Lymphocytic-plasmacytic enteritis

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Endoscopic appearance of duodenum showing white spots on the mucosal surface, characteristic of intestinal lymphangiectasia associated with LPE[1]

Lymphocytic-plasmacytic enteritis (LPE) is a type of inflammatory bowel disease of the dog characterized by protein-losing enteropathy, intestinal lymphangiectasia and a lymphocytic inflammatory response in the lamina propria of the small intestine[2].

This disease is one of the most common causes of chronic vomiting and diarrhoea in the dog[3].

The cause of LPE is thought to involve an exaggerated reaction of the mucosal immune system against the environment (bacteria and food antigens) in a susceptible dog[4].

In affected patients, there appears to be immunopathology in the intestinal microenvironment due to luminal antigns[5], characterized by upregulation of cytokines[6], leukocytes[7], lymphocyte apoptosis[8], toll-like receptors[9], nuclear factor kappa-beta[10] and intestinal microbial communities[11].

Symptoms which are commonly observed include chronic weight loss, intermittent anorexia, vomiting and diarrhea[12].

This disease may be multifactorial in origin as some dogs present with intestinal lymphangiectasia and pancreatic exocrine insufficiency[13].

Hematological examination may reveal characteristic hypoalbuminemia, hyperglobulinemia, lymphopenia, hypocalcemia, and hypercholesterolemia. Postprandial bile acids values should be evaluated to eliminate possible hepatic causes of gastrointestinal disease.

Radiography is usually unrewarding, but endoscopy may show peritoneal effusion, thickening of intestinal loops as well as corrugations[14] and intestinal masses with dilated lacteals[1]. Distended lacteals, defined as many expanded white villi in the duodenum, is an endoscopic finding strongly indicative of intestinal lymphangiectasia but can be found in dogs with LPE as well[15].

Intestinal biopsies are usually recommended, often obtained during an exploratory laparotomy in order to histologically examine samples for a definitive diagnosis.

Diagnosis is based on ruling out diseases that may cause intestinal inflammation along with histological evidence of inflammatory infiltration into the intestinal mucosa[16].

A differential diagnosis would include other causes of inflammatory bowel disease, intestinal lymphoma, leiomyoma, leiomyosarcoma, gastrointestinal stromal tumor and gastrointestinal parasites such as Giardia spp[17].

Treatment is usually symptomatic with antidiarrheal medication, dietary modification (low fat diet), prednisolone[18], metronidazole, metoclopramide, omeprazole and anthelmintic therapy[19].

With correct treatment, many dogs respond and clinical symptoms resolve. Long-term prednisolone may be required to maintain good quality of life and abeyance of clinical disease.

References

  1. 1.0 1.1 García-Sancho M et al (2011) White spots on the mucosal surface of the duodenum in dogs with lymphocytic plasmacytic enteritis. J Vet Sci 12(2):165-169
  2. Kobayashi S et al (2007) Measurement of intestinal mucosal permeability in dogs with lymphocytic-plasmacytic enteritis. J Vet Med Sci 69(7):745-749
  3. Guilford WG (1996) Idiopathic inflammatory bowel diseases. In: Guilford WG, Center SA, Strombeck DR, Williams DA, Meyer D, editors. Strombeck's Small Animal Gastroenterology. 3rd ed. Philadelphia: Saunders. pp:451–486
  4. Isaacs KL et al (2005) State of the art: IBD therapy and clinical trials in IBD. Inflamm Bowel Dis 11(1):S3–S12
  5. Luckschander N et al (2010) Activation of nuclear factor-κB in dogs with chronic enteropathies. Vet Immunol Immunopathol 133:228–236
  6. Jergens AE et al (2009) Intestinal cytokine mRNA expression in canine inflammatory bowel disease: a meta-analysis with critical appraisal. Comp Med 59:153–162
  7. Kleinschmidt S et al (2007) Characterization of mast cell numbers and subtypes in biopsies from the gastrointestinal tract of dogs with lymphocytic-plasmacytic or eosinophilic gastroenterocolitis. Vet Immunol Immunopathol 120:80–92
  8. Dandrieux JR et al (2008) Evaluation of lymphocyte apoptosis in dogs with inflammatory bowel disease. Am J Vet Res 69:1279–1285
  9. Burgener IA et al (2008) Upregulation of toll-like receptors in chronic enteropathies in dogs. J Vet Intern Med 22:553–560
  10. Luckschander N et al (2010) Activation of nuclear factor-κB in dogs with chronic enteropathies. Vet Immunol Immunopathol 133:228–236
  11. Xenoulis PG et al (2008) Molecular-phylogenetic characterization of microbial communities imbalances in the small intestine of dogs with inflammatory bowel disease. FEMS Microbiol Ecol 66:579–589
  12. Tams TR (2003) Handbook of Small Animal Gastroenterology. 2nd ed. Philadelphia: Saunders. pp:211–250
  13. Rodríguez-Alarcón CA et al (2012) Protein-losing enteropathy in a dog with lymphangiectasia, lymphoplasmacytic enteritis and pancreatic exocrine insufficiency. Vet Q 32(3-4):193-197
  14. Moon ML et al (2003) Ultrasonographic appearance and etiology of corrugated small intestine. Vet Radiol Ultrasound 44(2):199-203
  15. Tams TR (1999) Small Animal Endoscopy. 2nd ed. St. Louis: Mosby. pp:173–216
  16. Hall EJ & German AJ (2005) Diseases of the small intestine. In: Ettinger SJ, Feldman EC, editors. Textbook of Veterinary Internal Medicine: Diseases of the Dog and the Cat. St. Louis: Saunders. pp:1332–1378
  17. Willard MD (2012) Alimentary neoplasia in geriatric dogs and cats. Vet Clin North Am Small Anim Pract 42(4):693-706
  18. Steiner JM (2004) Protein-losing enteropathy. In: Tilley LP, Smith FWK, eds. The 5-Minute Veterinary Consult Canine and Feline, 3rd ed. Philadelphia: Lippincott Williams & Wilkins. pp:1070–1071
  19. García-Sancho M et al (2007) Evaluation of clinical, macroscopic, and histopathologic response to treatment in nonhypoproteinemic dogs with lymphocytic-plasmacytic enteritis. J Vet Intern Med 21(1):11-17