Canine Chronic Inflammatory Enteropathy (CIE) previously “IBD”  with Special Focus on the Bouvier des Flandres

Veterinary medicine now replaces the term canine "inflammatory bowel disease" (IBD) with Chronic Inflammatory Enteropathy (CIE) to prevent confusion with distinct human IBD phenotypes and more accurately reflect the broad spectrum of chronic canine gut inflammation

1. Current understanding of canine CIE

CIE is generally characterized by gastrointestinal signs lasting at least three weeks, with other causes of gastrointestinal disease excluded. 

Classification by Response: Rather than treating chronic gut inflammation as one fixed disease, CIE is categorized by how it responds to treatment:

• Food-Responsive Enteropathy (FRE): Resolves completely with specialized dietary trials (effective in 38%–89% of cases).

• Microbiota/Antibiotic-Responsive: Empirical antibiotics are now strongly discouraged due to dysbiosis; focus has shifted toward targeted microbiota modulation. Microbiome modulation is the intentional process of changing the balance, diversity, or function of the microorganisms living in or on the human body to improve health or treat disease

• Immunosuppressant-Responsive (IRE): Reserved for severe cases that do not respond to diet or gut-barrier support.

The 2026 ACVIM guidelines emphasize that CIE results from interactions among: genetic susceptibility + intestinal immune system + microbiome + diet + environmental factors. 

2.  Genetic component

There is strong evidence that genetics influence susceptibility to CIE. Certain breeds have clear predispositions. 

A prominent 2016 study published in BMC Veterinary Research titled "Does canine inflammatory bowel disease influence gut microbial profile and host metabolism?” included a Bouvier des Flandres among its study cohort of client-owned dogs evaluated for idiopathic inflammatory bowel disease (IBD). However, for the Bouvier des Flandres there is currently no evidence of a validated Bouvier-specific IBD gene or DNA test.

3.  Breed-health survey evidence

A UK Kennel Club Purebred Dog Health Survey reported gastrointestinal conditions in Bouviers, with colitis and vomiting among the reported gastrointestinal disorders.

The same survey also recorded immune-mediated conditions including food hypersensitivity and gluten-sensitive enteropathy. There is currently insufficient evidence to say that the Bouvier has the same well-defined inherited gluten-sensitive disease and the survey does not establish that these conditions represent genetically determined CIE.

However when reviewing the results of the ongoing OFA Bouvier health survey 14% of the dogs entered have some form of GI problems. 37% of those dogs have been diagnosed with IBD, and 19% with colitis. https://ofa.org/about/health-surveys/?breed=BF 

4. How to diagnosis CIE:  The diagnostic exam includes:

Step 1 — History

• Duration

• Vomiting

• Diarrhea

• Appetite

• Weight loss

• Stool characteristics

• Diet

• Treats

• Supplements

• Previous medications

• Previous GI disease

• Family history

Step 2 — Physical examination

• Body condition

• Muscle condition

• Hydration

• Abdominal palpation

• Edema

• Ascites

Step 3 — Laboratory evaluation

• CBC

• Chemistry

• Electrolytes

• Albumin

• Total protein

• Cholesterol

• Urinalysis

• UPC if hypoalbuminemic

• Cobalamin

• Folate

• Pancreatic lipase

• TLI

• Resting cortisol when appropriate

The current ACVIM recommendation specifically includes these investigations before invasive diagnostic testing.

Step 4 — Infectious/parasitic investigation must be done to identify the presence of other causes of GI distress.

• Giardia

• Intestinal parasites

• Other infectious disease based on history
  

Step 5 — Abdominal ultrasound to evaluate:

• Intestinal wall

• Layering

• Lymph nodes

• Pancreas

• Liver

• Intestinal masses

• Lymphangiectasia

• Other abdominal disease

Step 6 — Dietary intervention 

This is one of the biggest changes in the modern approach.

The 2026 ACVIM guidelines recommend dietary intervention first whenever possible.

Potential diets include:

• Highly digestible diets

• Novel-protein diets

• Hydrolyzed-protein diets

• Elemental diets

• Fiber-enriched diets

• Low/ultra-low-fat diets when appropriate

• Carefully formulated home-prepared diets

A trial should be exclusive—meaning no unauthorized treats, table food or supplements that could invalidate the trial. 

A properly performed exclusive therapeutic diet trial is now considered a central diagnostic and therapeutic component. Interestingly, approximately 38–89% of dogs with CIE have been reported to respond to dietary intervention, depending on the study population and definition used.

