If a dog with chronic enteropathy fails to respond to diet and antibiotics, what is the next step?

• A. Return to the diet trial
• B. Switch to a different probiotic
• C. Surgical resection
• D. Escalate to immunosuppressants and biopsy

Answer: (D)

When a dog with chronic enteropathy does not improve with a diet trial or antibiotics, the next move is to pursue a diagnosis of immune-mediated intestinal inflammation and obtain tissue to guide treatment. Intestinal biopsies are essential because they distinguish immune-mediated inflammatory bowel disease from other potential causes like infection, neoplasia, or structural problems, and they help gauge the severity and type of inflammation. With a confirmed immune-mediated enteropathy, immunosuppressive therapy—often starting with corticosteroids and adjusting with steroid-sparing agents as needed—is the standard approach to control inflammation and resolve clinical signs. The biopsy result also helps tailor prognosis and further therapy. Surgical resection is not appropriate for diffuse disease unless there is a discrete, localized lesion causing obstruction or other mechanical issues. Repeating a diet trial or relying solely on probiotics won’t address the inflammatory process driving the condition.