Product Focus: Digestive health
Supporting canine and feline gastrointestinal health: A guide to managing clinical casesby Select Healthcare from NVS
Supporting the equine microbiome as the seasons change
by Rupert Dyhouse, Protexin Equine
Digestive Health
By Katy Ellison MA VetMB MRCVS on behalf of Select Healthcare from NVS
Gastrointestinal (GI) disorders are among the most common reasons for veterinary consultations. The prevalence of enteropathies in dogs is reported to be around 10%,1 while in cats it is approx. 8.5%.2
These disorders range from mild, self-limiting conditions like transient diarrhoea, to chronic conditions such as inflammatory bowel disease (IBD). Effective management of these cases in first opinion practice is essential not only for ensuring the well-being of pets but also for maintaining a positive relationship with owners.
The gut microbiome is a complex ecosystem of trillions of micro-organisms, including bacteria, viruses and fungi. It is now widely accepted that a healthy, balanced gut microbiome is essential for maintaining gastrointestinal health as it plays a key role in mineral absorption, vitamin synthesis, energy regulation and immune function.
The intestinal epithelium, in turn, produces mucus which serves as a nutrient source for gut bacteria, creating a mutually beneficial relationship. A growing body of evidence suggests that the microbiome also has far-reaching effects on overall health, beyond the digestive system.
Alterations in the gut microbiome’s composition are referred to as small intestinal dysbiosis.3 This imbalance may result from dietary changes, inflammation, immune deficiency, infection or exposure to antibiotics or toxins. Dysbiosis tends to favour the growth of potentially pathogenic bacteria, leading to harmful bacterial blooms.
In dogs and cats, small intestinal dysbiosis often manifests as chronic, intermittent diarrhoea. Dysbiosis has also been linked to conditions such as obesity, metabolic diseases, cancer and even neurological conditions.4
Therefore treating dysbiosis and supporting a healthy gut microbiome is essential when managing GI disease, but it is equally important in maintaining the health of dogs and cats that have no clinical signs.
Acute diarrhoea is one of the most frequent reasons for veterinary visits, especially in dogs. Historically, antibiotics were commonly prescribed for diarrhoea but awareness of antibiotic stewardship, alongside a focus on evidence-based medicine has led to a shift in treatment practices.
Most acute diarrhoea cases are not caused by pathogenic bacteria5 and studies have shown that there is no association between antibiotic use and resolution of clinical signs.6 Inappropriate antibiotic use can also cause dysbiosis5 and result in long-lasting alterations in the gut microbiome. The resolution of acute canine diarrhoea is more positively associated with the use of gastrointestinal nutraceuticals and dietary modification than with antibiotics.7
While antibiotics are typically avoided in most diarrhoea cases, there are specific situations where their use is warranted:
Significant immunosuppression: patients with conditions like parvovirus are at high risk for bacterial translocation from the GI tract
Intestinal mucosal barrier compromise: conditions such as haemorrhagic enteritis increase the likelihood of bacterial translocation across the intestinal wall
Identified pathogens: when a specific pathogen, such as enteroinvasive Escherichia coli is identified
Antimicrobial-responsive diarrhoea (ARD): metronidazole is often used in ARD, although some patients may respond better to tetracyclines
In most other cases, alternative options such as prebiotics, probiotics and adsorbents should be prioritised over antibiotics.
Diarrhoea, regardless of its underlying cause, generally results from reduced water absorption by the GI tract (osmotic diarrhoea) or increased water secretion (secretory diarrhoea). This can lead to significant physiological disturbances, including:
Dehydration
Loss of electrolytes
Inflammation
Microbiome alteration
Changes to the mucous lining of the GI tract
Damage to enterocytes
So, in addition to fluid replacement and dietary management (highly digestible gastro-intestinal support diets or low-fat diets for example), prebiotics and probiotics play an essential role in supporting recovery and restoring GI health.
Adsorbents such as Diosmectite (also known as bentonite or montmorillonite), are also effective in managing diarrhoea by absorbing water and adsorbing toxins and pathogens. These compounds help stabilise the intestinal environment, support normal immune function and maintain mucosal integrity.
Diosmectite is 50 times more effective than kaolin, due to its unique layered structure and cation exchange properties, which enhance its water absorption capacity.
Prebiotics - indigestible carbohydrates that help encourage the growth and activity of beneficial bacteria. Commonly used prebiotics include oligosaccharides such as mannan oligosaccharides (MOS) and fructo oligosaccharides (FOS). These compounds act as a nutrient source and also as substrates for the production of short-chain fatty acids (SCFAs) such as butyrate, which nourish the intestinal epithelium and have anti-inflammatory effects.