Step 7 — Endoscopy and biopsy

Especially if:

• Severe disease

• Hypoalbuminemic

• Failure of appropriate dietary trials

• Suspicion of neoplasia

• Need to distinguish inflammatory disease from other pathology

The current consensus recommends upper and lower GI endoscopy with biopsies when endoscopy is indicated. 

Because the Bouvier has historical reports of:

• Colitis

• Vomiting

• Food hypersensitivity

• Gluten-sensitive enteropathy

• Enteritis/villous abnormalities

It is particularly relevant to the Bouvier to distinguish food-responsive disease from immunosuppressant-response rather that grouping everything under “IBD” 

6. Antibiotics

An important modern change: Routine empirical antibiotic therapy is no longer recommended for suspected CIE. 

The 2026 consensus specifically recommends against empirical antimicrobial treatment in CIE suspects. This is important because older approaches frequently used metronidazole or other antibiotics.

Current concerns include:

• Microbiome disruption

• Antimicrobial resistance

• Relapse after withdrawal

• Lack of treatment of the underlying immune/dietary problem
  

7. Immunosuppressive treatment

For dogs with documented disease that does not respond adequately to dietary management, treatment may include:

• Prednisone/prednisolone

• Budesonide in selected cases

• Cyclosporine

• Chlorambucil

• Other immunomodulatory strategies

However, the 2026 consensus places greater emphasis on documenting CIE before escalation to immunomodulatory treatment. This represents an important shift away from starting dogs with chronic diarrhea on steroids Instead approaching chronic diarrhea with a structured diagnostic investigation including diet change and targeted therapy.

8. Protein-losing enteropathy (PLE) 

Long-term CIE can lead to(PLE) in dogs.  This  is a serious medical condition where the intestines leak vital blood proteins out of the bloodstream and there is malabsorption of nutrients.

Clinical manifestations may include:

• Weight loss

• Muscle wasting

• Peripheral edema

• Ascites

• Severe diarrhea

• Low Vitamin B12 , Albumin, Globulins and other proteins

Current guidelines recommend measuring cobalamin as part of the diagnostic workup.

The 2026 consensus notes that approximately two-thirds of dogs with PLE may be under-conditioned with muscle atrophy at diagnosis. 

PLE also creates a substantial thromboembolic risk because severe CIE/PLE can produce a hyper-coagulable state. 

9. Prognosis

The overall prognosis for dogs with chronic inflammatory enteropathy (CIE) ranges from good to excellent when managed properly, though it depends heavily on how the dog responds to treatment and the severity of the disease. However it requires owner commitment and life long management.

One of the most useful modern observations is that treatment classification can change. A 2024 study following 60 dogs for at least a year found that many dogs initially classified as immunosuppressant-responsive later behaved as food-responsive cases. At one year, 73% were classified as food-responsive, compared with 45% initially.  Hodel S, Brugger D, Kook PH. Long-term evaluation of the initial response to therapy in 60 dogs with chronic inflammatory enteropathy. J Vet Intern Med. 2024;38(5):2444-2453. doi:10.1111/jvim.17161

For further information: 

(This is currently the most important clinical reference for diagnosis and treatment) :

1.  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. doi: 10.1093/jvimsj/aalaf017. PMID: 41742497; PMCID: PMC12881957.

 2.  Jergens AE and Heilmann RM (2022) Canine chronic enteropathy—         Current state-of-the-art and emerging concepts. Front. Vet. Sci. 9:923013. doi: 10.3389/fvets.2022.923013

Click HERE to download the PDF on Colitis.

Gastric Dilatation-Volvulus (Bloat) in Dogs 

With Special Consideration of the Bouvier des Flandres

Important: Gastric dilatation, especially when accompanied by volvulus (GDV), is a life-threatening emergency. A dog that is repeatedly trying to vomit but producing little or nothing, has a rapidly enlarging abdomen, is restless, drooling, weak, or collapsing should be taken to an emergency veterinary hospital immediately. 

I. Terminology

A. Gastric dilatation (GD)

Gastric dilatation means that the stomach becomes abnormally enlarged with:

• Gas

• Fluid

• Food

• A combination of these

Dilatation does not necessarily mean that the stomach has twisted.

B. Gastric dilatation-volvulus (GDV)

GDV occurs when the dilated stomach rotates/twists, obstructing both the entrance and exit of the stomach and compromising blood flow.

This is commonly called:

• Bloat

• Twisted stomach

• Gastric torsion

• GDV

The distinction is important:

Gastric dilatation → stomach expands

GDV → stomach expands + twists

The twist is what makes the condition particularly catastrophic. 

