Episode 25 - Two Week Takedown. Chronic Enteropathies and GIQuest, clients getting Kennel Cough and promising new medications for CKD and CHF

1.The GP hook

This month we dig into a genuinely practice-changing poo test for chronic enteropathies, a UK-first licensed option for CKD-related anaemia in cats, and a promising CHF angle borrowed from endocrinology — all through a GP lens.

This month’s two‑week takedown: a genuinely useful in‑house poo test for chronic enteropathies (GI Quest), a newly available UK medicine for non‑regenerative anaemia in CKD cats, a practical NSAID‑gut check you can start tomorrow — plus a quick, balanced take on kennel cough in pregnancy and a cardiology angle worth watching.

2.Quick summary

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• GI Quest (faecal calprotectin lateral‑flow) gives an objective, semi‑quantitative read on GI mucosal inflammation you can run in practice in ~15 minutes. Thresholds discussed on the pod: dogs ≥3, cats ≥2 (0–10 scale). Validation figures quoted on the episode: dogs ~94% sensitivity / 96% specificity; cats ~92% / 100% (lateral flow format).
• Use GI Quest as a chronic‑enteropathy decision and monitoring tool — baseline, 2‑week check during diet/empirical therapy, and to guide steroid tapering. It’s not a lymphoma discriminator and is not intended as a routine acute gastroenteritis test.
• A new UK‑market medicine (Varenzin) that acts via HIF prolyl‑hydroxylase inhibition to stimulate endogenous erythropoietic signalling has been discussed as an oral option for CKD‑associated non‑regenerative anaemia in cats. Check the UK product literature for indications, monitoring and contraindications before use.
• SGLT2 inhibitors show promising cardio‑renal effects in people and emerging veterinary reports suggest potential benefit in CHF — interesting, but not ready for routine CHF use without stronger veterinary evidence.
• Kennel cough vaccination in pregnancy is a shared‑decision conversation: discuss risks, exposure, and alternatives (injectable vs intranasal vs medical exemption) with owners.

3.Faecal calprotectin in practice: what GI Quest gives you

What it is

Why this matters in GP

Monday‑Morning Move

Add “faecal calprotectin baseline” to your chronic GI / “not‑quite‑right” cat checklist. Offer a nurse‑led, 15‑minute drop‑off slot for same‑day results at follow‑ups.

• A point‑of‑care lateral‑flow test measuring faecal calprotectin, a neutrophil‑derived protein that rises when the GI mucosa has active inflammation.
• Semi‑quantitative readout (0–10 colour gradient) you can trend over time.
• It answers a common practical question: “Is there active GI inflammation right now?” — which helps decide whether to escalate (ultrasound/biopsy), continue a diet trial, or look elsewhere for the problem.
• Negative results are useful: they can steer you away from costly, invasive GI work‑ups.
• Fast, low‑stress for patients (owners can often collect at home) and typically affordable for clients (figures discussed on the pod clustered around £50–£60; practices will vary).

4.Practical workflow and interpretation

Sample & running the test

Interpreting the number (pod discussion)

What it won’t do

Clinical Pearl

For the “not‑quite‑right” geriatric cat with normal bloods, a calprotectin baseline helps you decide whether the gut is worth chasing — with minimal stress and cost.

Common Trap

Don’t use calprotectin to “rule‑in” lymphoma or to manage purely acute, self‑limiting gastroenteritis. It’s a chronic enteropathy tool and a monitoring ally.

• Very small faecal amount needed (many use what’s on the glove after a rectal exam).
• Mix with reagent, drop onto cassette, read after ~15 minutes by matching the test line colour to the supplied chart to obtain the 0–10 number.
• Dogs: 3+ considered abnormal on the 0–10 scale. Cats: 2+ considered abnormal.
• Trend is key: a drop from 5 → 3 at two weeks suggests response even if not yet normal.
• A low/normal result in an intermittently‑signs patient can justify staying with a current diet or conservative plan.
• It won’t reliably distinguish chronic inflammatory enteropathy (CIE/“IBD”) from small‑cell lymphoma — histopathology remains the discriminator where that question matters.
• It’s intended for chronic/intermittent cases; routine acute gastroenteritis management is unlikely to be changed by a single result.

5.Where GI Quest fits into the diagnostic pathway

• Use it when owners balk at immediate invasive diagnostics, or when you want an objective monitor for a diet trial, empirical therapy, or steroid taper.
• The discussion referenced recent guidance suggesting diet trials may be attempted before invasive sampling in many chronic enteropathy cases; calprotectin is a practical adjunct to show owners whether a diet is helping.
• Examples from practice: intermittent gurgly dogs where a normal calprotectin justified keeping the current diet; cats too stressed for frequent clinic visits — owners bring stool samples and you trend numbers remotely.

