Author: Christal Pollock, DVM, Dipl. ABVP-Avian
Date: June 18, 2007
Keywords: Gastrointestinal disease, proventricular dilatation disease, PDD, fluids, crop, crop stasis, tube feeding, dumping syndrome, elemental diet, glutamine, fat, fiber, malabsorption, maldigestion, probiotic.
Key Points
- Begin nutritional support only when the patient is warm and hydrated.
- The bird with gastrointestinal disease should initially be fed a high-energy, low-fiber diet that contains an easily digestible protein source.
- Offer dietary fat cautiously since its digestion is a relatively complex process.
- Look for a diet that contains glutamine: the preferred source of energy and nitrogen for small intestinal mucosal cells in the mammal.
Introduction
The gastrointestinal tract acquires and digests food, absorbs nutrients and water, and expels unabsorbed material as feces. Nutritional support of the avian patient with gastrointestinal disease is challenging. In cats and dogs, it is easy to “rest” the gut, however the relatively high metabolic rate of birds makes this practice difficult to impossible in many avian patients. Crop stasis, a common condition in the bird with gastrointestinal disease associated with delayed crop emptying and regurgitation, further compounds this challenge.
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Basic approach to the GI patient
The initial approach to the bird with gastrointestinal disease should be to provide supplemental heat and fluids. If the patient is extremely weak, even a few drops of 50% dextrose or corn syrup (i.e. Karo syrup, ACH Food Co.) by mouth may help short-term.
Once the patient is warm and rehydrated, tube feed small amounts of a liquid diet as long as the patient is sufficiently
strong and alert. If an excessive amount of fluid is introduced into the intestines, this may induce “dumping syndrome” which manifests in mammals as cramping, diarrhea, and vomiting.
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Liquid diets
Liquid diets come in two basic forms. Elemental diets generally contain readily available nutrients in the form of glucose, amino acids and fatty acids. Lafeber Emeraid Psittacine™ and Emeraid Carnivore™ are examples of predominately elemental diets. Polymeric liquid diets such as hand-feeding formulas or Abbott Clinicare® are made of intact nutrients, and usually contain balanced and complete nutrition.
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Dietary recommendations for gastrointestinal diseases
As a general rule of thumb, the bird with gastrointestinal disease is initially fed a high energy, low fiber diet that contains an easily digestible protein source such as Lafeber Emeraid Psittacine™. If a carnivore must be fed, offer a liquid diet such as Lafeber Emeraid Carnivore™ or muscle meat as opposed to whole prey, which includes components which are difficult to digest such as fascia or connective tissue.
- Carbohydrates are present in the diet as simple sugars, disaccharides and polysaccharides. Their primary role is to serve as a readily available source of energy.
- Ideally, the diet should contain the amino acid, glutamine. Glutamine is the preferred source of energy and nitrogen for small intestinal mucosal cells. Epithelial cell renewal requires a great deal of energy.
- Offer dietary fat cautiously since fat digestion is a complex process easily disrupted in gastrointestinal disease. Medium-chain triglycerides may be a good substitute for fat because they do not require micelle formation for absorption and they are readily absorbed in the stomach and proximal small intestine.
- Although the amount of normal dietary fiber varies widely among avian species, a low fiber diet should generally be fed initially. Dietary fiber may assist in the management of bacterial overgrowth, inflammatory bowel disease, pancreatitis, and colitis. Fiber promotes gastrointestinal motility and provides nutrition to colonic epithelial cells. Colonic epithelial cells use butyrate, a short-chain fatty acid produced by bacterial fermentation within the cecum for energy. Avian species with a developed cecum include domestic fowl and waterfowl. Ceca are absent or vestigial in psittacines and songbirds.
- Supplement various vitamins and minerals for patients with maldigestion and malabsorption (i.e. proventricular dilatation disease or PDD). The antioxidant vitamin E has been specifically recommended for the patient with PDD (0.06 mg/kg IM q7d or 15 mg/kg PO once).
- Although there is no empirical data to support there use, there are commercially available diets labeled for gastrointestinal disease such as Roudybush Rice Diet®, Roudybush AI Intestinal Care®, and Roudybush APD Proventricular®.
- Parenteral nutrition may be indicated with severe intestinal disease.
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Probiotics
Probiotics have been recommended for prevention and treatment of infectious diarrhea as well as prevention of antibiotic-induced diarrhea. Probiotic use does not appear to hurt the patient, however data on its use in non-domestic bird species like the parrot is equivocal. Data in chickens and humans suggests that some probiotics exert a beneficial effect by modulating mucosal barrier function and immune activity. Research also suggests that a combination of probiotics may be more effective than a single strain. Multibacterial probiotics containing organisms such as Lactobacillus, Bifidobacterium, Enterococcus, and Pediococcus are available.
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References
Klapproth JM, Yang VW. Malabsorption. eMedicine. Jan 2, 2007. Accessed June 17, 2007 at http://www.emedicine.com/MED/topic1384.htm#section~treatment.
Meier R, Steuerwald M. Place of probiotics. Curr Opin Crit Care 11:318-325, 2005.
Mountzouris KC, Tsirtsikos P, Kalamara E, et al. Evaluation of the efficacy of a probiotic containing Lactobacillus, Bifidobacterium, Enterococcus, and Pediococcus strains in promoting broiler performance and modulating cecal microflora composition and metabolic activities. Poult Sci 86(2):309-17, 2007.
Zora DL. Nutrition and Management of GI Disease. ABVP 2006