II. Why GDV Is So Dangerous

As the stomach enlarges and/or twists:

1. Pressure builds inside the stomach.

2. Blood vessels are compressed.

3. Venous return to the heart decreases.

4. Cardiac output falls.

5. Blood supply to the stomach can be compromised.

6. The spleen may rotate with the stomach.

7. Stomach tissue may become ischemic and die.

8. The stomach can rupture.

9. Bacteria and toxins can enter the bloodstream.

10. Shock and multiple-organ dysfunction can develop.

Cardiac arrhythmias are also relatively common in severe GDV. 

III. Risk Factors

A. Body conformation - The strongest general risk factor is a large, deep-chested body shape. The risk is associated with a greater depth-to-width ratio of the thorax. 

B. Breeds traditionally recognized as high risk include :

• Great Dane

• Saint Bernard

• Weimaraner

• Irish Setter

• Gordon Setter

• Standard Poodle

• German Shepherd Dog

• Doberman

• Basset Hound

• other large/deep-chested breeds

However, any dog can develop gastric dilatation or GDV. 

IV. Additional Risk Factors

A. Feeding behavior: Risk has been associated with:

• Eating rapidly

• One large meal per day

• Large meal volume

• Swallowing large amounts of air
  

B. Age: Risk increases with age. 

C. Body condition: A lean body condition has been associated with increased risk.

D. Genetics : A dog with a first-degree relative that has experienced GDV has increased risk

E. Temperament/stress: Fearful, anxious, or highly stressed dogs may have increased risk.

F. Exercise: Strenuous activity around meals has been associated with increased risk, although the precise contribution of exercise remains difficult to quantify.

V. Clinical Signs

Early signs:

1. Restlessness

The dog may:

• Pace

• Get up and lie down repeatedly

• Be unable to get comfortable

2. Abdominal discomfort

The dog may:

• Look toward its abdomen

• Stretch repeatedly

• Assume a "praying" position

3. Drooling

Excessive salivation is common.

4. Nonproductive retching

This is one of the most important warning signs.The dog repeatedly tries to vomit but produces little or nothing.

VI. Progression 

As the condition worsens:

• Abdomen becomes distended

• Panting increases

• Breathing becomes difficult

• Heart rate increases

• Pulse becomes weak

• Gums may become pale

• Weakness develops

• Collapse may occur

Eventually the dog can develop profound shock.

VII. The Classic Emergency Combination

A particularly concerning combination is: Restlessness + abdominal distention + repeated unproductive retching

• Treat this as GDV until proven otherwise.

• Do not wait to see whether the dog improves.

• Do not attempt to treat it at home.

• Do not induce vomiting.

Immediate veterinary evaluation is required.

VIII. Diagnosis

A. Physical examination - The veterinarian evaluates:

• Heart rate

• Respiratory rate

• Pulse quality

• Mucous membranes

• Capillary refill

• Abdominal distension

• Abdominal pain

• Signs of shock

B.  Blood Testing

Blood work is important not because it alone diagnoses GDV, but because it determines:

• Severity of shock

• Electrolyte abnormalities

• Acid-base disturbances

• Organ dysfunction

• Anemia

• Clotting abnormalities

• Surgical/anesthetic risk

Potential testing includes:

CBC to evaluate for:

• anemia

• leukocytosis

• platelet abnormalities

Chemistry panel to evaluate :

• kidney function

• liver enzymes

• electrolytes

• glucose

• protein levels

Lactate :

Blood lactate can be useful for assessing tissue perfusion and disease severity and for monitoring response to resuscitation.

C. Imaging

Abdominal radiographs:  Radiographs are central to diagnosis.

They can demonstrate:

• Severe gastric dilation

• Abnormal stomach position

• Gas distribution

• Evidence of volvulus

A characteristic abnormal gas pattern can support the diagnosis of GDV. 

Ultrasound : May provide additional information but generally does not replace radiography for diagnosing GDV.

D. Electrocardiogram

An ECG may be performed because GDV can cause:

• Ventricular arrhythmias

• Other cardiac rhythm disturbances

Arrhythmias can occur before, during, or after surgery. 

IX. Differential Diagnosis

Other causes of abdominal enlargement or vomiting can include:

• Simple gastric dilation

• Intestinal obstruction

• Foreign body

• Pancreatitis

• Peritonitis

• Hemorrhage

• Ascites

• Gastric/intestinal tumors

But: A large abdomen + repeated unproductive retching = emergency evaluation regardless of the ultimate diagnosis.

X.  Emergency Treatment

Treatment occurs simultaneously rather than sequentially.

