Doença inflamatória intestinal idiopática em cães: estudo retrospetivo de 21 casos clínicos
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2017-05-04
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A doença inflamatória intestinal idiopática é uma das causas mais frequentes do surgimento de sinais gastrointestinais persistentes e recorrentes no cão.
As novas investigações apontam as alterações da permeabilidade da mucosa, com perda da tolerância a antigénios endógenos provenientes da dieta ou do microbiota intestinal como fatores desencadeantes da sua patogenia, resultando numa resposta inflamatória descontrolada e aberrante.
O diagnóstico é obtido a partir da exclusão de todas as doenças que provoquem inflamação crónica do intestino. O tratamento da doença inflamatória intestinal é essencialmente baseado na modificação da dieta e no recurso à utilização de imunossupressores.
Este trabalho tem como objetivo caracterizar uma população diagnosticada com doença inflamatória intestinal no período compreendido entre Janeiro de 2013 a Junho de 2015 nos Hospitais Veterinários onde realizei estágio: Hospital Veterinário das Laranjeiras, Hospital Veterinário de Canis (Espanha) e no Hospital Veterinário do Restelo. Foram avaliados vinte e um animais, dos quais cinco responderam simplesmente à modificação da dieta, um com alteração do antibiótico e quinze ao uso de imunossupressores. Quanto à resposta ao tratamento foram classificados como “controlados”, “não-controlados” e “intermitentes”.
Avaliou-se a existência de correlação entre vários parâmetros (gravidade histológica, índice de atividade clínica da doença inflamatória intestinal canina (CIBDAI) e a concentração sérica de albumina). Foi encontrada associação entre a gravidade histológica e a concentração de albumina (p <0.01), o que revela a importância da alteração da barreira intestinal na patogenia da doença inflamatória intestinal idiopática. Foi também objetivo deste estudo verificar se a idade, a gravidade histológica, o CIBDAI e a concentração da albumina apresentam valor como indicadores de prognóstico, para tal foram implementados três modelos logísticos com objetivo de calcular o risco, Odds Ratio (OR). Verificou-se que os animais com classificação CIBDAI grave têm cerca de oito vezes (OR= 8.17) mais probabilidade de não responder apenas à mudança de dieta. Os outros resultados não se mostraram estatisticamente significativos, mas há uma tendência para um risco crescente para não responder apenas à mudança da dieta ao nível quando há um aumento da gravidade histológica, com a idade e com hipoalbuminemia.
The idiopathic inflammatory bowel disease is one off the most frequent causes of the persistent and recurrent gastrointestinal signs appearance in dogs. New investigations show that permeability changes on the mucosa, with loss of endogenous antigen tolerance, originated from a diet or from endogenous microbiota as the triggering factors of their pathogenicity, causing an uncontrolled aberrant and inflammatory response. The diagnosis is obtained from the exclusion of all diseases that cause intestine chronic inflammation. The inflammatory bowel disease treatment is mainly based on a diet modification and requires an immunosuppressant use. This study intends to characterize the population diagnosed with inflammatory bowel disease, it was done in a period from January 2013 and June 2015 in Veterinary hospitals were I did my internship: in Hospital Veterinário das Laranjeiras, in Hospital Veterinário de Canis (Spain) and in Hospital Veterinário do Restelo. From the twenty-one animals evaluated, five responded only with a diet modification; one with a change in antibiotic; and other fifteen required an immunosuppressant use. About the treatment answers it was classified as "controlled", "non-controlled" and "intermittent". The existence of correlation according various parameters was evaluated (histological severity, activity index CIBDAI and serum albumin concentration). Only one association between histological severity and albumin concentration was found (p <0.01), which reveals how important is the intestinal barrier alteration in the pathogenesis of idiopathic inflammatory bowel disease. It was also a goal of this study verify if the age, histological severity, Clinical Activity Index of Inflammatory Bowel Disease in dogs and albumin concentration presents value as prognostic indicators, for this was implemented three logistic models in order to calculate the risk, odds Ratio (OR). It was checked that animals with serious CIBDAI classification have around eight times (OR= 8.17) more chances to not respond only to the diet modifications. Other results were not statistically significant, but it was verified that there is a tendency for an increasing risk to not respond only to the diet modification when there is an increase of the histological severity, with the age and hypoalbuminemia.
The idiopathic inflammatory bowel disease is one off the most frequent causes of the persistent and recurrent gastrointestinal signs appearance in dogs. New investigations show that permeability changes on the mucosa, with loss of endogenous antigen tolerance, originated from a diet or from endogenous microbiota as the triggering factors of their pathogenicity, causing an uncontrolled aberrant and inflammatory response. The diagnosis is obtained from the exclusion of all diseases that cause intestine chronic inflammation. The inflammatory bowel disease treatment is mainly based on a diet modification and requires an immunosuppressant use. This study intends to characterize the population diagnosed with inflammatory bowel disease, it was done in a period from January 2013 and June 2015 in Veterinary hospitals were I did my internship: in Hospital Veterinário das Laranjeiras, in Hospital Veterinário de Canis (Spain) and in Hospital Veterinário do Restelo. From the twenty-one animals evaluated, five responded only with a diet modification; one with a change in antibiotic; and other fifteen required an immunosuppressant use. About the treatment answers it was classified as "controlled", "non-controlled" and "intermittent". The existence of correlation according various parameters was evaluated (histological severity, activity index CIBDAI and serum albumin concentration). Only one association between histological severity and albumin concentration was found (p <0.01), which reveals how important is the intestinal barrier alteration in the pathogenesis of idiopathic inflammatory bowel disease. It was also a goal of this study verify if the age, histological severity, Clinical Activity Index of Inflammatory Bowel Disease in dogs and albumin concentration presents value as prognostic indicators, for this was implemented three logistic models in order to calculate the risk, odds Ratio (OR). It was checked that animals with serious CIBDAI classification have around eight times (OR= 8.17) more chances to not respond only to the diet modifications. Other results were not statistically significant, but it was verified that there is a tendency for an increasing risk to not respond only to the diet modification when there is an increase of the histological severity, with the age and hypoalbuminemia.
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Dissertação de Mestrado Integrado em Medicina Veterinária
Palavras-chave
Cão , Doença inflamatória intestinal , Inflamação crónica , Diagnóstico diferencial