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Epi4Dogs “Managing SID in EPI dogs”
December 2017

The topic of managing SID (small intestinal dysbiosis) formerly known as SIBO, in EPI dogs is vast, variable and ever evolving.  Over the years, working with veterinarian researchers around the world and also listening to over 3,000 actual EPI pet parents, much information has passed through this website.  We, at Epi4Dogs are proud of the fact that we can and do revise information when more advanced technology is available, more in depth research is done, and as soon as we have permission to do so, we then share the findings with you.

Epi4Dogs objective is to present the very best and most thorough information on EPI by including as much actual and pertinent veterinarian research supporting what we suggest. Too many sites will give recommendations as absolute truths based on human studies and although there are many similarities between the dog and human… there are differences that do affect how things are processed. This is why Epi4Dogs cites veterinarian canine studies, preferably related to EPI when possible. We also strongly recommend that pet owners share with their vets everything that is suggested. We may be the largest resource of EPI and have the only EPI database, however this does not take the place of a vet. An EPI patient’s vet and owner best knows that individual EPI patient’s history and any other possible health concerns, contraindications, etc. An EPI dog (or cat) will best be served when everyone works together and shares information.

With regards to managing SID.  Years ago, vets prescribed Metronidazole (in the USA) that sometimes worked and sometimes didn’t. Back then they didn’t know what else to try.  They now know more…. much more!  Over the years, Tylosin Tartrate (Tylan) has evolved as a better antibiotic in most cases to address the bugs in the gut. Although at that time it was presumed that the gut was overloaded with bad bacteria.  Since then they have further discovered that is not true either.  Now they understand that there is an imbalance of bacteria and that the health of the host and it’s interaction / synergy with the gut flora is also key. However, with antibiotics that do work on SID, sometimes once the course of antibiotics is completed there is a relapse called ARD (Antibiotic Responsive Diarrhea) or TRD (Tylosin Responsive Diarrhea). When SID continues to return, Epi4Dogs recommends a repeat course of antibiotics (Tylan is the preferred drug, given twice a day for 6 weeks) and a change in the diet. These recommendations are from multiple veterinarian research, that is also included on this site. It has also been observed that sometimes instead of stopping the antibiotics completly when the antibiotic course is completed, some dogs do better if slowly withdrawn from the antibiotic. Another point of interest is if the dog does not show noticeable improvement within 7 to 10 days on the antibiotic prescribed (usually Tylan) then continue the course of antibiotic with a different antibiotic (usually Metronidazole, or Amoxycillan or Oxytetracycline [Oxytet]). The opposite is also advised. If starting with Metronidazole or something else and there is no noticeable improvement within 7 to 10 days, then stop that antibiotic and continue the antibiotic course with Tylan. Sometimes, even after trying all of the above, some dogs simply have to be placed on a reduced maintenance dose of antibiotics for life.  If this happens it is Tylan that is prescribed as Metronidazole should not be taken long term (adverse effects).  However, in a recent study, dogs with SID were divided into two treatment groups. 1/2 received FOS (Fructooligosaccharides) a dietary prebiotic, 1/2 received Tylan (antibiotic). Both groups improved. However some in the antibiotic group relapsed, but those in the FOS group continued to do well.  Is FOS a possibility? maybe.

Epi4Dogs and various Veterinarian Medical Schools continue to work together in an effort to find maybe even a better way to address SID than with antibiotics.

As you can see, “how to” manage SID is a work in progress!  With the onset of the study of Microbiome they are now discovering amazing things but realize they have so much more to discover. For example, even bacteria that we considered “bad” has it’s place (in the correct concentration) in the gut. The other thing they have very recently discovered is that some of the bacteria strains that are overall key to good health in the dog…. are different from humans.  In sick dogs, the variety of bacteria strains are less, what you feed a dog does make a difference and can change the gut flora composition, different composition preferences appear with different diseases, not all diseases will respond accordingly to the same set of probitoics.  Some life situations that occur may forever destroy certain bacteria strains, and yet not affect others.

The premise of probiotics sounds good, but they may or may not work depending on the individual dog’s gut flora and health situation. Most probiotic research is based on humans, not dogs and they now know there is a difference between the two. Obviously more studies are needed specifically on dogs so that there is a better understanding of which probiotics might be more appropriate for which condition, habits, and dietary concerns.  If probiotics are given, what is known is to also give a prebiotic for a much better response.

Prebiotics have been shown to make a difference with SID in dogs. A major difference between probiotic and prebiotics is that prebiotics do not depend on the specific gut flora composition like probiotics do. Prebiotics is a food source for probiotics and it also manufactures it’s own necessary probiotics too. However, as beneficial as prebiotics are, too much can also cause a gastrointestinal issues/discomfort. There are different types of prebiotics, some commercial diets currently include FOS ( Fructooligosaccharides ) in moderation which may benefit a dog with SID. Slippery Elm has prebiotic properties but to what degree and why it appears to help in most but not all cases is not yet apparent. Is it the prebiotic composition? the vitamins & minerals?, the mucilage? or the SCFA “Butyrate” in the composition? Further investigation is needed.

