Use of systemic steroids in GI stasis?

[Theodorusrex]

Hi all,

Wanted to ask a quick question about treatment of GI stasis. For those who don’t know my rabbit Theo is extremely prone (a few time each year) to bouts of quite severe GI stasis. He’s had all the tests going and no cause is clear – vet is stumped.

Anyway – I recently was staying with my parents for a few days and had Theo with me and he went into the early stages of stasis. I was 60 miles from my regular vet so I had no option other than take him to an emergency vet I was unfamiliar with in my Mom’s home town. I didn’t realise at the time but this vet gave him metoclopramide (which he doesn’t usually respond very quickly to – ranitidine seems to work much better) and a systemic steroid shot. I only realised he had got the steroids when I got home and checked the bill – otherwise I would have questioned it at the time.

I think it was dexamethasone he was given, but it could also have been hydrocortisone I can’t remember and the bill just had the brand name on it. 

With these steroids he bounced back to health in a matter of hours – rather than a matter of days which is the norm. I understand that steroids increase appetite etc so this is logical but I also read a lot of articles after the fact about the many dangers of steroids in rabbits. 

Are steroids a normal treatment in stasis in anyones experience / are they safe or do they do more harm than good?

If I thought they would safe I would ask for them in the future as he recovered so much more quicky! 

[Wick & Fable]

That’s a good question Theo, and one I’m not too comfortable commenting a lot on because of my inexperience with GI stasis medications, as well as steroid-use in rabbits.

From a cursory research standpoint, steroids are typically avoided because if your rabbit is going through GI stasis due to an infection, the steroid will heavily suppress an already-stressed immune system. This is why Wick’s vet doesn’t give him a particular shot after his dental grindings if it’s occurring at the same time he’s being treated with for a ringworm episode.

Moreso on the GI-related aspect, it seems use can cause some strain on the GI-tract (as expected), and some major consequences, like hemorrhaging, can occur. I suspect this is more common is a pre-existing condition is already severe and in place, or through frequent use— though this is an educated guess at best.

Wick will see his vet in one to two weeks, so I can ask what Wick’s vet’s thoughts are on the matter as well.

The answers provided in this discussion are for general guideline purposes only. The information is not intended to diagnose or treat your pet. Seek the advice of your veterinarian or a qualified behaviorist.

[LBJ10]

Steroids are definitely not standard protocol in treating stasis. There are just a few, rare scenarios where oral or injected steroids are used. This includes situations where swelling needs to be reduced immediately (e.g. a back injury and swelling is putting pressure on the spinal cord) or severe allergic reactions. Even then, steroids are given for an extremely short period of time. There is a lot of risk associated with steroids including hemorrhages in the GI tract, delayed healing and immunosuppression. Topical steroids are less worrisome, but should still be used with caution. Wooly has had topical steroids in the past, but the vet used them sparingly.

The steroid Theo received did seem to work. A single dose probably won’t cause him harm. At least, I wouldn’t think so. The fact that it helped so much does make you wonder though… does he have some kind of inflammatory bowl disease? Because all the steroid would be doing to help would be reducing inflammation rapidly. I know they prescribe steroids to dogs and cats for inflammatory bowl disease. But the risks are different for dogs and cats.

[Bam]

Hi Theo! Good to see you, but I’m sorry Theo still has his tummy problems.

As LBJ says, the fact that the steroids worked so swiftly suggests some sort of inflammatory bowel disease. It’s apparently sth that rabbits can have and it’s a coming and going thing, just as what you’re seeing in Theo. Inflammation is, as I know you know, caused by the immune defense reacting to something it perceives as harmful or “foreign”. Allergy to certain foods is one suspected cause, other suggestions are an immune reaction to certain bacterial proteins. IBD is rather common in dogs. It’s probably more common in rabbits than we know.

I’m personally wary of corticosteroids in rabbit care – it’s a “last resort” -measure and although it can be of great help in for example EC, repeat doses are not recommended. It has powerful anti-inflammatory properties, but it doesn’t address any underlying cause. Maybe it’d be possible to keep a chronic inflammation down with other meds and dietary measures? I think it’d be worth to discuss it with a good vet.

[Theodorusrex]

Thanks everyone for your really helpful and informative replies! I originally trained as a pharmacist (for humans ) before going into research, so I was aware of the possible side effects etc that they can cause in humans so I wouldn’t really have been comfortable giving them to Theo had I known at the time that the vet was doing so. However, I took Theo to our regular vet and showed them the bill etc so they could update his records when we returned home from my parents’ and the vet nurse gave him a quick once over. I asked her about the steroids and she said that they were ‘magic stuff’ and would help him get eating due to their appetite stimulating properties but I was concerned about risk of GI bleed and immunosuppression – I wish now I had asked to see our vet but the surgery was really busy and they were squeezing us in only because they know Theo so well (unfortunately).

I have to admit that it didn’t occur to me that because he responded so well to the steroids this could definitely suggest an inflammatory cause of these flares of stasis – I just thought that maybe they caused greater appetite increase in rabbits than humans. That is an interesting thought as we know at this stage its not his diet (he is on a hay and greens diet only now) or his teeth (been checked so many times its tiresome now) so that’s interesting, and perhaps may help us control it. I live in constant fear that he will have one of his flares and not make it next time

I will definitely discuss this with my vet – I’m scared of using anti-inflammatory drugs such as NSAIDs in Theo as well though, as they can also cause GI side effects. It seems you can’t win sometimes. My regular vet is good, and knowledgable about rabbits, but sometimes I think Theo goes beyond his expertise. I live in Northern Ireland, so a very tiny country and a very rural country, where house rabbits are not the norm, and as such we don’t really have vets that specialise in rabbits with difficult health issues. I think I will struggle to get him the specialised care he needs if it is something like IBD he has

[Q8bunny]

Sorry to hear your gorgeous boy had another near-bout, Theo.
But I read everyone’s replies with great interest. It does feel like an “aha!” moment.
At this point I would be doing two things: trying to determine if it’s at all possible that he’s reacting to a particular type of hay or green. And trying to find a plant-based (a herb maybe?) supplement to reduce or prevent inflammation naturally.
Sending lots of loving vibes to you guys (((Theodorus)))

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