Key Takeaways:
- CIE/IBD is a common, chronic, and relapsing disease in dogs.
- CIE significantly impacts the quality of life of both pets and their owners.
- Diagnosis and management are complex and often require long-term therapy.
- The high number of inadequately controlled patients highlights the need for novel disease-modifying therapies.
Chronic inflammatory diseases (such as CIE) remain difficult to manage - many patients experience incomplete response, relapses and high treatment-related burden.
Chronic inflammatory diseases are:
- mostly progressive
- often underdiagnosed
- associated with relapsing clinical signs
- symptomatically managed with immunosuppressives (e.g. steroids)
- linked to reduced quality of life for pets and pet parents
Therefore, there is a high unmet need for novel, disease-modifying approaches
Critical challenges of chronic inflammatory enteropathy
Gastrointestinal symptoms are one of the most common reasons for pet owners to seek medical care. Up to 20–30% of veterinary visits in companion animals are related to vomiting or diarrhea or both (O’Neill DG et al. 2014).
The umbrella term “Chronic Inflammatory Enteropathy” (CIE) describes a group of gastrointestinal (GI) disorders with persistent or recurrent GI signs lasting ≥3 weeks and variable mucosal inflammation after ruling out metabolic, infectious or neoplastic causes.
Depending on the segment of the GI tract involved and the extent of mucosal inflammation the clinical signs vary; in particular diarrhea, vomiting, alterations in appetite, or weight loss (Jergens E 2022).
Pathogenesis of CIE
The exact pathogenesis remains incompletely understood and is considered multifactorial. Potential contributing factors include:
- dysregulated mucosal immune responses
- genetic susceptibility
- alterations of the intestinal microbiome (dysbiosis)
- impaired intestinal barrier function
- dietary antigens
- environmental factors
| Old terminology | New terminology |
|---|---|
| IBD = Inflammatory Bowel Disease* | CIE = Chronic Inflammatory Enteropathy |
| CIE Subtypes | ||
|---|---|---|
| Food-responsive Enteropathy (FRE) | Immunosuppressant- responsive Enteropathy (IRE) | Non-responsive Enteropathy (NRE) |
Pathophysiology of CIE
The healthy intestine
In the healthy intestine there is a complex balance between protection against bacteria and external antigens AND tolerance to the body´s physiological microbiota = Homeostasis
The intestine in CIE
Current evidence suggests that genetically susceptible dogs and cats develop an inappropriate, exaggerated immune response to luminal antigens, including dietary components and intestinal microorganisms.
This immune dysregulation results in
- chronic intestinal inflammation,
- alterations in the intestinal microbiome (dysbiosis),
- impaired function of the epithelial barrier,
- and changes in microbial metabolism.
The resulting mucosal inflammation can impair nutrient absorption and intestinal function, leading to various chronic gastrointestinal signs.
Clinical symptoms of CIE
Clinical signs may vary depending on the affected gastrointestinal segment and disease severity:
- Chronic diarrhea (small bowel, large bowel or mixed)
- Vomiting
- Weight loss
- Altered appetite (hyporexia, anorexia or polyphagia)
- Borborygmi
- Flatulence
- Abdominal discomfort
- Lethargy
- Ascites or peripheral oedema (in protein-losing enteropathy)
Burden of disease for pets and pet parents
The burden of CIE extends beyond clinical symptoms. As a chronic and often relapsing disorder, CIE can substantially impair both patient well-being and owner quality of life (QoL). Studies show that
- dogs with CIE have a significantly lower overall QoL compared to healthy dogs and, for some parameters, an even lower QoL than dogs affected by cancer [Marchetti V 2021]
- disease severity was directly associated with worsening quality-of-life scores [Marchetti V 2021]
Affected dogs and cats frequently require life-long veterinary care.
This represents a considerable emotional and financial burden for owners. [Dandrieux 2019, Heilmann RM 2026, Bandara Y 2023]
Dogs and cats with severe or refractory cases have substantially poorer prognoses, as the disease can severely impact survival.
