Stomach and Intestinal Ulcers in Dogs

In order for the gastrointestinal barrier to function and protect, there are specific conditions that need to be met. Support for the mucosa comes from epithelial cells that are capable of spreading in order to cover defects in the barrier, adequate blood flow through the mucosa, and a mucus/bicarbonate layer offering protection. The three most common causes of stomach and intestinal (duodenal) ulcers in dogs are hepatic (liver) disease, use of non-steroidal anti-inflammatory drugs and corticosteroids, and neoplasia (abnormal growth of cells).

The mucosa of the stomach and intestine normally offer protection from acid-induced injury. If the gastric acid secretion increases substantially, or if there is an upset in the normal protective function of the gastrointestinal mucosa, your dog may get an ulcer. Disruption to the mucosal barrier can result independently or as a result of a secondary cause.

Though some dogs with stomach or intestinal ulcers may not show symptoms, it is unusual. If your pet is exhibiting any of the symptoms below, a visit to the veterinary clinic is necessary:

• Anemia (an iron deficiency due to chronic bleeding)
• Weight loss
• Lack of appetite
• Fever
• Vomiting; there may be the presence of blood (hematemesis)
• Pallor of mucous membrane due to severe bleeding
• Rapid heart rate (tachycardia)
• Weakness
• Stool that appears black due to presence of blood (melena)
• Increased salivation
• Abdominal distention
• Pain in abdomen
• Shock

If there is an excess of acid and pepsin or a breakdown in protection for the stomach and intestine, an ulcer will form. Without treatment, there is the risk of perforation of the ulcer, which can quickly lead to septic peritonitis and death. Causes of stomach and intestinal ulcers are many, some of which are listed below:

• Gastrinoma (tumor in pancreas or duodenum that stimulates stomach acids)
• Ingestion of poison or toxin
• Irritable Bowel Syndrome
• Chronic gastritis
• Lymphoma
• Adenocarcinoma (tumor in epithelial tissue)
• Helicobacter (bacterium that causes chronic inflammation in stomach)
• Hepatopathy (congestion in liver that results from venous congestion usually in right side heart failure)
• Excess of extreme exercise
• Shock
• Hepatic disease (can cause increased gastric acid secretion and changes in mucosal blood flow)
• Corticosteroid use
• Long term or high dose NSAID use can cause direct damage to the stomach and intestinal mucosa

After a physical examination and collection of notes on your pet’s medical history, the veterinarian will suggest a urinalysis, complete blood count as well as a full serum chemistry profile. They may advise a liver function test to look for liver disease if liver enzymes are elevated. Another test which may be ordered is the adrenocorticotropic hormone stimulation test to check your pet’s adrenal glands, ruling in or out Cushing's disease and Addison's disease.

Imaging tests, such as radiographs, will not accurately identify an ulcer but will rule out instances like an obstruction. An ultrasound may be able to identify a gastrointestinal mass, but gas may interfere with the image.

The best test to diagnose a stomach or intestinal ulcer or lesion is the gastroscopy. With this type of test, the veterinarian can view the esophagus, stomach, duodenum. After viewing, choosing to do a biopsy must be carefully considered because of the risk of perforation of the ulcer. Sometimes, a surgical biopsy is necessary. A test of the PH of the gastric fluid may be done as well.

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The veterinarian will explain that treating the underlying cause of the ulcers is an important part of the medical care required to heal your pet. In the meantime, immediate care will begin with intravenous fluids if necessary, depending on the present condition of your dog.

Medication, such as Cimetidine, will be given to reduce gastric acidity. Preventing more damage to the mucosa is very important so steps will be taken to ensure this happens, including more prescriptions of medication. It should be noted that the drugs may need to be given for a period of six to eight weeks.

Antacids and additional drugs aimed at promoting healing must be given on a frequent basis in order to prevent the return of the previous gastric acidity. Careful scheduling of all medications is a must because some must be taken without food or other drugs in the system.

If bacteria is a concern, antibiotics will be prescribed as well. If there is the unfortunate circumstance of life-threatening hemorrhaging due to the ulcers, or if the ulcers cannot be dealt with through medical therapy and medication alone, surgery and blood transfusions will be needed.

As with all recovery protocols, rest and quiet are always recommended upon return home from the clinic. As stress can irritate and contribute to ulcers, a comfortable spot for your dog to lie, in a room away from the normal busyness of home, is highly suggested.

The veterinarian will advise on the regimen for feeding after treatment or surgery. Drinking water must be accessible at all times. Small meals, several times throughout the day may be the suggestion, in order to put less pressure on the stomach and intestine.

You should expect to see some sort of improvement in your dog within a few days, but keep in mind that recovery from an ulceration can take up to a few weeks. The prognosis is good (as long as the underlying cause can be resolved) for stomach and intestinal ulcers that can be treated with medication. If there has been liver or kidney complications, the prognosis may be more guarded. If there are abnormal cell growth or tumors, the end result will depend upon the eradication of the masses, if possible, and the health status of your pet upon the discovery of the ulcers.