1.  Stabilization: The first priorities are: IV access,  Shock treatment,  Oxygen, Pain control, Electrolyte/acid-base correction 

 B.  Gastric Decompression:The stomach must be decompressed as quickly as possible.

•  Stomach tube - A tube may be passed through the mouth into the stomach.   If successful:

  • Gas escapes

  • Fluid can be removed

  • Food can be removed
    

• Trocarization:  If a tube cannot be passed because the stomach has twisted or the esophagus is obstructed, a large needle/catheter may be inserted through the abdominal wall into the stomach to release gas. This can provide rapid temporary decompression. 

XI. Surgery

GDV generally requires emergency surgery.  Surgery allows the veterinary team to:

1. Open the abdomen.

2. Identify the position of the stomach.

3. Untwist the stomach.

4. Evaluate stomach viability.

5. Evaluate the spleen.

6. Remove damaged stomach tissue if necessary.

7. Remove the spleen if necessary.

8. Perform a gastropexy.
   

XII. Gastropexy

This is one of the most important parts of GDV surgery. The stomach is surgically attached to the abdominal wall.

Purpose: It greatly reduces the likelihood that the stomach will twist again. Gastropexy does not prevent the stomach from becoming distended. It primarily prevents the life-threatening volvulus/twisting component. 

XIII. Prognosis

Prognosis depends heavily on:

• How quickly treatment begins

• Degree of shock

• Duration of GDV

• Gastric tissue viability

• Whether splenectomy is necessary

• Presence of arrhythmias

• Development of sepsis

• Development of clotting abnormalities

Early recognition and rapid treatment are critical.

XIV. Prevention

1. Feeding 

Avoid one large meal/day -This decreases the volume of food entering the stomach at one time. 

B. Slow eating

For dogs that gulp food:

• Slow-feeder bowls

• Food puzzles

• Dividing meals

may reduce rapid ingestion.

C. Avoid strenuous activity around meals

D. Avoid excessive water consumption immediately around meals/exercise - Large amounts of water can contribute to gastric distention.

E. Raised food bowls - This point has changed over time. Raised food bowls should not automatically be recommended as a GDV-prevention strategy. Some evidence actually associates elevated feeding with increased GDV risk in susceptible dogs. Cornell and ACVS now advise against assuming that elevated bowls prevent GDV. 

XV.  Prophylactic Gastropexy

For a high-risk dog, prophylactic gastropexy is an important preventive option.

It can be performed:

• At spay

• At neuter

• As a separate elective procedure

• Using open surgery

• Laparoscopically/laparoscopic-assisted techniques in appropriate patients

ACVS notes that prophylactic gastropexy is commonly considered for large/deep-chested dogs and dogs with close relatives affected by GDV. 

XVI. Bouvier-Specific Risk Assessment

1. Chest conformation

The Bouvier has a deep chest, which is a recognized anatomical risk factor for GDV. 

VCA specifically identifies GDV as a health concern in the Bouvier and notes that the breed's deep chest increases risk. 

PetMD similarly identifies Bouviers as a deep-chested breed susceptible to bloat/GDV. 

Reviewing the  ongoing OFA Health Survey 44% of the dogs that have entered have GI problems, and 3% reported they had experienced problems with Bloat.  https://ofa.org/chic-programs/browse-by-breed/?breed=BF 

A deeper/narrower thorax potentially increases risk. But the precise breed-specific incidence is less well established than for several classic GDV breeds.

2. Family history

Ask specifically: "Has a parent, sibling, offspring, or close relative ever had bloat or GDV?"

This may be more informative for an individual Bouvier than simply relying on breed averages. Genetics are recognized as a risk factor for GDV. However, GDV is not a simple single-gene disease. It appears to be multifactorial, involving anatomy, genetics, environment, feeding behavior and other factors. 

3. Eating speed

A Bouvier that rapidly consumes meals deserves additional preventive management.

4. Meal size

Avoid feeding the entire day's food in one large meal.

5. Age Older dogs are at higher risk

XVII. Summary review

The most useful distinction is: 

Gastric dilatation = enlarged stomach.

GDV = enlarged stomach + twisting.

The first can sometimes resolve without surgery; GDV is a surgical emergency.

For the Bouvier des Flandres, the breed's deep chest makes GDV prevention and recognition particularly important. Current evidence supports discussing multiple smaller meals, controlled post-meal activity, avoidance of rapid eating, family-history assessment, and prophylactic gastropexy in appropriately selected dogs. If a Bouvier ever develops repeated unproductive retching, sudden abdominal enlargement, drooling, restlessness, weakness, or collapse, the correct response is an emergency veterinary hospital immediately—not observation at home.

For further information :

https://www.aaha.org/resources/understanding-canine-bloat-gdv-a-medical-emergency/