GI stasis & Possible Ulcer?

[pjov0001]

My sweet girl, Daisy, is recovering from a really bad bout of stasis right now. She’s had stasis 4-5 times in the past 4 months, but this time, she’s taking much longer to recover. Usually it’s like 2-3 days, but this time it’s been 7 days, and her recovery journey is really up and down. When she got noticeably better about 3 days ago, her poo was approaching normal size, appetite for hay was good and of course she goes crazy for veggies (she only gets celery leaves and bok choy for now). I thought to myself, thank goodness!

But the over the past 2 days, her poo has become smaller and smaller again, now it’s about a third of the normal size… she’s still excited for veggies and I spoon feed her 2 -3 tsp of critical care daily (she loves the stuff). She’s relatively active and grinds her teeth when we pat her because she’s enjoying it- but she’s less interested in hay and water. My partner and I are so confused, her recovery is really up and down!

My rabbit-savvy vet is really great, and she suspects possible stomach ulcer. Now she’s on meloxicam, ranitadine and sucralfate twice daily (but will probably stop meloxicam soon). This is the 4th day that she’s on sucralfate, and she’s been on meloxicam and ranitadine for 7 days.

I just wanted to hear from anyone who has had similar experiences. Is it normal to expect such a slow and rocky recovery, or is it perhaps a side effect of the meds? I don’t want to stress her out too much by taking her to the vet- but is it sounding serious enough to get her in again?

Thanks

[Bam]

I’m sorry your bun is having trouble.

It can take quite a while -several weeks- to get a bunny tummy back in full working order after a bout of stasis, especially if theres gastric ulceration involved. The medications you have been prescribed are the correct ones. I’d say treating a gastric ulcer takes at least 2 weeks. Meloxicam  can be hard on the stomach, and hopefully you’ll see more marked improvement after you have taken her off that.

Sucralfate creates a protective coating in the stomach,, and should be given 1 hour before a meal. It’s best not to give the ranitidine at the same time as the sucralfate, because the sucralfate can bind the ranitidine, thus inactivating it.

 https://pgblazer.com/pharmacology-mcq-124-drug-interaction-ranitidine-and-sucralfate/

There is no good way to diagnose a bun with gastric ulcer except clinically (by symtoms). If your vet suspects a gastric ulcer, they will treat your bun with meds. If the gut is slow, your vet can prescribe a gut stimulant that is more powerful than ranitidine (metoclopramide). I think it’d be wise to talk to them, they may not think it’s a good idea to come in, a vet visit is, as you say, stressful, and then there’s covid, but they may prescribe you more meds, depending on their assessment of her symptoms. Or they’ll just tell you to keep up your good work -in any case it often feels better to have consulted with the vet.

 

[ergodic]

Lesions like ulcers can be detected if they have they are bleeding with barium swallow. Also CBC will indicate if there is actually bleeding by the red blood cell count. George had a terrible ulcer. an antibiotic might help if the ulcer is open. Omeperazole  tends to better for ulcer but it can be difficult to compound.

[Bam]

A CBC is very useful. It is a very good diagnostic tool for rabbits and will pick up on many things that could be wrong. Hopefully theres no fully developped ulceration with actual bleeding. Both sucralfate and ranitidine are commonly prescribed to prevent full blown ulceration, although there doesnt seem to be scientific support that concomitant use gives a better outcome than single use of any of those two drugs.

https://pubmed.ncbi.nlm.nih.gov/8480730/

How is he doing now? Are you seeing any progress?

 

[pjov0001]

Hi guys,

 

Thanks for your responses! 🙂 I really do appreciate it. She’s doing better now- she’s been slowly eating more and more hay every day, especially since I mixed oaten and timothy hay. So I’ve slowed down and stopped with critical care. My vet said that apparently, critical care may cause poo to become smaller sometimes (I wonder why?). I think she’s happier now too.

 

I’m just curious- there’s not too much information on rabbit ulcers out there. Is an ulcer brought on by too many bouts of stasis, or is stasis a symptom of an ulcer? Or is it kind of both? I should have asked my vet to clarify a bit more whether the reason she’s had stasis so much recently because she has an ulcer. Because I really hope this treatment clears everything up, and we stop having stasis altogether 🙂

 

I should also mention that Daisy is a rescue rabbit, she’s been with us for ~1.5 years already and she was severely mistreated in her previous home. Who knows how stressed she’s been and what type of poor diet she’s had before that. This stress might have started her ulcer.

 

Thanks again to you both for your concern and replies!

[Bam]

I’m glad to hear she’s doing better! I would assume Critical Care can cause smaller poop because even though it has a high fiber content, it cant compete with hay. It’s filling too, so the bun might not bother with the hay even if it technically could eat hay as well. I’m glad you’ve been able to stop the CC!

The most common cause of gastric ulceration in rabbits seems to be stress. Stress changes the pH in the gut, and buns are, as you know, very susceptible to stress. I read about a study of post mortems performed on 1000 buns, where 7.3 % were found to have gastric ulcers. It was more commonly found in females than in males, so perhaps there is a hormonal component. I assume your bun is spayed, though.

https://www.sciencedirect.com/science/article/abs/pii/0021997580900171

My rabbit developped clinical signs of gastric ulcer/gastritis after a longer course of meloxicam for pain and inflammation.  He was prescribed sucralphate and ranitidine. It seemed to help him a lot.

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