

Abstract

Intestinal lymphangiectasia was first described in the dog over 50 years ago. Despite this, canine IL remains poorly understood and challenging to manage. Intestinal lymphangiectasia is characterized by variable intestinal lymphatic dilation, lymphatic obstruction, and/or lymphangitis, and is a common cause of protein-losing enteropathy in the dog. Breed predispositions are suggestive of a genetic cause, but IL can also occur as a secondary process. Similarly, both primary and secondary IL have been described in humans. Intestinal lymphangiectasia is definitively diagnosed via intestinal histopathology, but other diagnostic results can be suggestive of IL. Advanced imaging techniques are frequently utilized to aid in the diagnosis of IL in humans but have not been thoroughly investigated in the dog. Management strategies differ between humans and dogs. Dietary modification is the mainstay of therapy in humans with additional pharmacological therapies occasionally employed, and immunosuppressives are rarely used due to the lack of a recognized immune pathogenesis. In contrast, corticosteroid and immunosuppressive therapies are more commonly utilized in canine IL. This review aims toward a better understanding of canine IL with an emphasis on recent discoveries, comparative aspects, and necessary future investigations.

Diagnostisches und therapeutisches Vorgehen bei der Proteinverlust-Enteropathie (PLE) des Hundes – altbekannt und doch vieles neu

“…Die Proteinverlust-Enteropathie (Protein-Losing Enteropathy, PLE) ist eine ernstzunehmende Erkrankung, die primär bei Hunden zu einem Verlust von Serumprotein und Chylomikronen über den Gastrointestinaltrakt führt 1 , 2 . Die Pathophysiologie der PLE ist nach aktuellem Wissensstand nicht vollständig geklärt, u. a. da dieser Verlust über die Lymphgefäße der Darmschleimhaut stattfindet.…”

Use of octreotide for the treatment of protein‐losing enteropathy in dogs: Retrospective study of 18 cases

“…Despite first being described and identified as a cause of PLE over 60 years ago, 10 IL in dogs remains poorly understood with no clear consensus on the optimal therapeutic management 11 . Furthermore, disease‐associated death occurs in 48% to 54% of dogs with PLE 2,5 .…”

“…Furthermore, disease‐associated death occurs in 48% to 54% of dogs with PLE 2,5 . Standard management strategies for dogs with PLE involve dietary changes, glucocorticoids (at anti‐inflammatory or immunosuppressive doses), immunosuppressive agents, and supplemental and supportive therapies, often regardless of the suspected or confirmed disorder causing PLE 2,11 . Some dogs fail to improve clinically, biochemically, or both in response to a variety of therapies 1,2,12,13 .…”

“…Despite first being described and identified as a cause of PLE over 60 years ago, 10 IL in dogs remains poorly understood with no clear consensus on the optimal therapeutic management. 11 Furthermore, disease‐associated death occurs in 48% to 54% of dogs with PLE. 2 , 5 Standard management strategies for dogs with PLE involve dietary changes, glucocorticoids (at anti‐inflammatory or immunosuppressive doses), immunosuppressive agents, and supplemental and supportive therapies, often regardless of the suspected or confirmed disorder causing PLE.…”

“… 2 , 5 Standard management strategies for dogs with PLE involve dietary changes, glucocorticoids (at anti‐inflammatory or immunosuppressive doses), immunosuppressive agents, and supplemental and supportive therapies, often regardless of the suspected or confirmed disorder causing PLE. 2 , 11 Some dogs fail to improve clinically, biochemically, or both in response to a variety of therapies. 1 , 2 , 12 , 13 Octreotide, a long‐acting somatostatin analogue that is purported to decrease intestinal fat absorption, inhibit gastrointestinal vasoactive peptides, and stimulate the autonomic nervous system, is successful in the treatment of some cases of primary intestinal lymphangiectasia (PIL) in children and adults.…”