Are we giving nutrition enough opportunity to work in dogs with chronic enteropathy?

Recent research suggests the challenge is becoming more prominent. In a survey of 500 veterinarians across the US, UK, Brazil, China, and Thailand, more than 90% reported seeing an increase in canine chronic enteropathy (CE) cases over the previous 2 years.¹

CE encompasses a heterogeneous group of conditions characterized by persistent or intermittent gastrointestinal (GI) signs lasting at least 3 weeks, after other causes have been excluded.

Most veterinarians recognize the importance of nutrition and have a go-to diet for dogs with CE. The problem arises when that diet fails. Too often, we interpret this as meaning that nutrition itself has failed. Instead, we should view dietary management as an individualized part of the clinical pathway.

Nutrition should be a cornerstone of treatment

In a recent peer-reviewed paper, my coauthors and I reviewed the available evidence on dietary management of normoalbuminemic canine chronic enteropathies. Approximately 50% of dogs with CE seen in referral practice respond to dietary intervention alone, with success rates improving when multiple systematic dietary trials are undertaken.²

The traditional lines between “diet-responsive,” “steroid-responsive,” and other categories are often blurred. A dog may improve partially with one diet but ultimately require medication as well. If diet has meaningfully improved clinical signs, there is value in maintaining it while introducing additional therapies where needed.²

Rather than simply asking, “Did the diet work?” we should ask: “What did this dietary trial teach me about this patient?”

There is no single best diet for CE. When the first is unsuccessful, the next choice should be informed by the patient’s clinical signs, dietary history, nutritional status, and previous response. For example, if increased fiber improves stool quality but the dog continues to lose weight, we may need to retain what worked while increasing caloric density or intake. We might consider digestibility, fat content, fiber, and protein source or form, among other factors.²

This is why I am cautious about attaching an arbitrary number to how many diets should be tried. Updated American College of Veterinary Internal Medicine guidance reinforces dietary trials as a preferred first-choice diagnostic intervention and recommends considering multiple properly designed trials before more invasive diagnostics in clinically stable patients.³

A series of 2 or 3 trials may help identify the diet that ultimately works, but we should not ascribe a number at which we stop thinking about nutrition.

Persistence needs to be individualized

A young dog with predominantly large-bowel signs, a normal physical examination, and normal fecal testing can often undergo several dietary trials following anthelmintic therapy before additional diagnostics. By contrast, vomiting, dehydration, abdominal pain, weight loss, or muscle loss warrant earlier investigation.

GI signs often improve within 2 to 3 weeks—but the wider gut environment, including inflammation or dysbiosis, can take longer to improve.² A partial response can therefore be meaningful. If clinical signs or quality of life are improving, the right decision may be to wait rather than immediately abandon the nutritional strategy.

Owner communication is key

Managing diarrhea, vomiting, or poor appetite can be stressful and costly, and owners may expect a therapeutic diet to deliver rapid improvement. We need to set realistic expectations.

Owners need to understand the importance of an appropriate transition, particularly with a picky eater, and that signs can sometimes worsen before they get better. Where clinically appropriate, supportive management may help prevent clinical signs from derailing a dietary trial.

We should explain what we are trying to learn from the diet, what improvement may look like, and what happens if the response is incomplete. Clear communication can turn a second dietary strategy from a perceived “failure” into a logical next step.

Treat nutrition as a science

We often talk about veterinary diets through labels—“GI,” “hepatic,” “renal”—which can take away from the fact that nutrition is a science that requires care and thought.

We have excellent therapeutic diets and tools to help us choose an appropriate first strategy. The challenge is knowing what to do when that first approach does not deliver the response we hoped for. For some dogs, the first diet will work. For others, finding the right approach will require iteration, careful observation, and collaboration with the owner.

The goal is not persistence for persistence’s sake. It is to keep learning from the patient in front of us—and give nutrition the same individualized clinical consideration we would give any other part of their treatment.

References

1. Censuswide. The Silent Epidemic and the Prescription Gap. Royal Canin; 2026.
2. Kathrani A, Allenspach K, Dito D, et al. Dietary management of normoalbuminaemic canine chronic enteropathies. J Small Anim Pract. 2026;67:492-503. doi:10.1111/jsap.70089
3. Heilmann RM, Jergens AE, Kathrani A, et al. 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;40(1). doi:10.1093/jvimsj/aalaf017