Page 665 - Clinical Small Animal Internal Medicine

59 Diagnosis and Management of Chronic Enteropathies 633

Canine Pancreatic Lipase levels may also be hampered by increases of CRP related
VetBooks.ir Canine pancreatic lipase (now measured with the Spec‐ to diseases other than IBD.

cPL assay) has recently become available as a commer-
cial test and is useful in the assessment of possible Fecal Alpha‐1‐Proteinase Inhibitor
pancreatitis in dogs. However, it can also be elevated in Fecal alpha‐1‐proteinase inhibitor (alpha‐1‐PI) can be
dogs with a primary diagnosis of CE. In a retrospective used as a test for dogs in which the clinician suspects
study of 50 dogs with IBD, clinical signs, age, serum PLE but clinical signs are not overt. Alpha‐1‐proteinase
lipase and amylase activities, albumin and cobalamin inhibitor is a plasma protein of similar size to albumin. If
concentrations, abdominal ultrasound examination, his- the intestinal mucosal barrier is compromised and loss of
topathologic review of intestinal biopsies, management protein into the intestinal lumen occurs, alpha‐1‐PI is
of IBD, and follow‐up in dogs with CE were evaluated. lost at approximately the same rate as albumin. Unlike
Sixteen dogs with increased cPL and 32 dogs with nor- albumin, however, its proteinase inhibitor properties
mal cPL values were compared. No significant differ- protect alpha‐1‐PI from being degraded by intestinal
ences were found in clinical activity score, serum amylase proteases. Therefore, it is able to persist throughout the
activity, serum lipase activity, serum cobalamin concen- intestinal transit and is passed undamaged in the feces,
tration, serum albumin concentration, abdominal ultra- in which it can then be measured.
sound scores, and histopathology scores for IBD. There Prompt diagnosis of PLE in a patient with IBD is
was also no difference in the frequency of steroid treat- important, as hypoalbuminemia is a risk factor for a neg-
ment between the groups. Interestingly, dogs with ele- ative outcome and the cause should be treated aggres-
vated Spec‐cPL had a higher risk of a poor follow‐up sively in order to improve survival. The alpha‐1‐PI assay
score and were significantly more likely to be euthanized is especially valuable in a patient with intestinal disease
at follow‐up. that also suffers from concurrent renal or hepatic dis-
These data suggest that elevated Spec‐cPL in canine
IBD identifies a subset of these patients that could also ease. In these patients, measurement of fecal alpha‐1‐PI
can help assess which portion, if any, of the protein loss
have chronic subclinical pancreatitis. In patients which can be attributed to the intestine. This test is so far only
have been diagnosed with CE and also have elevated available at the Texas GI lab and ideally, three consecu-
Spec‐cPL without overt imaging evidence of acute pan- tive freshly collected, frozen fecal samples should be sub-
creatitis, it is recommended to discuss treatment mitted in order to improve the accuracy of the test. This
options for IBD that will also treat possible autoim- means that fecal alpha‐1‐PI is to date not a useful test for
mune pancreatitis. The author has had anecdotal suc- practitioners outside North America.
cess with cyclosporin at 5 mg/kg SID for eight weeks in
such cases.
Polymerase Chain Reaction for Antigen
Receptor Rearrangement from Intestinal
C‐Reactive Protein Biopsies

C‐reactive protein (CRP) is a serum acute phase protein Polymerase chain reaction for antigen receptor rear-
that can be elevated in many different diseases. In peo- rangement (PARR) amplifies the highly variable T or B
ple with IBD, several indices of clinical disease activity cell antigen receptor genes, and is used to detect the
incorporate measurements of CRP. In dogs, a similar presence of a clonally expanded population of lympho-
correlation between the Canine IBD Activity Index cytes. This test has been advocated to be useful when
(CIBDAI) and CRP serum concentrations has been applied on endoscopic biopsies if a diagnosis of intestinal
found in one large study incorporating 58 dogs. CRP lymphoma is suspected but not confirmed by conven-
was elevated when compared to normal in 28 of the 58 tional histopathology. It is, however, important to note
dogs in this study, which had CIBDAI scores above 5 that dogs with CE can in up to 20% of cases have biopsies
(which represents mild to moderate disease activity). In which test positive for clonality. The test therefore needs
these dogs CRP decreased significantly after successful to be evaluated as an additional measure to help with the
treatment. differentiation of intestinal lymphoma versus CE, but
In another study, CRP did not seem to be very helpful, should not be used as the sole differentiating factor or
as it was only elevated in 6/21 dogs with CE. Based on even the gold standard. Other tests that can help with
available published data, it is possible that CRP is useful this question are immunohistochemistry for B and T
as an additional assessment tool in severely ill patients, cells, abdominal ultrasound and possibly fine needle
even though a large percentage of dogs with IBD do not aspirates of enlarged mesenteric lymph nodes, if they are
show any elevations in CRP. Interpretation of elevated present.