Condition guide
Chronic enteropathy in Dogs: Diagnosis, Treatment & Prognosis
Canine chronic enteropathy is a diagnosis-of-exclusion syndrome characterized by gastrointestinal signs lasting 3 weeks or longer or by persistent or recurring gastrointestinal signs, including diarrhea, vomiting, appetite change, and weight loss.[1][4][5] In dogs, classification is based largely on response to treatment and includes food-responsive, antibiotic-responsive or microbiota-related modulation-responsive, immunosuppressant-responsive, and nonresponsive enteropathy; protein-losing enteropathy is a fifth type usually associated with a more guarded prognosis.[1] In clinically stable dogs suspected of having chronic inflammatory enteropathy, dietary treatment trials are the preferred first-choice diagnostic recommendation before invasive diagnostic tests are performed, and efficacy of treatment trials is also considered diagnostic.[11]
Key points
- Definition: In dogs, chronic enteropathy is characterized by GI signs such as diarrhea, vomiting, and anorexia that last for 3 weeks or longer.[1]
- Diagnosis: In dogs, chronic enteropathy is a diagnosis of exclusion, and response to treatment is part of the diagnostic process.[1][2][11]
- Classification: In dogs, chronic enteropathy is classified by treatment response into food-responsive, antibiotic-responsive or microbiota-related modulation-responsive, immunosuppressant-responsive, and nonresponsive enteropathy.[1]
- PLE: In dogs, protein-losing enteropathy is a fifth type of chronic enteropathy and is usually associated with a more guarded prognosis.[1]
- Diet first: In clinically stable dogs suspected of having chronic inflammatory enteropathy, dietary treatment trials are the preferred first-choice diagnostic recommendation before invasive diagnostic tests are performed.[11]
Overview
Chronic enteropathy in dogs is a syndrome of chronic or recurrent gastrointestinal disease rather than a single diagnosis.[1][4][5]
- In dogs, chronic enteropathy has been described as gastrointestinal clinical signs for more than 3 weeks and also as persistent or recurring gastrointestinal signs.[1][4]
- In dogs, reported signs include diarrhea, vomiting, loss of appetite, and weight loss.[4][5]
- In dogs, diagnosis is often based on history, clinical signs, physical examination, and response to treatment.[1]
- In dogs, laboratory and imaging studies are normal in most cases.[1]
- In dogs, chronic enteropathies are commonly subdivided into food-responsive, antibiotic-responsive, immunosuppressant-responsive, and nonresponsive categories.[1]
- The term microbiota-related modulation-responsive enteropathy may be preferred over antibiotic-responsive enteropathy because of uncertainty about antimicrobial utility in most forms of chronic enteropathy.[1]
- In dogs, idiopathic IBD should be reserved for chronic enteropathy characterized by persistent clinical signs and histological evidence of inflammatory cell infiltrate of unknown etiology.[1]
Causes & risk factors
Canine chronic enteropathy appears to involve host, microbial, dietary, and immune factors.[6]
- Pathogenesis: Most forms of chronic enteropathy in dogs are thought to involve a complex interplay among host genetics, the intestinal microenvironment, primarily bacteria and dietary constituents, and the immune system.[6]
- Breed associations: In one retrospective study from two Swedish animal hospitals, breeds with the highest relative risk for chronic enteropathy in dogs included Norwegian Lundehund, West Highland White Terrier, and Miniature Poodle.[4]
- Breed-linked food-responsive disease: Gluten-sensitive enteropathy in Irish setters is included in the food-responsive enteropathy category.[5]
- Breed-linked food-responsive disease: Paroxysmal gluten-sensitive dyskesia in Border terriers is included in the food-responsive enteropathy category, and 50% of affected dogs express gastrointestinal signs.[5]
Clinical signs
Canine chronic enteropathy usually presents with chronic or recurrent gastrointestinal signs.[1][4][5]
- Diarrhea: Diarrhea is a common sign of chronic enteropathy in dogs.[1][4][5][10]
- Vomiting: Vomiting is a common sign of chronic enteropathy in dogs.[1][4][5]
- Appetite change: Anorexia, loss of appetite, or decreased appetite can occur in dogs with chronic enteropathy.[1][4][10]
- Weight loss: Weight loss is reported in dogs with chronic enteropathy.[4][5][10]
- Other GI signs: In dogs, chronic inflammatory enteropathies may also cause nausea, borborygmus, flatulence, eructation, and abdominal pain.[5]
