THERAPEUTIC NUTRITION

Useful information about the needs of cats and dogs with nutritionally sensitive health conditions.

Gastrointestinal Disorders

Food-Responsive Enteropathy (Diarrhea) in Dogs

Food-responsive enteropathy is one of the most common forms of chronic enteropathy in dogs and includes those with adverse food reactions (i.e., food allergy and food intolerance) and those with intestinal inflammation that benefits from properties of a different diet.¹ Food-responsive enteropathy is characterized by persistent or intermittent gastrointestinal (GI) clinical signs lasting 3 weeks or longer in the absence of other causes (e.g., dietary indiscretion, parasitism, identified enteropathogens, or neoplasia) and non-GI diseases.^2,3

Dogs with food-responsive enteropathy are more likely to be younger, have less severe clinical signs, and exhibit more large-bowel diarrhea compared to dogs with immunosuppressant-responsive enteropathy.^4─6

Since many dogs with chronic idiopathic GI signs respond well to dietary changes, an elimination diet trial is often recommended before endoscopy for those dogs with mild or moderate signs unless negative prognostic factors (e.g., hypoalbuminemia, hypocobalaminemia, high clinical activity index score) are present.^1,2,4,7,8

The goals of nutritional intervention are to provide a complete and balanced diet that avoids known allergens or ingredients that cause adverse food reactions and resolves or minimizes clinical signs.

Key Messages

No single diet or approach to dietary management of chronic enteropathy works for all dogs, even when choosing a food for a diet elimination trial.^4,7─9
- Identifying the intestinal origin of diarrhea as small or large bowel or mixed can help guide selection of an appropriate diet.
- Dietary strategies commonly used in general veterinary practices include:^{4,5,8,10─13}
  - hydrolyzed or novel protein diets, especially if food allergies or intolerance are suspected
  - highly digestible, low-residue (i.e., low fiber) diets
  - fiber-enhanced diets if fiber-responsive large bowel diarrhea is suspected
Exclusive feeding of the recommended diet is essential to diagnosing and managing dogs with food-responsive enteropathy, especially if the underlying cause is food allergy or intolerance.
- Although improvement in dermatological signs often requires a diet elimination trial lasting 8 weeks or longer, improvement in gastrointestinal signs may be seen within 1 to 4 weeks.^1,4
Dogs who respond positively to a hydrolyzed or novel protein diet within the first 4 weeks of a diet trial are categorized as having food-responsive enteropathy.
- Not all dogs with food-responsive enteropathy will respond to a particular food within 1 to 4 weeks. If no response occurs during the initial dietary trial, a second dietary trial that uses a different nutritional approach may be beneficial before considering an antibiotic trial or intestinal biopsies.¹⁴
- Studies have shown, following 12 to 14 weeks of feeding an elimination diet after diagnosis, many dogs with food-responsive enteropathy could be gradually transitioned back to their original diet without recurrence of clinical signs.^4,5
Following resolution of clinical signs, some owners may decline to perform the challenge phase of an elimination diet trial to confirm the presence of a food allergy or intolerance. These dogs should be continued on dietary therapy for maintenance of their food-responsive condition.
Dogs whose clinical signs resolve during an elimination diet trial and relapse upon challenge with the original diet (or its components) should be continued on dietary therapy for maintenance of their food-responsive condition.

Diet characteristics and nutrients of concern include digestibility, protein, fat, and fiber.^10,15 However, not every nutrient of concern is relevant for every patient.
For dogs with suspected food allergies, protein is the nutrient of greatest concern since, in most cases of food allergy, the allergen is a dietary protein. Hydrolyzed protein, amino acid-based or novel protein diets can be used with these patients.
- Common food allergens in dogs are beef, dairy, wheat, chicken, and egg.^16,17 Allergies can form to any protein since allergies are an inappropriate immune reaction to a normal protein.
- A comprehensive diet history is essential to identify a novel protein diet but is not critical to the selection of a hydrolyzed protein diet.
Food intolerance, which is an adverse reaction to a food or food additive, is not recognized as having a specific immune component.^1,18
- These idiosyncratic reactions are variable, usually dose-dependent, can happen at any age, and may occur any time after the triggering food or ingredient is eaten.¹⁸
- Identifying the ingredient responsible for the adverse reaction can be challenging.
For dogs with evidence of large bowel diarrhea, a high-fiber diet containing mixed fibers (e.g., soluble/fermentable and insoluble/poorly fermentable) may be indicated to help reduce tenesmus and assist mucosal repair in the colon.^10,19
Increased levels of omega-3 fatty acids, which have anti-inflammatory and immune response-modulating effects, may benefit dogs with food-responsive enteropathy.^1,20
Prebiotics, probiotics, or synbiotics may help dogs with food-responsive enteropathy by influencing the composition of the GI microbiome.^1,10