And last  but not least…. veterinarian researchers well versed in Microbiome studies are re-visiting fecal transplants as another option to treating SID. This is mostly  based on successful trials with humans dealing with SID and some cases of fecal transplants in dogs. But how often does this affordable procedure need to be done? We don’t know yet, just that we are seeing success with the cases that have been done.

There are now many more choices on how to manage SID in the EPI dog…. but there are no guarantees. Please read the research articles on this site as there is a wealth of information, and much that is not readily known but may be beneficial.   The best treatment any EPI dog (or cat) can receive is when both the vet and the pet owner work together sharing valid, veterinarian research. Assess an individual dog’s situation, observe, keep notes and ascertain what works and what doesn’t for that individual dog.

 

Olesia Kennedy, President, Epi4Dogs
December 2017

 

Possible causes and fixes with “acid reflux” from SID
 

  Acid reflux, wet burps, slight regurgitation??  Although for years we have referred to this as possible Acid Reflux…recent research theories now suggests that what we may be dealing with in EPI dogs is Bile Acid Reflux not true Acid Reflux….. however until there is substantiating research, which we will post when available…. for now, we will continue to refer to it as Acid Reflux, unless we have specific information that states otherwise.

 

Sometimes our EPI dogs struggle with this and the easiest response is to just offer acid reduction drugs…. BUT this may not always be the best solution. It all depends on why the acid reflux issue is happening. What is not told to us is that some of these “acid reducers” often permanently alter the inhibition of gastric acid secretion, which is not such a good thing.

Acid is supposed to be in the stomach.  Oftentimes, the real issue isn’t too much acid in the stomach, but rather too little of the right type of acid“.. Of course there is much more to acid reflux such as why is the esophagus shortening, where is that acid going and why is it going there, sometimes there is a malfunctioning stomach valve, but for purposes of managing acid reflux in EPI patients, we will focus on the most common causes:

The two most common causes of acid reflux are:

·         Inadequate stomach acid not able to process the food properly

·         Inadequate digestive enzymes leading to improper digestion of food

Some triggers of acid reflux can be things like:

·         Food sensitivities/allergies

·         Gut flora imbalance (hmmmmmm?. Sound familiar???!)

·         Some antibiotics

·         Parasites

·         Ileocecal valve dysfunction

·         Environmental toxicities

·         Blood sugar imbalances

What to try to help reduce the acid reflux???

  • Sometimes too little enzymes cause acid reflux by not being enough enzymes to digest food properly causing fermentation and gut imbalance.
  • Sometimes too much enzymes cause acid reflux (depending on why the acid reflux is happening) try reducing the enzymes by a pinch for a few days.
  • Try Slippery Elm first before chemically prepared mfg acid reducers. Slippery Elm coats the intestinal lining with mucilage without permanently altering the digestive gastric inhibitors.
  • http://www.scirp.org/journal/PaperInformation.aspx?PaperID=34284#.U9ZQ7_ldXzt
  • Try pre+probiotics, to help alter the gut flora imbalance, a frequent cause of acid reflux.
  • Try pure canned pumpkin, for the correct fiber to help move the food better and not ferment.
  • Try feeding smaller portions but more often.
  • Sometimes the B12 is slipping and this prompts acid reflux, try adding B12 to the regimen.
  • Often times a food change is needed? something in the diet is not agreeing, either the composition isn?t right or there might even be a food sensitivity.
Sometimes it is not real acid reflux… but a little “vurp” which can come from the following which you might want to curb:
  • drinking too much liquid just before or after a meal
  • running /bouncing around too soon after a meal

Please be sure to try any of the “acid reducers” treatments above one at a time? give it 3-5 days to see if there is a positive or no change at all. As mentioned above, the most common cause of acid reflux is not too much acid, but not enough of the right acid?. HOWEVER..  If none of the above works, then the problem is more likely the less common cause of acid reflux, too much acid, in which case, an acid reducer is needed.  Please talk to your vet about which product might be best suited for your pup: Pepcid AC (famotidine), Prilosec (omeprazole), ranitidine, cimetidine, sucralfate, etc….

FYI.  Famotidine dosing recommendations are listed in this publication… a very good read that also points out possible interactions of famotidine with other listed medications : https://www.mypetneedsthat.com/famotidine-for-dogs/

Wrong food perpetuating SID

Sometimes when SID is in play and the dog is already on antibiotics….. which may be keeping the SID at a minimum, but it is just not being fully eradicated…. sometimes it is because of a certain food in the diet that is perpetuating the SID, or what may be going on in addition to EPI is either IBD or IBS (food sensitivities).  There is a new test by Dr. Jean Dodds that has been performed on some of our member dogs with great success. If you are interested, check out the Nutriscan test http://www.nutriscan.org/knowledge-center/food-sensitivities.html

 

About those “wet-burps” ….

Very often, when our dogs are first diagnosed…. we get the right enzymes, change their diet to something more suited to them, their “SID” (SIBO) is treated and appears resolved and if needed their B12 is taken care of.. and things are fine….. for a while…………………………………………

But then…. some dogs start to have wet burps after they eat.  This is not something to get overly upset about but rather… something you just need to find the cause of in your dog and make the necessary adjustments.