6.NSAIDs and the gut — a simple plan you can start tomorrow

Quick Check

Long‑term NSAID plan? Baseline calprotectin then a two‑week recheck — a simple way to personalise analgesia and reassure owners.

• On the episode a small two‑week NSAID exposure set (20 dogs) was discussed: ~25% rose into the abnormal inflammatory range after two weeks (many dogs had been on meloxicam).
• Practical approach in GP:
• Capture a calprotectin baseline before starting long‑term NSAIDs for OA.
• Recheck at ~2 weeks to personalise decisions (change NSAID, consider COX‑2 options, multimodal analgesia or closer monitoring).
• Use nurse clinics for baseline/recheck sampling to keep it low‑burden.

7.Diet trials, motivation and monitoring

• Owners stick to diet trials more when you can show objective improvement at two weeks (even if stool quality isn’t perfect).
• Suggested pathway used in practice: baseline → two‑week progress check → four–six‑week “are we normal yet?” check to decide whether to continue, switch diets, or escalate.
• Calprotectin acts as a “cheerleader” for owners who need motivation to continue a trial.

8.Kennel cough vaccination in pregnancy — a balanced GP conversation

Key points to cover with owners

Suggested wording for the consult

“Because you’re pregnant, let’s discuss options. We can use the injectable alternative, contact the kennel about an exemption, or proceed with the intranasal vaccine if you’re comfortable — here are the pros and cons so you can choose.”

• It’s not a core vaccine; the decision is context dependent (degree of exposure to kennels/daycare, household risk tolerance, owner pregnancy status).
• Discuss options: intranasal (live attenuated in many products) vs injectable alternatives, or a medical exemption if the kennel accepts one.
• Be clear that vaccination reduces risk and severity but doesn’t guarantee prevention.

9.CKD cats and non‑regenerative anaemia — a new oral option to be aware of

• A medicine (Varenzin) that stabilises hypoxia‑inducible factor (HIF) — a HIF prolyl‑hydroxylase inhibitor — was discussed as a UK‑available oral option to stimulate endogenous erythropoietic signalling and improve iron utilisation in CKD‑associated non‑regenerative anaemia.
• Why it matters in GP: it provides a licensed, oral mechanism that avoids parenteral erythropoietin administration and may offer a more practical option for some owners/patients.
• Important: the episode did not cover doses or full monitoring protocols. Before prescribing, check current UK product literature and SPC for indications, contraindications and monitoring requirements.

10.SGLT2 inhibitors and CHF — interesting, not yet routine

• SGLT2 inhibitors have demonstrated cardiovascular and renal benefits in people beyond glucose lowering (mild diuresis, natriuresis, plasma‑volume effects, potential myocardial metabolic benefits).
• Early veterinary signals and retrospective reviews suggest fewer CHF admissions and improved outcomes in some cohorts, but robust randomized veterinary trials are not yet available.
• Bottom line: promising and worth watching, but don’t change standard CHF practice until stronger veterinary evidence emerges.

11.Practical access & education

• GI Quest is distributed via the usual veterinary wholesalers and Carus Animal Health provides resources, webinars and team sessions for clinics. Practices typically incorporate it into nurse‑led pathways for baseline/recheck sampling.

12.Take‑home points

Final word

A five‑minute poo test that changes management, an oral option to help anaemic CKD cats, and a cardiology idea to keep an eye on — small practical wins that make Monday mornings easier.

• GI Quest faecal calprotectin = in‑house, semi‑quantitative marker of GI mucosal inflammation (dogs ≥3, cats ≥2 on 0–10 scale were discussed). Use it for chronic/intermittent GI signs, diet trials, steroid monitoring and NSAID gut checks.
• It’s a monitoring and decision‑support tool — not a lymphoma test and not intended to replace histopathology when tissue diagnosis is required.
• Consider baseline + two‑week recheck for long‑term NSAID starts to personalise analgesia decisions.
• A new oral HIF‑PHI medicine for CKD‑related non‑regenerative anaemia in cats is now discussed in GP; consult the product information before use.
• SGLT2s for CHF are an intriguing development — watch for future veterinary trials.
• Kennel cough in pregnancy = informed, shared decision; discuss exposure, vaccine options and owner preference.