- Studies show high rates of GI disease-related death or euthanasia among dogs with non-responsive disease [Allenspach K et al. 2007; Craven M et al. 2004]
- A retrospective study of 65 cats with CE found that 20 cats were euthanized because of GI disease, highlighting the potential for significant mortality despite treatment [Bandara Y 2023]
Overall, CIE represents a significant chronic disease burden due to its impact on patient quality of life, owner well-being, the persistent need for veterinary care and effective long-term treatment strategies as well as the risk of disease progression requiring euthanasia. [Marchetti V 2021, Bandara Y 2023]
Prevalence of CIE in dogs
- The prevalence of CIE in dogs is up to 2% [Dandrieux JR. 2016]
- Any dog, regardless of breed, can be affected by CIE [Kathrani A et al. 2011]
Subtypes of canine CIE
According to the ACVIM Canine CIE Consensus Guidelines 2026, canine CIE can be classified into the following categories:
- Food-responsive enteropathy (FRE) = Dogs with clinical remission following dietary management
- most common form of CIE
- accounts for up to 70% of CIE patients
- often affects younger dogs but can occur at any age
- Immunosuppressant-responsive enteropathy (IRE) = Dogs that fail to achieve remission with dietary management alone
- require immunomodulatory or immunosuppressive therapy
- histopathologic intestinal inflammation is commonly present
- Non-responsive enteropathy (NRE) = Dogs that will not adequately respond to treatment with corticosteroids or other immunosuppressants
- affects approximately 15 - 43% of dogs classified as IRE [Jergens AE 2022]
- canine NRE is a serious and life-threatening disease
Subgroups of chronic inflammatory enteropathies in dogs
There is a good long-term outcome for dogs with CE that initially respond to a dietary trial. However, there are growing concerns that dogs classified as non-food responsive when first diagnosed, will not respond longer term to the same degree. [Dandrieux JRS 2019]
Given the current lack of evidence that protein-losing enteropathy (PLE) and granulomatous colitis (GC) are entirely separate disease entities from CIE in dogs, both PLE and GC were considered distinct phenotypes within the spectrum of CIE phenotypes.
- Protein-losing enteropathy (PLE)
- severe phenotype of CIE characterized by excessive gastrointestinal protein loss
- associated with hypoalbuminaemia
- may be accompanied by ascites, oedema and thromboembolic complications
- Granulomatous colitis
- uncommon subtype, most frequently reported in Boxer dogs and French Bulldogs
- often associated with invasive Escherichia coli
- requires specific diagnostic and therapeutic approaches
Diagnosis of CIE
According to the current guidelines on canine (Heilmann 2026) and feline (Marsilio S et al 2023) chronic enteropathy, diagnosing CIE requires an integrated stepwise approach to establish a minimum data base and rule out relevant diseases that mimic CIE.
Diagnostic approach for companion animals
You want to find out more about diagnosis of chronic enteropathy in dogs and cats?
Current treatment options for CIE
"Chronic enteropathy” (CE) is a heterogeneous clinical syndrome that, due to its complexity, requires a multimodal therapeutic approach. Clinical response to treatment remains the primary prognostic indicator.
Therapy of CIE in dogs
| Food-responsive CIE (FRE) | Immunmodulatory-responsive CIE (IRE) | Non-responsive CIE (NRE) |
|---|---|---|
| Therapeutic diet | Immunosuppressants + therapeutic diet | Fecal Microbiota Transplantation (FMT) as possible adjunctive option |
| ± B vitamin supplementation | ± B vitamin supplementation | |
| ± pre-/pro-, synbiotics | ± pre-, pro-, or synbiotics | |
| If 3 food trials fail = add medication | NEW OPTION COMING SOON: Authorized ready-to-use mesenchymal umbilical-cord stem cells | NEW OPTION COMING SOON: Authorized ready-to-use mesenchymal umbilical-cord stem cells |
New therapeutic paradigm in veterinary medicine.
