Prophylactic omeprazole in dogs treated for acute thoracolumbar intervertebral disc extrusion
Gastrointestinal (GI) mucosal injury is common in dogs treated surgically for acute thoracolumbar intervertebral disc extrusion (TL-IVDE). Such mucosal lesions, predominantly consisting of submucosal hemorrhages, are identified endoscopically in 76% of TL-IVDE dogs.
Fecal occult blood (FOB) positivity and increases in serum canine pancreatic lipase immunoreactivity concentrations (cPLI) are also common in these dogs. A clinical GI complication rate of up to 47% has been reported, but the relationship between endoscopic or clinicopathologic evidence of injury and clinical GI signs is poorly characterized.
Background
Proton pump inhibitors are administered prophylactically in dogs treated surgically for acute thoracolumbar intervertebral disc extrusion (TL-IVDE). However, their efficacy in decreasing GI complications is unknown.
Hypothesis
Omeprazole does not decrease the frequency of GI complications compared to placebo in dogs treated surgically for acute TL-IVDE.
Animals
Thirty-seven client-owned dogs undergoing hemilaminectomy for acute TL-IVDE.
Methods
Randomized double-blinded placebo-controlled prospective clinical trial. Dogs received PO placebo or omeprazole at 1 mg/kg q12h for 5 days during hospitalization. Development of GI signs (e.g., diarrhea, vomiting, regurgitation, hematochezia, melena) was recorded daily. Clinicopathologic testing performed during hospitalization and at 2 and 4-week re-evaluations included: fecal occult blood, PCV, blood urea nitrogen/creatinine ratio, fecal calprotectin, canine pancreatic lipase immunoreactivity and fecal alpha-1 proteinase inhibitor concentrations. Omeprazole and placebo groups were compared using chi-squared or Fisher's exact tests.
Results
Gastrointestinal signs developed in 10/20 (50%) dogs in the omeprazole group and in 7/17 (41%) dogs in the placebo group (P = .59). Diarrhea was common (8/20 omeprazole, 5/17 placebo), hematochezia was rare (1/20 omeprazole, 1/17 placebo); melena was not observed.
Clinicopathologic evidence suggestive of bleeding was present in 9/20 dogs treated with omeprazole and in 11/17 dogs that received placebo (P = .23). Fecal occult blood positivity was more common in dogs with GI signs (P = .03). Canine pancreatic lipase immunoreactivity was higher during hospitalization compared to re-evaluations (P = .01).
Conclusions and clinical importance
Short-term, prophylactic omeprazole treatment did not decrease clinically detectable GI complications in dogs with acute TL-IVDE.
Jaya M. Mehra, M. Katherine Tolbert, Phillip Guadiano, Jörg M. Steiner, George E. Moore, Melissa J. Lewis. "Double-blinded placebo-controlled clinical trial of prophylactic omeprazole in dogs treated surgically for acute thoracolumbar intervertebral disc extrusion." Journal of Veterinary Internal Medicine. 11 February 2023. https://doi.org/10.1111/jvim.16642
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