- PLE-associated hypoalbuminemia signs: Dogs with protein-losing enteropathy may have ascites, pleural effusion, or peripheral edema.[10]
- PLE-associated bleeding signs: In dogs with protein-losing enteropathy, hematochezia and melena are rare.[10]
- PLE-associated hypocalcemia signs: Dogs with significant ionized hypocalcemia secondary to malabsorption of calcium and vitamin D may exhibit tremors or facial rubbing or develop focal or generalized seizures.[10]
- PLE-associated thromboembolic signs: In dogs with protein-losing enteropathy, respiratory, neurologic, or musculoskeletal signs may occur as a result of thromboembolic disease.[10]
Diagnosis
Canine chronic enteropathy is diagnosed by excluding other causes of gastrointestinal signs and assessing response to treatment.[1][2][11]
- Elimination process: Diagnosis of chronic enteropathy in dogs consists in an elimination process that rules out other diseases of known etiology that may cause similar clinical signs.[2]
- Core clinical assessment: In dogs, diagnosis is often based on history, clinical signs, physical examination, and response to treatment, with histological examination as required.[1]
- Parasite testing: Fecal flotation and a Giardia antigen test should be performed in all dogs with suspected chronic enteropathy.[2]
- Empiric deworming option: In dogs with suspected chronic enteropathy, empiric parasiticide treatment can be administered as an alternative approach during the exclusion process.[2]
- What must be excluded: In dogs, the diagnostic workup should exclude extra-digestive disorders causing gastrointestinal clinical signs, intestinal parasitosis, digestive neoplastic disorders, and infectious disorders.[5]
- Routine ancillary testing: In dogs with chronic enteropathy, laboratory and imaging studies are normal in most cases.[1]
- Diet trials in classification: In dogs with suspected chronic inflammatory enteropathy, several dietary trials are performed in the current classification system, usually including a highly digestible diet, a hydrolyzed protein diet, a fiber-rich diet, and/or a home-cooked novel protein diet with limited ingredients.[5]
- Imaging after failed trials: In dogs that fail to improve after dietary and antibiotic trials, an ultrasound examination is usually pursued to exclude any focal disease of the gastrointestinal tract.[5]
- Biopsy indications: In dogs that do not respond to antibiotics, histological examination of gastrointestinal biopsies is required to confirm mucosal inflammation and rule out diffuse neoplastic disorders and atypical infections.[5]
Differential diagnoses
Canine chronic enteropathy should only be diagnosed after exclusion of other causes of chronic gastrointestinal signs.[1][2][5]
- Intestinal parasitism: Intestinal parasitosis or endoparasitism can mimic chronic enteropathy in dogs.[1][5]
- Giardia infection: Giardia is specifically included in the exclusion workup for dogs with suspected chronic enteropathy.[2]
- Extra-digestive disease: Extra-digestive disorders causing gastrointestinal clinical signs should be excluded in dogs.[5]
- Foreign body disease: Gastric foreign bodies are listed among causes of gastrointestinal signs that should be excluded in dogs.[1]
- Neoplasia: Neoplastic etiologies such as lymphoma and diffuse neoplastic disorders should be excluded in dogs with suspected chronic enteropathy.[1][5]
- Infectious disease: Digestive infectious disorders and atypical infections should be excluded in dogs with suspected chronic enteropathy.[5]
- Focal GI disease: Focal disease of the gastrointestinal tract should be excluded in dogs that fail empirical treatment trials.[5]
Treatment
Treatment of chronic enteropathy in dogs is typically multimodal, with nutritional intervention prioritized first.[7][11]
- Diet first: In clinically stable dogs suspected of having chronic inflammatory enteropathy, dietary treatment trials are the preferred first-choice diagnostic recommendation before invasive diagnostic tests are performed, provided the dogs are not hypo- or anorexic.[11]
- Diet as therapy and test: In dogs with chronic inflammatory enteropathy, dietary modification as a test of treatment is an adequate therapeutic point because 38%-89% of dogs are food-responsive, and many maintain long-term clinical remission of at least three months on dietary treatment alone.[11]
- General approach: In dogs, therapy includes dietary changes, modulation of the microbiome, and potentially steroids or cytotoxic drugs.[1]