To Share With Pet Owner:

Screening Diet History Form

This short, screening diet history form is a practical, easy-to-use document that can help clients provide important information about their pets’ diets.

View Tool 1 min to 5 min

How to Encourage Finicky Pets to Eat

Pets who are finicky, fussy or not interested in food can be a challenge.

View Brief 1 min to 5 min

Canine Body Condition System Sheet

A visual aid to the Purina Body Condition Score System for dogs.

View Tool 1 min to 5 min

Food Allergies & Food Intolerances in Pets

The terms “food allergy” and “food intolerance” are often used interchangeably, but they are not the same. How do they compare, and how are they diagnosed and managed?

View Hot Topic 6 min to 10 min

Switching Pet Foods - Dogs

Gradually transitioning onto a new diet minimizes the risk of stomach upset.

View Brief 1 min to 5 min

References

Gaschen, F. P., & Merchant, S. R. (2011). Adverse food reactions in dogs and cats. Veterinary Clinics of North America: Small Animal Practice, 41(2), 361─379. doi: 10.1016/j.cvsm.2011.02.005
Dandrieux, J. R. S., & Mansfield, C. S. (2019). Chronic enteropathy in canines: Prevalence, impact and management strategies. Veterinary Medicine: Research and Reports, 10, 203─214. doi: 10.2147/VMRR.S162774
Jergens, A. E., & Simpson, K. W. (2012). Inflammatory bowel disease in veterinary medicine. Frontiers in Bioscience-Elite, 4(4), 1404─1419. doi: 10.2741/470
Allenspach, K., Wieland, B., Gröne, A., & Gaschen, F. (2007). Chronic enteropathies in dogs: Evaluation of risk factors for negative outcome. Journal of Veterinary Internal Medicine, 21(4), 700─708. doi: 10.1111/j.1939-1676.2007.tb03011.x
Allenspach, K., Culverwell, C., & Chan, D. (2016). Long-term outcome in dogs with chronic enteropathies: 203 cases. Veterinary Record, 178(15), 368. doi: 10.1136/vr.103557
Volkmann, M., Steiner, J. M., Fosgate, G. T., Zentek, J., Hartmann, S., & Kohn, B. (2017). Chronic diarrhea in dogsꟷRetrospective study in 136 cases. Journal of Veterinary Internal Medicine, 31(4), 1043─1055. doi: 10.1111/jvim.2017.31.issue-4
Dandrieux, J. R. S. (2016). Inflammatory bowel disease versus chronic enteropathy in dogs: Are they one and the same? Journal of Small Animal Practice, 57(11), 589─599. doi: 10.1111/jsap.12588
Mandigers, P. J., Biourge, V., van den Ingh, T. S., Ankringa, N., & German, A. J. (2010). A randomized, open-label, positively-controlled field trial of a hydrolyzed protein diet in dogs with chronic small bowel enteropathy. Journal of Veterinary Internal Medicine, 24(6), 1350─1357. doi: 10.1111/j.1939-1676.2010.0632.x
Makielski, K., Cullen, J., O’Connor, A., & Jergens, A. E. (2019). Narrative review of therapies for chronic enteropathies in dogs and cats. Journal of Veterinary Internal Medicine, 33(1), 11─22. doi: 10.1111/jvim.15345
Lenox, C. E. (2021). Nutritional management of dogs and cats with gastrointestinal diseases. Veterinary Clinics of North America: Small Animal Practice, 51(3), 669─684. doi: 10.1016/j.cvsm.2021.01.006
Marks, S., Laflamme, D. P., & McAloose, D. (2002). Dietary trial using a commercial hypoallergenic diet containing hydrolyzed protein for dogs with inflammatory bowel disease. Veterinary Therapeutics: Research in Applied Veterinary Medicine, 3(2), 109─118.
Procoli, F. (2020). Inflammatory bowel disease, food-responsive, antibiotic-responsive diarrhoea, protein losing enteropathy: Acronyms, clinical staging, and treatment of chronic inflammatory enteropathy in dogs. Advances in Small Animal Care, 1, 127─141. doi: 10.1016/j.yasa.2020.07.010
Simpson, K. W., & Jergens, A. E. (2011). Pitfalls and progress in the diagnosis and management of canine inflammatory bowel disease. Veterinary Clinics of North America: Small Animal Practice, 41(2), 381─398. doi: 10.1016/j.cvsm.2011.02.003
Rudinsky, A. J., Rowe, J. C., & Parker, V. J. (2018). Nutritional management of chronic enteropathies in dogs and cats. Journal of the American Veterinary Medical Association, 253(5), 570─578. doi: 10.2460/javma.253.5.570
Zoran, D. L. (2017). Nutritional management of gastrointestinal disease. In S. J. Ettinger, E. C. Feldman & E. Côté (Eds.), Textbook of veterinary internal medicine: Diseases of the dog and the cat (8th ed., pp. 1892─1899). Elsevier.
Mueller, R. S., Olivry, T., & Prélaud, P. (2016). Critically appraised topic on adverse food reactions of companion animals (2): Common food allergen sources in dogs and cats. BMC Veterinary Research, 12, Article 9. doi: 10.1186/s12917-016-0633-8
Verlinden, A., Hesta, M., Millet, S., & Janssens, G. P. (2006). Food allergy in dogs and cats: A review. Critical Reviews in Food Science and Nutrition, 46(3), 259─273. doi: 10.1080/10408390591001117
Craig, J. M. (2019). Food intolerance in dogs and cats. Journal of Small Animal Practice, 60(2), 77─85. doi: 10.1111/jsap.12959
Leib, M. (2000). Treatment of chronic idiopathic large bowel diarrhea in dogs with a highly digestible diet and soluble fiber: A retrospective review of 37 cases. Journal of Veterinary Internal Medicine, 14(1), 27─32. doi: 10.1111/j.1939-1676.2000.tb01495.x
Cave, N. (2012). Nutritional management of gastrointestinal diseases. In A. J. Fascetti & S. J. Delaney (Eds.), Applied veterinary clinical nutrition (pp. 175─220). John Wiley & Sons.

