Dear Barbara:
 
>After reading all the information from Dr. Williams on IBD I confess I'm
>still confused.  Chico, a three year old male was diagnosed with IBD by
>biopsy almost a year ago.  As we don't see cases of ECE in Alberta I'm
>guessing that he most likely has the Helicobacter infection.
 
First, we would have to know what area was biopsied - without looking at
the stomach, you can't diagnose Helicobacter.  IBD is a syndrome affecting
the intestine, so I am hopeful that was the organ biopsied.
 
I think some people have the idea that I believe that all cases of IBD
are due to ECE.  That's not true, but I believe that a significant amount
are, and that other chronic infections result in the rest.  IBD is not a
disease, but the morphologic end result of a number of diseases which
results in the accumulation of a large number of lymphocytes in the
intestine.  The end lesion is the same, regarding of the etiology, so we
lump them all into a big pile, and call it inflammatory bowel disease.
However, that is a short cut that does not absolve the veterinarian and
pathologist from the task of finding the true etiology, in order to
prescribe the most appropriate therapy.
 
Most patholligsts and vets find it easy to just say 'Oh it's IBD" and lets
give it prednisone.  However, there is a lot more we have to learn about
this syndrome before we write it off like this.
 
>Since he's been diagnosed Chico has been on prednisone (actually
>pedia-pred).  Several times we've tried weaning him off it but within
>two to three weeks the symptoms come back.  Right now he's on .5ml every
>other day which seems to be working.
 
Then keep him on it.  He probably has some form of inflammatory bowel
disease - it would be nice one day to be able to tell what is causing it,
and I think one day, we will.
 
>If this is Helicobacter infection should we be using a different course of
>treatment and if so would this make the infection go away so he no longer
>has to take the prednisone?
 
Yes - Helicobacter infections are treated by a combination of antibiotics
rather than immunosuppressive drugs.  The only way to be sure would be to
go back and take a good look at that pathology report and see what was
biopsied, and what lesions were seen.
 
With kindest regards,
Bruce Williams, DVM
[Posted in FML issue 3296]