- Sequential strategy: In dogs, sequential treatment using specially formulated diets, antimicrobials, and immunosuppressive drugs is the most common strategy used to achieve clinical remission.[6]
- Antibiotics in current classification: In dogs whose clinical signs fail to improve with dietary trials, antibiotics have historically been advocated for, mainly metronidazole or tylosin.[5]
- Immunosuppression: In dogs, most chronic GI signs will not need immunosuppressant treatment, so the term inflammatory bowel disease can be misleading when used broadly.[1]
- Severe cases: In debilitated or hypoproteinemic dogs with chronic enteropathy, more aggressive treatment is sometimes required.[1]
- Cobalamin: In dogs with chronic enteropathy and hypocobalaminemia, oral cobalamin supplementation has been confirmed as effective in recent studies and offers an alternative to parenteral supplementation that may be easier and more cost-effective than monthly injections for some owners.[3]
- Source-reported regimen: In one canine chronic enteropathy case with hypocobalaminemia, oral cobalamin supplementation was initiated at the following dose.[3]
| Drug | Species | Dose | Route | Frequency |
|---|---|---|---|---|
| Cobalamin | Dog | 1 mg | PO | q24h [3] |
Monitoring
Response to treatment should be followed closely in dogs with chronic enteropathy because treatment efficacy is also considered diagnostic.[11]
- Treatment response: In dogs, response to treatment is part of the diagnosis of chronic enteropathy.[1][11]
- Severity stratification: In dogs, the diagnostic process differs between those with mild clinical signs and no evidence of systemic complication such as hypoproteinemia and those that are more severely affected.[2]
- Markers of nonresponse: In one retrospective study, dogs with non-responsive chronic enteropathy were more likely to present with anemia, hypoproteinemia, hypoalbuminemia, increased C-reactive protein concentrations, and ascites.[4]
- Albumin as a prognostic marker: In dogs with chronic enteropathy, severe hypoalbuminemia at presentation, defined as serum albumin < 2 g/dL or < 20 g/L, was identified as a negative prognostic factor.[2]
Prognosis
Prognosis in canine chronic enteropathy depends strongly on treatment response and the presence of hypoalbuminemia or protein-losing enteropathy.[1][2]
- Diet-responsive disease: The prognosis for diet-responsive chronic enteropathy in dogs is good.[2]
- Long-term diet control: In dogs with diet-responsive chronic enteropathy, 77–80% are still controlled only with an elimination diet one year after diagnosis.[2]
- Failure of dietary response: In dogs with chronic enteropathy that do not respond to a dietary treatment trial, prognosis is significantly worse, with up to 1/3 of patients euthanized within 3 months of diagnosis.[2]
- Hypoalbuminemia: In dogs with chronic enteropathy, severe hypoalbuminemia at presentation, defined as serum albumin < 2 g/dL or < 20 g/L, is a negative prognostic factor.[2]
- PLE: In dogs, protein-losing enteropathy is usually associated with a more guarded prognosis.[1]
Frequently asked questions
How is chronic enteropathy diagnosed in dogs?
In dogs, diagnosis of chronic enteropathy consists in an elimination process that rules out other diseases of known etiology causing similar clinical signs.[2] In dogs, diagnosis is often based on history, clinical signs, physical examination, and response to treatment, with histological examination as required.[1]
What tests should all dogs with suspected chronic enteropathy have?
When should idiopathic IBD be used as a diagnosis in dogs?
In dogs, idiopathic IBD should be reserved for chronic enteropathy characterized by persistent clinical signs and histological evidence of inflammatory cell infiltrate of unknown etiology.[1] In dogs, the term IBD also implies that treatment trials with diet and deworming have failed and that immunosuppressives will be needed to control clinical signs.[1]
When are gastrointestinal biopsies indicated in dogs with chronic enteropathy?
In dogs whose clinical signs fail to improve after diet and antibiotic trials, an ultrasound examination is usually pursued to exclude focal gastrointestinal disease.[5] In dogs that do not respond to antibiotics, histological examination of gastrointestinal biopsies is required to confirm mucosal inflammation and rule out diffuse neoplastic disorders and atypical infections.[5]
What is the prognosis for diet-responsive chronic enteropathy in dogs?
