Evaluation of a structured individualised protocol as a potential cost‐effective diagnostic and therapeutic approach to chronic diarrhoea in the dog. Issue 2 (11th February 2019)

• Record Type: Journal Article
• Authors: Bryan, Christine E.; Cade, Jeb C.; Mackin, Andrew J.; Sullivant, Alyssa M.
• Is Part Of: Veterinary medicine and science. Volume 5:Issue 2(2019)
• Page Start: 210
• Page End: 221
• Publication Date: 2019-02-11
• Subjects: diarrhoea -- large bowel -- small bowel; Veterinary medicine -- Periodicals; Animal Diseases; Veterinary medicine; Periodicals; Periodicals; 636.08905
• DOI: 10.1002/vms3.154
• Languages: English
• ISSNs: 2053-1095

Abstract

Abstract: Diagnostic investigation and management of chronic diarrhoea in dogs can be cost‐prohibitive to many owners. The objectives of this study were to evaluate evidence‐based, individualised diagnostic and therapeutic protocols for management of dogs with chronic diarrhoea, where financial constraints dictate a budget‐limited approach and where more expensive approaches are deferred until simple affordable protocols are unsuccessful. Twenty‐two client‐owned dogs with chronic (minimum 2 weeks duration) untreated small, large or mixed small/large bowel diarrhoea were enrolled in a budget‐limited step‐wise management protocol (maximum expenditure $300 over 6 weeks), with diagnostic testing and therapeutic trials managed in an individualised and evidence‐based fashion. Success was defined as complete resolution of diarrhoea for a minimum of 1 month. Dogs that failed to respond to a budget‐limited protocol were then enrolled for complete, referral‐level management. Four dogs exited the project early (one death due to caval syndrome, three lost to follow‐up). Thirteen out of the remaining 18 dogs had complete resolution of diarrhoea utilising a budget‐limited approach (success rate 72.2%, confidence intervals 46.5–90.3%) and five dogs were moved on to a referral‐level investigation, with complete resolution of diarrhoea in four out of five. Seventeen out of the 18 dogs therefore responded to a protocol based on a budget‐limited approach followed by extensive investigation only if needed, for an overall success rate of 94.4% (CI 72.7–99.9%). Comprehensive investigation of chronic diarrhoea can be deferred while simple affordable diagnostics and therapeutic trials are conducted in stable canine patients and, often, an extensive management approach will be unnecessary. Abstract : Management of chronic diarrhoea in dogs can be cost‐prohibitive to many owners. This study evaluated evidence‐based, individualised diagnostic and therapeutic protocols for management of dogs with chronic diarrhoea, where financial constraints dictated a budget‐limited approach and where more expensive approaches were deferred until simple affordable protocols were unsuccessful. Our results demonstrated that comprehensive investigation of chronic diarrhoea can be deferred while simple affordable diagnostics and therapeutic trials are conducted in stable canine patients and, often, an extensive management approach will be unnecessary.