When they have wet burps there are a couple of different things to try…..PLEASE try one thing at a time and wait 3-5 days to see if it had a positive effect or not (with the poo and wet burps).

Here are some things you can try (in no particular order) to alleviate them wet-burps:

 

1. Reduce the enzymes just a wee bit. If you are giving 1 level teaspoon of the pancreatic powdered enzymes per 1 cup of food…….and have been doing this for a while AND if the poos are ggreat and have been great for a while on this does….. then… try reducing the enzymes by 1/8 or even just 1/16th of a tsp… try this for 3 days… see if the burps subside AND also watch the poos to make sure that they are still good…The reason why i am suggesting this is because when we first start treating EPI dogs with enzymes you need to hit them hard and heavy with enzymes… but once they become stable, it is recommended to try and reduce the amount of enzymes to the lowest dose possible while still yielding good results (translation= good poo!) ….so if you haven’t tried this yet… it might be that your dog doesn’t need as much enzymes anymore now that he/she is stable and this might be the cause of the burping……However, please know that not all EPI dogs can have the enzymes dosage reduced even after they become stable….

 

2. Try Tylan antibiotic … often… wet burps are because of SID brewing……or sometimes it is because not the right amount of Tylan is being given…. the standard recommendation has been:

Tylan Dosage for dogs (administer twice daily with food) ….with 100g Tylan powder which means: 5-10mg per pound (or 10-20mg/kg) every 12 hours for 4-6 weeks:

  • 30 lbs – 1/8 tsp
  • 60 lb – 1/4 tsp
  • 90 lb – 3/8 tsp
  • 120 lb – 1/2 tsp

 

OR…. try the newer recommendation (2010) from Dr. Jorg Steiner at TAMU where they have actually increased the amount of Tylan (slightly):

Tylosin (25 mg/kg BID for 6 weeks) is the new antibiotic agent of choice.  For the breakdown in teaspoons per weight.. please see the Antibiotic page for dosing instructions.

So…. with the latest on Tylan being slightly increased and with more insistence on longer duration….. I think either or is fine, it is your choice which you want to follow.. Overall,  Tylan is safe with a lot of wiggle-room  one way or the other.

 

3. Add a little fiber like pure canned pumpkin (1/2 teaspoon and work up to 1 level teaspoon)… or… there is a new product out called “Diggin Your Dog Firm Up” which can be purchased thru Amazon.com (or charity donation SMILE AMAZON.com) http://smile.amazon.com/gp/product/B006CBD7UQ?psc=1&redirect=true&ref_=oh_aui_detailpage_o03_s00

 

4. B12 is needed.… is yet another possibility because the B12 is not holding or needs to be upped….this could be why (if it is SID / SIBO is brewing… )

 

5. Change the food…. sometimes is is simply that the food just is not agreeing 100% with your individual EPI pet.  And itmight be a food intolerance or something triggering SID.

 

6. Add Slippery Elm Powder… this is a mucilage, and a prebiotic with SCFAs that coats the intestinal system and helps with any intestinal lining damage or bacterial imbalance that is often the cause of acid reflux. See the Slippery Elm page for more information, but the suggested dose is:

Give Slippery Elm powder with breakfast and dinner meals. 1/8 tsp for dogs under 10lbs, ¼ tsp for dogs 10lbs to 30lbs, ½ tsp for dogs 30lbs to 80lbs, 3/4 tsp for dogs 80lbs to 100lbs, and 1 tsp for dog 100/+lbs. Mix in meal, add 1 to 2 tablespoons of water, mix and serve meal as you normally would. Incubating not necessary…. or even give a little less…. sometimes less is even better for some dogs!

 

7. Add probiotics/prebiotics to the regimen. Although this is a trial and error thingy that will take time… and money obviously trying different products….but when you happen upon the right pre-probiotic for YOUR dog… it often helps with any gut flora imbalance which triggers SID

 

8. Try acid reducers work, but bear in mind that one type of acid reducer may work in one EPI dog but not another, so if one type doesn’t work, always feel free to talk to your vet about trying a different stomach coater or acid reducer. Some options are: Pepcid AC (famotidine), Prilosec (omeprazole), ranitidine, cimetidine, sucralafate, etc…. but ALWAYS… discuss with your vet before using any of these drugs.   We are actually finding great success with Slippery Elm vs. most of the acid reducers.

 

9. Other things to watch for are as follows:

  • make sure that your pup doesn’t bounce around right after eating,
  • or doesn’t gulp an excessive amounts of water just before or after they eat,
  • or you can also try feeding smaller meals but more often …

 

10. And the last option that i know of to look into if this just doesn’t clear up and or gets worse and goes on and on and on is to then talk to the vet about using short-term steroids to straighten it out…. but i always save this as a last possibility….. i know steroids work wonders many, many times… but i am of the opinion that if you don’t have to use them it is always great to see if you can resolve the problem another way….. but then this is just my personal opinion…. ALWAYS talk to your vet about what the best option is for your individual pet!