Can oral cobalamin be used in dogs with chronic enteropathy and hypocobalaminemia?
Recent studies have confirmed the efficacy of oral cobalamin supplementation in dogs with chronic enteropathy and hypocobalaminemia.[3] Oral cobalamin offers an alternative to parenteral supplementation and may be easier and more cost-effective than monthly injections for some owners, particularly when long-term maintenance supplementation is needed.[3]
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Veterinarian · Reviewed 26 Oct 2026
References
- Chronic Enteropathies in Small Animals - Digestive System
Passage read from this source
Full Review: Aug 2025 ByAllison Collier, DVM, DACVIM, Ontario Veterinary College, University of Guelph | Peer reviewed byJoyce Carnevale, DVM, DABVP, College of Veterinary Medicine, Iowa State University Last updated: Jun 2026 v3266670 View the Pet Owner Version Chronic enteropathies are characterized by the presence of GI signs such as vomiting, anorexia, and diarrhea that last for 3 weeks or longer. Diagnosis is typically based on history, clinical signs, and response to treatment. Therapy includes dietary changes, modulation of the microbiome, and potentially steroids or cytotoxic drugs. For debilitated or hypoproteinemic patients, more aggressive treatment is sometimes required. - Etiology and Pathophysiology| - Epidemiology| - Clinical Findings| - Diagnosis| - Treatment| - Prognosis| - Key Points| - For More Information|…
Chronic enteropathies are characterized by the presence of GI clinical signs (diarrhea, vomiting, anorexia) for more than 3 weeks. Chronic enteropathies refer to instances in which intestinal inflammation is suspected but not confirmed histologically. A diagnosis of chronic enteropathy does not imply that any specific treatment is indicated to control clinical signs. Chronic enteropathies can be subdivided into four main categories: - Food-responsive (diet-responsive) enteropathy - Antibiotic-responsive enteropathy - Immunosuppressant-responsive enteropathy - Nonresponsive enteropathy The term microbiota-related modulation-responsive enteropathy may be preferred over antibiotic-responsive enteropathy because of the uncertainty of antimicrobial utility in most forms of chronic enteropathy.
Protein-losing enteropathy (PLE) is a fifth type of chronic enteropathy that affects small animals and is usually associated with a more guarded prognosis. Historically, the term inflammatory bowel disease (IBD) has been used to describe chronic enteropathy. However, most dogs with chronic GI signs will not need immunosuppressant treatment, so this term is misleading. For this reason, the term idiopathic IBD should be reserved to describe chronic enteropathy characterized by persistent clinical signs and histological evidence of inflammatory cell infiltrate of unknown etiology. Additionally, the term IBD implies that immunosuppressives will be needed to control clinical signs and that treatment trials with diet and deworming have failed.
- History - Clinical signs - Response to treatment - Histological examination as required Chronic enteropathies are diagnosed by excluding other causes of GI signs (eg, gastric foreign bodies, endoparasitism, or neoplastic etiologies such as lymphoma). Diagnosis is often based on history, clinical signs, and physical examination. Laboratory and imaging studies are normal in most cases.
- Approach and Management of Chronic Enteropathies in Dogs
Passage read from this source
Diagnosis of CE consists in an elimination process. The aim is to rule out other diseases of known etiology that may cause similar clinical signs: fecal flotation and a Giardia antigen test should be performed in all dogs. Alternately, empiric parasiticide treatment can be administered (e.g., fenbendazole 50 mg/kg q 24 h for 3–5 days). Subsequently, the diagnostic process is different for dogs with mild clinical signs and no evidence of systemic complication such as hypoproteinemia, and for dogs that are more severely affected.
The prognosis for diet-responsive CE is good. It appears that 77–80% of these dogs are still controlled only with an elimination diet one year after diagnosis. However, several studies showed that the prognosis of dogs with CE that do not respond to a dietary treatment trial is significantly worse, with up to 1/3 of patients euthanized within 3 months of diagnosis. Moreover, severe hypoalbuminemia (serum albumin < 2 g/dL or < 20 g/L) at the time of presentation was identified as a negative prognostic factor. Value of Diet in Other Chronic Enteropathies
- Nutritional Assessment in a Dog with Chronic Enteropathy
Passage read from this source
Oral cobalamin supplementation has been proven to be effective in humans with cobalamin deficiency,1-5 and recent studies have confirmed its efficacy in dogs and cats with chronic enteropathy and hypocobalaminemia.6-9 It offers an alternative to parenteral supplementation and may suit some owners better, as oral administration may be an easier and more cost-effective alternative to monthly injections, particularly for patients requiring long-term maintenance supplementation. Because oral supplementation in dogs with hypocobalaminemia had not been studied at the time of this case, the potential for failure of this therapy was carefully discussed with the owners before supplementation (1 mg PO q24h) was initiated.
