Gastrointestinal Disorders

Nutritional Management of Acute Gastroenteritis

Alison Manchester

DVM, MS, DACVIM (SAIM)

Colorado State University

Fort Collins, Colorado, USA

Q. What is the typical approach to management for dogs and cats with acute gastroenteritis?

A. The therapeutic approach to patients with acute gastroenteritis is multimodal and includes treating the underlying cause, correcting fluid deficits, and controlling nausea ± pain. Nutritional therapy should also be included in the treatment strategy. Recent studies refute the once widely accepted practice of withholding food from acute gastroenteritis patients. Fasting has been associated with reduced villus height and increased risk of bacterial translocation in dogs and humans.^1,2 Waiting 2 to 4 hours after the last episode of vomiting to feed and using antiemetics may help prevent recurrence of signs.

Q. What nutritional strategies should be used in dogs and cats with acute gastroenteritis?

A. For patients with recent vomiting, it is prudent to initially offer small amounts of food (e.g., 25% of resting energy requirements if hospitalized, divided throughout the day). Division of daily calories over 3 to 6 small meals may be continued during the recovery period. Patients can gradually transition back to their normal feeding regimen as their clinical signs subside. Palatability is an important consideration, particularly for finicky eaters. Food aversions to diets offered during the acute illness may ensue.

No single diet will be appropriate for all patients. The ideal macronutrient blend of protein, fat, and carbohydrate for dogs with acute gastroenteritis is yet to be determined. Fiber is a nutrient to pay attention to and tailor to the individual patient. In some cases, supplemental fiber may help with diarrhea^3,4 and provide beneficial prebiotic effects. However, fiber reduces digestibility and may delay gastric emptying, which may be undesirable in vomiting patients.

Ultimately, there are many diets that can be effective in acute gastroenteritis. These include commercial (e.g., gastroenteric formulas) and home-cooked diets. Commercially available gastroenteric diets are complete and balanced and contain nutrients such as prebiotics that may support gastrointestinal health. Home-cooked diets will be more labor intensive for clients and should be formulated by a veterinary nutritionist to be complete and balanced. The veterinary health care team should work together with the client to evaluate each patient as an individual and develop an appropriate nutrition plan.

Q. What client communication tips can be helpful for pet owners?

A. Optimizing positive outcomes in these patients involves providing realistic expectations to clients. Provided the diagnostic workup did not reveal a specific cause for gastroenteritis and no red flags (e.g., hypovolemic shock, anemia, hypoalbuminemia) were encountered, clients can be counseled that most causes of acute gastroenteritis are self-limiting, and that diet has been shown to be a safe and successful tool for management.⁴ However, it may take several days for things to normalize. Clients should be provided with specific instructions regarding feeding, including what diet to offer, how much of the diet to offer and how often, and signs that their pet could need further evaluation.

1. Hernandez, G., Velasco, N., Wainstein, C., Castillo, L., Bugedo, G., Maiz, A., Lopez, F., Guzman, S., & Vargas, C. (1999). Gut mucosal atrophy after a short enteral fasting period in critically ill patients. Journal of Critical Care, 14(2), 73-77. doi: 10.1016/s0883-9441(99)90017-5

2. Qin, H. L., Su, Z. D., Gao, Q., & Lin, Q. T. (2002). Early intrajejunal nutrition: Bacterial translocation and gut barrier function of severe acute pancreatitis in dogs. Hepatobiliary and Pancreatic Diseases International, 1(1), 150-154.

3. Lappin, M. R., Zug, A., Hovenga, C., Gagne, J., & Cross, E. (2022). Efficacy of feeding a diet containing a high concentration of mixed fiber sources for management of acute large bowel diarrhea in dogs in shelters. Journal of Veterinary Internal Medicine, 36(2), 488-492. doi: 10.1111/jvim.16360

4. Rudinsky, A. J., Parker, V. J., Winston, J., Cooper, E., Mathie, T., Howard, J. P., Bremer, C. A., Yaxley, P., Marsh, A., Laxalde, J., Suchodolski, J., & Perea, S. (2022). Randomized controlled trial demonstrates nutritional management is superior to metronidazole for treatment of acute colitis in dogs. Journal of the American Veterinary Medical Association, 260(S3), S23-S32. doi: 10.2460/javma.22.08.0349