Probiotics - live microorganisms that, when administered in adequate amounts, confer a health benefit to the host.9 Commonly used probiotics in veterinary medicine include Enterococcus, Lactobacillus and Bifidobacterium species. The mechanism of action varies depending on the species and strain, but in general, probiotics promote a healthy microbial balance, support healthy digestion and aid in normal immune function. Moreover, in cases where antibiotics are indicated, probiotics help mitigate the impact on the gut microbiome.
Probiotic Digestive paste combines Diosmectite with prebiotics and probiotics to reduce acute intestinal adsorptive disorders during diarrhoea and to support recovery after clinical signs have resolved.
Low-fat content - provides additional support for recovery from severe diarrhoea
Electrolytes - helps to restore and maintain electrolyte balance in the body.
Essential energy source - formulated with dextrose and glutamine
Designed for ease of use:
Paste in dial-a-dose syringe
15ml/30ml/60ml options
Palatable formulation
Wide syringe tip for ease of application
STABILISE + SUPPORT + ENERGISE
Beyond GI disorders, the adsorbent properties of Diosmectite also play an important role in addressing accidental toxicity. Many toxin exposures involve unknown substances and it is the chemical properties of these substances that determine which binders are most suitable.
High affinity for acidic molecules
The carbon, hydroxyl and carboxylic groups are able to adsorb different molecules with differing affinities.
Acidic substances
Non-ionised substances
Poorly water-soluble substances
Non-polar organic molecules
Anionic particles
Non-Specific adsorption
High affinity for basic molecules
The high surface charge between its negatively charged outer layers and positively charged inner layers, gives it a high cation exchange capacity and powerful adsorptive capacity.
Alkaline or basic substances
Hydrophilic substances
Cationic compounds
Amphoteric compounds
Non-ionic compounds
Organic solutes
Specific adsorption
The percentage absorption of some commonly presented toxic substances, including medications, pesticides and heavy metals and how they differ between Activated Charcoal and Diosmectite can be seen in the following graph.
For cases involving unknown toxins, broad-spectrum binding is essential and products like Select from NVS Duotox, which combines the tried and tested ingredients of Diosmectite with Activated Charcoal, offer comprehensive coverage.
Discover more about toxins and adsorbents… In this free webinar by Simon Boulton, BVetMed (Hons) MRCVS
Duotox is a broad-spectrum toxin binder containing a combination of Activated Charcoal and Diosmectite. A complimentary feed to help with adsorption and excretion, it is suitable for dogs, cats and fur animals. Duotox also contains:
Sorbitol - retains water in the large intestine through osmotic pressure, exerting a diuretic, laxative and cathartic effect.
Glycerine - acts as a cathartic, increasing the urge to defecate, and decreasing GIT transit time and systemic absorption of toxins.
Curcumin - aids in renal and liver protection by reducing the expression of tight-junction proteins, suppressing proinflammatory cytokines, and the reduction of oxidative stress within the liver.
Piperine - enhances absorption of curcumin, thereby increasing clinical outcomes of free radical scavenging and downregulation of inflammatory mediators.
Designed with ‘use’ in mind, Duotox is available in both liquid suspension for first administration and a 30ml paste for follow on administration where necessary.
60ml paste coming soon!
Soft, squeezy bottle and bendy nozzle to aid administration
Nozzle fits directly to tubes
Dial-a-dose syringe for easy administration
Wide nozzle bore for ease of flow
Reduces pressure needed on plunger
Reduces risk of blocking and sudden product release
Up to 75% wider than other products
ADSORB + ELIMINATE + SUPPORT
#1 Outline the treatment plan at the outsetClear and effective communication with clients is critical, particularly when managing expectations around antibiotic use. Start by outlining the treatment plan at the outset. This initial step helps meet expectations and sets the groundwork for what to expect moving forward.
#2 Include a ‘Plan B’Incorporate a ‘Plan B’ if the clinical signs do not resolve as expected. Including an alternative course of action fosters confidence and trust, ensuring clients that there’s a contingency plan to address potential issues.
#3 Acknowledge the owner’s perspectiveIt's essential to acknowledge and understand the client's perspective. Taking the time to listen and affirm their concerns helps build a better client-provider relationship, making them feel valued and heard.
#4 Explain the rationale behind avoiding unnecessary antibiotic useTake time to explain the rationale behind avoiding the unnecessary use of antibiotics. Educate clients on why reducing antibiotic use is important, both for the health of their pet and for broader public health concerns.