- Chronic Enteropathy in Dogs—Epidemiologic Aspects and ...
Passage read from this source
Canine chronic enteropathy is characterized by persistent (>3 weeks) or recurring gastrointestinal signs, such as diarrhea, vomiting, loss of appetite, and weight loss. Depending on treatment response, chronic enteropathy is classified as food-responsive-, antibiotic-responsive-, immunosuppressant-responsive-, or non-responsive enteropathy. Information about prevalence and breed disposition of dogs with chronic enteropathy is limited. The aim of this retrospective study was to investigate period prevalence, breed distribution, and characterization of chronic enteropathy in dogs presenting at two Swedish animal hospitals. A total of 814 dogs met inclusion criteria and the period prevalence of chronic enteropathy was 1.1% of the total number of dogs. Breeds with the highest relative risk included Norwegian Lundehund, West Highland White Terrier, and Miniature Poodle. Treatment outcome was classified…
- Updating the Classification of Chronic Inflammatory ... - PMC
Passage read from this source
Canine chronic inflammatory enteropathies (CIEs) are a group of diseases resulting in chronic (i.e., a 3-week duration or longer) or recurrent gastrointestinal clinical signs, including diarrhea, vomiting, nausea, borborygmus, flatulence, eructation, abdominal pain, weight loss or a combination of these signs. The diagnosis is made after the exclusion of extra-digestive disorders causing gastrointestinal clinical signs, intestinal parasitosis, and digestive neoplastic and infectious disorders [1].
In dogs with chronic gastrointestinal signs, diagnoses of CIEs are considered after the exclusion of intestinal parasitism and extra-digestive disorders. In the current classification, once a CIE is suspected, several dietary trials are performed, usually including a highly digestible diet, a hydrolyzed protein diet, a fiber-rich diet, and/or a home-cooked novel protein diet with limited ingredients [9,10]. If clinical signs resolve with a dietary trial, the diagnosis falls in the FRE category. If clinical signs fail to improve, antibiotics have historically been advocated for (mainly metronidazole or tylosin). If the clinical response to the antibiotic trial is adequate, it is classified as an ARE. In the absence of a response to antibiotics, an ultrasound examination is usually pursued to exclude…
Food-responsive enteropathies account for the majority of CIEs in dogs, ranging from 50 to 65% of cases [1,6,11,12]. Dogs with FREs seem to be younger than dogs with IREs (FRE median: 3 years, range: 0–12; IRE median: 6 years, range: 1–13 years, with p ≤ 0.001 in a cohort of 203 dogs diagnosed with CIEs [12]) and to exhibit more clinical signs consistent with large bowel disease. They have a lower canine chronic enteropathy clinical activity index (CCECAI) score in comparison with that of dogs suffering from AREs or IBD (median FRE: 6, range: 2–12; median ARE: 8, range: 0–14; median IRE: 9, range: 5–14, p ≤ 0.001 in a cohort of 203 dogs diagnosed with CIEs) [9,12,13,14]. However, no…
- Narrative review of therapies for chronic enteropathies in dogs ...
Passage read from this source
Chronic enteropathies (CE) are a common cause for persistent or recurrent gastrointestinal (GI) signs in dogs and cats. Although the different forms of CE, including food‐responsive enteropathy (FRE),1, 2 antimicrobial‐responsive diarrhea (ARD),3 and corticosteroid or immunosuppressive‐responsive inflammatory bowel disease (IBD) (steroid‐responsive disease, SRD)4, 5 have different etiologies, clinical signs often overlap and distinguishing among these disorders may be difficult, even with GI endoscopy and histopathologic review of mucosal biopsy specimens. Alternatively, the different phenotypes of CE might reflect a single disease process of increasing severity affecting the intestinal immune system and selectively responsive to different interventions over time. A prevailing hypothesis is that most forms of CE involve a complex interplay among host genetics, the intestinal microenvironment (primarily bacteria and…
- Managing Chronic Enteropathies: Beyond Antimicrobials
Passage read from this source
The currently recommended treatment of chronic enteropathy in dogs is multimodal, with the first consideration being nutritional intervention.