References
- Jergens AE, Heilmann RM. Canine chronic enteropathy-Current state-of-the-art and emerging concepts. Front Vet Sci. 2022 Sep 21;9:923013. doi: 10.3389/fvets.2022.923013
- Allenspach K, Wieland B, Gröne A, Gaschen F. Chronic enteropathies in dogs: evaluation of risk factors for negative outcome. J Vet Intern Med. (2007) 21:700–8. doi: 10.1111/j.1939-1676.2007.tb03011.x bowel
- Craven M, Simpson JW, Ridyard AE, Chandler ML. Canine inflammatory disease: retrospective analysis of diagnosis and outcome in 80 cases (1995-2002). J Small Anim Pract. (2004) 45:336–42. doi: 10.1111/j.1748-5827.2004.tb00245.x
- Dandrieux JR. Inflammatory bowel disease versus chronic enteropathy in dogs: are they one and the same? J Small Anim Pract. (2016) 57:589 99. doi: 10.1111/jsap.12588
- Dandrieux JRS, Mansfield CS. Chronic Enteropathy In Canines: Prevalence, Impact And Management Strategies. Vet Med (Auckl). 2019 Dec 6;10:203-214.
- O’Neill DG, Church DB, McGreevy PD, Thomson PC, Brodbelt DC. Prevalence of disorders recorded in dogs attending primary-care veterinary practices in England. PLoS ONE. (2014) 9:e90501. doi: 10.1371/journal.pone.0090501
- Kathrani A, Werling D, Allenspach K. Canine breeds at high risk of developing inflammatory bowel disease in the south-eastern UK. Vet Rec. (2011) 169:635. doi: 10.1136/vr.d5380
- Heilmann RM, Jergens AE, Kathrani A, Allenspach K, Salavati Schmitz S, Priestnall SL, Dandrieux JRS, O'Connor AM. ACVIM-endorsed statement: consensus statement and systematic review on guidelines for the diagnosis and treatment of chronic inflammatory enteropathy in dogs. J Vet Intern Med. 2026 Jan 21;40(1):aalaf017.
- Marsilio S. Feline chronic enteropathy. J Small Anim Pract 2021; 62: 409–419
- Marsilio S, Freiche V, Johnson E. ACVIM consensus statement guidelines on diagnosing and distinguishing low grade neoplastic from inflammatory lymphocytic chronic enteropathies in cats. J Vet Intern Med 2023; 37: 794–816
- Henry CJ. Neoplasien des Dünndarms. In: Steiner JM. Hrsg. Gastroenterologie bei Hund und Katze. 1. Aufl.. Hannover: Schlütersche; 2011: 219-222
- Rissetto K, Villamil JA, Selting KA. Recent trends in feline intestinal neoplasia: an epidemiologic study of 1,129 cases in the veterinary medical database from 1964 to 2004. J Am Anim Hosp Assoc 2011; 47 (01) 28-36
- Crisi PE, Giordano MV, Luciani A, Gramenzi A, Prasinou P, Sansone A, Rinaldi V, Ferreri C, Boari A. Evaluation of the fatty acid-based erythrocyte membrane lipidome in cats with food responsive enteropathy, inflammatory bowel disease and low-grade intestinal T-cell lymphoma. PLoS One. 2024 Jul 29;19(7):e0307757
- Marchetti V, Gori E, Mariotti V, Gazzano A, Mariti C. The Impact of Chronic Inflammatory Enteropathy on Dogs’ Quality of Life and Dog-Owner Relationship. Veterinary Sciences. 2021; 8(8):166.
- Bandara Y, Priestnall SL, Chang YM, Kathrani A. Outcome of chronic inflammatory enteropathy in cats: 65 cases (2011-2021). J Small Anim Pract. 2023 Mar;64(3):121-129.