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Gastrointestinal ulceration occurs when the surface layer of the lining of the gut (lower part of oesophagus, stomach, and first part of small intestine) is damaged.
Gastrointestinal ulceration is an under-diagnosed illness in domestic pets. This is due to the fact that gastrointestinal bleeding is not always obvious in our patients and ulcerations do not always bleed. It is more commonly reported in dogs than cats. There are many reported causes of gastric ulceration. The most common causes are mast cell tumours, drug associated and primary gastric tumours. Severe gastric ulceration can cause life-threatening haemorrhage (blood loss) and perforation leading to infection with the abdominal cavity.
Dexamethasone at high doses or the combination of corticosteroids (e.g. prednisolone) in combination with NSAIDs
Non-steroidal anti-inflammatories (e.g. carprofen, meloxicam, robenocoxib, etc) all have the potential to cause gastrointestinal ulceration, although this is less commonly seen that with the use of older non-steroidal drugs.
Those that produce excessive amounts of gastric acid such as gastrinoma or mast cell tumours
Primary gastric neoplasia, such as gastric adenocarcinoma, leiomyoma /leiomyosarcoma, lymphoma
Primary Gastric Disease
(such as inflammatory bowel disease and Helicobacter-associated inflammation)
Disseminated Intravascular Coagulopathy (DIC)
Other Conditions Include:
Pyloric outflow obstructions e.g foreign body
Haematemesis – vomiting up blood, especially “coffee granule” like vomit
Melena – dark tarry faeces usually with a foul odour (this is the presence of digested blood within the faeces)
The veterinarian will conduct a thorough physical examination of your pet. The findings may suggest the underlying cause as well as reveal the extent of illness. A blood test is then required to provide further evidence of the disease associated with the ulceration and is useful to determine the severity of blood loss and consequences of vomiting. If the vet suspects a gastric ulceration but melena is not present they may also conduct a faecal occult blood test to look for microscopic evidence of blood loss in the faeces.
Diagnostic imaging such as an abdominal ultrasound will be required to rule out other causes of vomiting, spot concurrent illness, and detect early evidence of perforation of the ulceration. Abdominal ultrasound, however, does not always help in the diagnosis of gastric ulceration and other studies (such as CT and endoscopy) may be required.
Ancillary testing based on the physical examination findings such as aspirates of lymph nodes and masses and measurement of gastric pH may also be required.
Treatment aims to treat the underlying disease process if possible, restore the integrity of the gastric mucosal wall, and reverse fluid and electrolyte imbalances. Analgesia and anti-emetics are also utilised in the early phase of treatment. Surgical management may also be required depending on the underlying cause or if perforation has occurred. Medical treatment is aimed at restoring the gastric mucosal barrier and comprises the administration of anti-secretory drugs together with mucosal protectants. Some of the drugs used may include:
Cimetidine, ranitidine or famotidine: these are powerful antacid medications and help to reduce the acidity within the stomach.
Omeprazole: effective in reducing gastric acid secretion within the stomach, thereby also reducing the acidity.
Misoprostol: When there has been history of non-steroid anti-inflammatory or corticosteroid use, this drug may help to counteract the effects on the gut.
Sucralfate: This isextremely effective in protecting those areas which are already ulcerated by binding to them and acting as a bandaid. The only common side-effect is constipation.
Nutritional management is also very important in these patients, and should be tailored to the animal’s individual needs.
The severity of gastric ulceration is highly dependent on the severity of the clinical signs, the underlying disease process, and whether perforation has occurred. Some animals can recover rapidly with simple medical treatment. Other animals may have serious underlying illness, develop life-threatening blood loss, or require emergency surgery. Therefore, timely diagnosis of the ulceration and cause are extremely important in these cases.
This content has been provided by the Sydney University Veterinary Teaching Hospitals.
The Sydney University Veterinary Teaching Hospitals, located on the Sydney University campuses in central Sydney and Camden, are acclaimed internationally for their exceptional health, care and welfare of animals. Both hospitals work as a general practice veterinary clinic, a referral centre for other vets to send complex cases, and a teaching hospital for veterinary science students to learn the practical components of the veterinary profession. The Camden facility also offers large animal and equine specialist services.