- Canine chronic enteropathy—Current state-of-the-art ... - PMC
Passage read from this source
by AE Jergens · 2022 · Cited by 187 — Medical treatment of dogs with SRE/IRE usually involves the administration of glucocorticoids (predniso[lo]ne or budesonide) and/or other ...
- Approach and Management of Chronic Enteropathies in Dogs
Passage read from this source
Diagnosis of CE consists in an elimination process. The aim is to rule out other diseases of known etiology that may cause similar clinical signs: fecal flotation and a Giardia antigen test should be performed in all dogs. Alternately, empiric parasiticide treatment can be administered (e.g., fenbendazole 50 mg/kg q 24 h for 3–5 days). Subsequently, the diagnostic process is different for dogs with mild clinical signs and no evidence of systemic complication such as hypoproteinemia, and for dogs that are more severely affected.
The prognosis for diet-responsive CE is good. It appears that 77–80% of these dogs are still controlled only with an elimination diet one year after diagnosis. However, several studies showed that the prognosis of dogs with CE that do not respond to a dietary treatment trial is significantly worse, with up to 1/3 of patients euthanized within 3 months of diagnosis. Moreover, severe hypoalbuminemia (serum albumin < 2 g/dL or < 20 g/L) at the time of presentation was identified as a negative prognostic factor. Value of Diet in Other Chronic Enteropathies
- Protein-Losing Enteropathy in Dogs: Diagnosis, Outcome
Passage read from this source
Dogs with PLE typically have a history of chronic relapse or progressive GI signs (eg, diarrhea, weight loss, decreased appetite, vomiting) and may have clinical signs associated with hypoalbuminemia (eg, ascites, pleural effusion, peripheral edema). The most commonly reported GI signs associated with PLE are diarrhea, weight loss, and decreased appetite. Vomiting is less common, and signs of GI bleeding (eg, hematochezia, melena) are rare. Additional uncommon signs may be related to systemic complications of PLE. Dogs with significant ionized hypocalcemia secondary to malabsorption of calcium and vitamin D may exhibit tremors or facial rubbing or develop focal or generalized seizures. Respiratory, neurologic, or musculoskeletal signs may occur as a result of thromboembolic disease. The cause of thromboembolic disease in…
- Updated guidance on canine chronic inflammatory enteropathy ...
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**Published on** February 23, 2026 **By** Christine Won As research has advanced understanding of chronic gastrointestinal (GI) inflammation in dogs, the American College of Veterinary Internal Medicine (ACVIM) has endorsed a new consensus statement on the diagnosis and treatment of chronic inflammatory enteropathy (CIE) in dogs. The consensus statement, published on January 21, outlines a stepwise diagnostic approach, that includes patient history, clinical signs, physical examination findings, sequential diagnostic tests, and imaging. It also covers practical treatment strategies for managing CIE that tailor care based on a patient's underlying disease subtype and response to therapy.
Dr. Heilmann, a professor of small animal internal medicine at Leipzig University in Germany, said the new guidance, based on evidence from the past 16 years, places a stronger emphasis on well-designed dietary trials. The authors noted that dietary modification as a test of treatment is an adequate therapeutic point because 38%-89% of dogs with CIE are food-responsive, and many maintain long-term clinical remission of at least three months on dietary treatment alone. "Because CIE is a diagnosis of exclusion and is subclassified based on response to treatment … efficacy of treatment trials is also considered diagnostic," the authors wrote. "Dietary treatment trials are the preferred first-choice diagnostic recommendation in dogs suspected of having CIE before invasive diagnostic tests are…
- ACVIM–endorsed statement: consensus statement and systematic ...
Passage read from this source
. 2026 Jan 21;40(1):aalaf017. doi: 10.1093/jvimsj/aalaf017 ## ACVIM–endorsed statement: consensus statement and systematic review on guidelines for the diagnosis and treatment of chronic inflammatory enteropathy in dogs Romy M Heilmann
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