Comparison of diet, lactulose, and metronidazole combinations in the control of pre-surgical clinical signs in dogs with congenital extrahepatic portosystemic shunts.

Abstract

BACKGROUND: Hepatic supportive diet (HSD), lactulose, and antimicrobials are medical treatments for dogs with congenital extrahepatic portosystemic shunts (cEHPSS). The relative contribution of these treatment components is currently unknown. OBJECTIVES: To determine which treatment combinations are most efficacious in pre-surgical control of clinical signs of cEHPSS in dogs. ANIMALS: Thirty-six dogs with untreated cEHPSS. METHODS: Three-arm randomized clinical trial. At inclusion (T0), dogs were divided into 3 groups: HSD (n&#xa0;=&#xa0;12), HSD&#x2009;+&#x2009;lactulose (n&#xa0;=&#xa0;12), or HSD&#x2009;+&#x2009;metronidazole (n&#xa0;=&#xa0;12) and received the randomized treatment for 4&#x2009;weeks (T1) followed by combined treatment of HSD&#x2009;+&#x2009;lactulose + metronidazole for 2&#x2009;weeks or until cEHPSS attenuation (T2). Clinical score as well as fasting ammonia (FA) and C-reactive protein (CRP) concentrations were compared among groups and time points. RESULTS: Thirty-four dogs were evaluated. Thirty-four dogs reached T1 and 29 dogs T2. At T1, clinical scores decreased in the HSD&#x2009;+&#x2009;lactulose (n&#xa0;=&#xa0;11; P&#xa0;=&#xa0;.001), but not in the HSD (n&#xa0;=&#xa0;8; P&#xa0;=&#xa0;.96) and HSD&#x2009;+&#x2009;metronidazole (n&#xa0;=&#xa0;10; P&#xa0;=&#xa0;.06) groups. Adding metronidazole to HSD&#x2009;+&#x2009;lactulose (n&#xa0;=&#xa0;11) did not result in further clinical score improvement (T2; P&#xa0;=&#xa0;1.000). Moderate and weak correlation between clinical score and FA and clinical score and CRP was present (&#x3c1;&#xa0;=&#x2009;.35, P&#x2009;<&#x2009;.001; &#x3c1;&#xa0;=&#x2009;.27, P&#xa0;=&#xa0;.01, respectively) with FA decreasing over time on medical treatment (P&#xa0;=&#xa0;.001). CONCLUSIONS AND CLINICAL IMPORTANCE: Combined HSD&#x2009;+&#x2009;lactulose seems sufficient for pre-surgical cEHPSS stabilization unlike sole HSD or HSD&#x2009;+&#x2009;metronidazole. Medical treatment of cEHPSS clinical signs decreases FA.