dvm360: How to manage chronic inflammatory enteropathies for young canines, in general practice

Chronic inflammatory enteropathies (CIE) in dogs are defined as persistent gastrointestinal (GI) signs lasting more than 3 weeks after other systemic and extra-GI causes have been ruled out. As a small-animal internist practicing in a major metropolitan referral center, one of the most frequent presentations I encounter is the young dog—typically under 5 years of age—with chronic GI signs. These dogs have often already undergone baseline diagnostics with their primary veterinarian, including normal blood work and fecal screening, before being referred for advanced evaluation.

While many of these patients are referred for abdominal ultrasound or endoscopy, it is worth emphasizing that most young dogs with CIE do not require these advanced diagnostics initially. In my experience, ultrasound findings in these cases rarely change the initial treatment plan, which nearly always begins with a diet trial. For most young dogs with chronic GI signs, the disease is ultimately food-responsive enteropathy (FRE).

The cornerstone of management for CIE in young dogs is dietary therapy. The goal is to minimize antigenic stimulation of the intestinal mucosa. Several studies have shown that hydrolyzed or novel-protein diets can induce clinical remission in approximately 60–88% of dogs with CIE and normal serum albumin. In one randomized controlled trial evaluating hydrolyzed fish-protein diets, 83% of dogs with non-protein-losing enteropathy (non-PLE) responded to their first diet, and all remaining non-responders achieved remission after switching to a second hydrolyzed diet.

When initiating a diet trial, client education is essential. Owners must understand that strict adherence is non-negotiable: the prescribed diet must be the only source of nutrition. No other animal-protein treats, supplements, chews, or table scraps should be allowed. Approved hydrolyzed protein treats or small amounts of specific non-animal foods, such as certain vegetables or fruits, are acceptable but should remain limited.

This article originally appeared on dvm360.com on November 11, 2025, as part of Thrive Pet Healthcare's Strategic Alliance with dvm360.

Dr. Max Emanuel is an internal medicine specialist at ACCESS Specialty Animal Hospitals in Los Angeles, part of Thrive Pet Healthcare’s community of hospitals. Originally from Connecticut, he earned his Bachelor of Science degree from the University of Miami and his veterinary doctoral degree from the University of Pennsylvania School of Veterinary Medicine (PennVet). Following graduation, Dr. Emanuel completed a rotating internship at MSPCA-Angell in Boston and a three-year internal medicine residency at the Animal Medical Center in New York City. During his training, he developed special interests in interventional endoscopy and radiology, urinary tract disease, and gastrointestinal disorders. Dr. Emanuel’s career has been shaped by diverse experiences with both domestic and wild animals through his work and training across the United States and abroad.