#5 Highlight the importance of supporting the microbiomeHighlight the importance of supporting the gut microbiome. Explain how maintaining a healthy microbiome can benefit their pet's overall well-being and can often mitigate the need for antibiotics.
#6 Finish with a clear recommendationIn human healthcare, up to 80% of medical information provided by healthcare providers is forgotten immediately.9 Concluding with clear advice and a brief summary of key points aids recall and increases adherence to the proposed treatment plan. In one study, pet owners were seven times more likely to stick to a treatment plan when given clear recommendations.10
Click here for references
By Rupert Dyhouse - Veterinary International Technical Manager, Protexin Equine
As with our human and companion animal counterparts, the interest (and research) into the equine microbiome has significantly boomed in the last 10 years. As a result, not only are horse owners more inquisitive and better informed about all things microbiome-related, but they are increasingly looking for appropriate support for this system – whether that be diet, pharmaceutical or nutraceutical.
These conversations may often be had between vets and owners in the transition between summer and winter, when various factors may have influence on, or be influenced by, the microbiome.
The equine gastrointestinal microbiota (the collection of micro-organisms within the microbiome) is influenced by a range of factors such as nutrition and management (diets, supplements, exercise), medications (e.g. antibiotics and anthelmintics), animal-related factors (age) and pathological conditions, as well as stress factors 1.
The composition of the microbiota alters throughout the year. In one study of grazed horses, there is a variation associated with changes in the grass, additional forage and with differing weather conditions2, all things that typically happen as we go into the winter months.
We will often see significant diet changes around this seasonal transition period, due to an increase in housing and a reduction in both pasture quality and grazing time. The horse may become stressed by the increase in stabling as well as the possible mixing with a different cohort of both horses and owners in their stable yard or barn.
Owners may also choose to ramp up exercise regimes, such as National Hunt racehorses or sport horses competing on the indoor circuit. In addition, many of these events will involve some degree of transportation, which has been shown to impact the equine microbiome in a very short space of time3.
This range of changing factors may have an implication on the microbiome and may lead to the potential to induce an unwanted dysbiosis4 - an imbalance of the gut microbiota, shifting away from the ‘status quo’ of the typical composition of the microorganisms in its gut. Dysbiosis of the gut can have a range of negative implications on horses and ponies, both in the short and long term.
As vets on the frontline, we often may have to not only treat the condition of the horse or pony we have been called out for but also advise the owner on management and feeding strategies, all to help improve or prevent an unwanted dysbiosis of the gastrointestinal microbiome.
As we are increasingly becoming aware of the interplay between the gut microbiome and all of these management factors, it may be worth considering a gut support product for these horses during the seasonal transition, as an adjunct to a treatment protocol or alongside a management/lifestyle/diet change.
Protexin Equine offers a range of gut health supplements to help support horses and ponies during the autumn and winter months.
A palatable, peppermint-flavoured nutritional supplement formulated to support hind gut health and encourage the formation of normal droppings.
Key ingredients:Montmorillonite (Bentonite) – a natural binding clay, which is highly adsorptive. Psyllium husk – not only does this act as a prebiotic, promoting the growth of health-positive gut bacteria and nourishing the cells of the gut lining, but it also is highly absorbent of excess water in the gut.
Use as a 1–2-week course, or longer under veterinary guidance. Gut Sponge can be used in conjunction with Gut Balancer.
A palatable probiotic and unique dual-source prebiotics for daily use.
Key ingredients:Saccharomyces Cerevisiae probiotic - promotes fibre digestion and increases relative abundance of cellulolytic and lactate-utilising bacteria (i.e. health-positive species). Unique dual-source prebiotics Fructo-oligosaccharide (FOS) and Acacia - act as a food source for the microbiota.
A daily gut health powder which can be used in the short, medium or long term, depending on the indication of each case.
A highly concentrated probiotic and prebiotic paste to help maintain digestive function over periods of stress, such as travel or worming.
Key ingredients:Contains the same probiotic and prebiotic as Gut Balancer, in a convenient paste form.
An antacid and gut supplement powder, to calm excess acid.
Key ingredients:Calcium carbonate - to buffer excess acid. Kaolin, pectin, psyllium and L-threonine – all contribute towards the fibre mat and the coating of the stomach, to help soothe the lining and help prevent splashback of stomach acid. Saccharomyces cerevisiae probiotic – to provide additional hindgut support.
All of our products are included in the BETA NOPS assurance scheme.
Find out more…
For more details, including feeding guidelines and advice articles - www.equinepremium.com
If you have any further questions of when to use each product, then please don’t hesitate to contact the Protexin Veterinary Technical Team on technical@protexin.com.