THERAPEUTIC NUTRITION

Food-Responsive Enteropathy (Diarrhea) in Dogs

Key Messages

Diet Elimination Trials

Taking a Good Diet History

Nutritional Assessment Is an Iterative Process: Extended Evaluation

Purina Fecal Scoring Chart

Why Distinguish Between Small and Large Bowel Diarrhea

Distinguishing Characteristics of Small and Large Bowel Diarrhea Chart

Intestinal Dysbiosis in Dogs and Cats

To Share With Pet Owner:

Screening Diet History Form

How to Encourage Finicky Pets to Eat

Canine Body Condition System Sheet

Food Allergies & Food Intolerances in Pets

Switching Pet Foods - Dogs

References

THERAPEUTIC NUTRITION

Food-Responsive Enteropathy (Diarrhea) in Dogs

Key Messages

Nutritional management approaches to consider

Diet characteristics, nutrients of concern, and related interventions

Download or share this resource

Related Tools and Content:

Diet Elimination Trials

Taking a Good Diet History

Nutritional Assessment Is an Iterative Process: Extended Evaluation

Purina Fecal Scoring Chart

Why Distinguish Between Small and Large Bowel Diarrhea

Distinguishing Characteristics of Small and Large Bowel Diarrhea Chart

Intestinal Dysbiosis in Dogs and Cats

To Share With Pet Owner:

Screening Diet History Form

How to Encourage Finicky Pets to Eat

Canine Body Condition System Sheet

Food Allergies & Food Intolerances in Pets

Switching Pet Foods - Dogs

References