BY: SAMANTHA BARTLETT, DVM
The latest consensus statement released by the American College of Veterinary Internal Medicine (ACVIM) addresses the appropriate use of gastroprotectants in dogs and cats. The consensus is that GI protectants are used excessively and inappropriately especially in management of pancreatitis and renal disease. The ACVIM has thus put out the statement to provide guidance on the best practices for use of these medications.
Gastroprotectants addressed in the statement include Antacids, H-2 blockers, proton pump inhibitors, misoprostol and sucralfate. Also stressed in the statement is that none of the acid reducing medications used in dogs and cats is approved for u se in these animals underlying the need for more research.
Antacids are short-acting and do not act significantly on the pH of the GI tract. There are therefore not considered useful in the treatment o gastric ulcers or GERD. The consensus finds that H-2 receptor antagonist such as famotidine are inferior to proton pump inhibitors for the treatment of Ulcers or reflux. In addition, the use of H2 blockers in conjunction with PPIs may inhibit the effectiveness of PPIs.
Proton Pump Inhibitors used twice daily are best for treating gastroduodenal ulceration and erosion and have best effects after 3-4 days of therapy. Long-term use should be tapered to avoid rebound effects. Keep in mind that these drugs may interfere with the effectiveness of other drugs that may require an acidic environment to work. Side effects include diarrhea and dysbiosis.
The statement position on misoprostol discussed that one study showed a significant reduction in gastric damage caused by administration of high dose aspirin to dogs, but no evidence exists to support the use in cases of NSAID or glucocorticoid administration. Likewise, the use of sucralfate for esophageal damage has not been supported and the ACVIM deems that sucralfate is an inferior choice to PPIs for the treatment of GUE.
The ACVIM recommendations are that PPIs are indicated twice daily for the treatment of gastroduodenal ulceration and erosion, to prevent esophagitis from reflux. Use of antacids in patients with renal disease is only indicated if they are at a higher risk of GI ulceration or bleeding. Otherwise, injudicious long-term use of gastroprotectants in renal patients puts them at increased risk of decreased bone mineral density. Once daily dosing of PPIs may help prevent stress related mucosal disease in high performance animals.
The ACVIM does not recommend the use of gastroprotectants for pancreatitis, nonerosive gastritis, renal disease, thrombocytopenia-induced bleeding, non–H pylori Helicobacter infection, hepatic disease without GI bleeding or spinal cord injury unless they are also at increased risk for GI ulceration and bleeding.
In conclusion, the ACVIM opinion advocates for the judicious use of gastroprotectants in dogs and cats and recognizes the need for more specific research in the use of the pharmaceuticals for specific conditions in dogs and cats. Newer generations of PPIs may also become more relevant as new research is concluded.
