Hemorrhagic Gastroenteritis in Dogs

Hemorrhagic gastroenteritis symptoms in dogs is scary to witness, but thankfully HGE in dogs responds to fast treatment.

15

HEMORRHAGIC GASTROENTERITIS IN DOGS: OVERVIEW

1. Pay attention to the symptoms of hemorrhagic gastroenteritis in dogs, especially vomiting and diarrhea (either at once or alternating consistently).

2. If you see blood in your dog’s stool or vomit, don’t wait. Take your dog to veterinarian immediately.

3. If you live in an area known to have HGE outbreaks, be especially vigilant.

4. Do what you can to keep your dog’s immune system strong. It can’t hurt and might help.


The signs of hemorrhagic gastroenteritis came fast and furious. One day Chloe was a healthy, tail-wagging Labrador Retriever and the next day she was vomiting mucus all over the house. Then her vomit turned red with blood and then came matching diarrhea. Chloe had hemorrhagic gastroenteritis (HGE).

Hemorrhagic gastroenteritis is a mystery disease. No one knows what causes hemorrhagic gastroenteritis in dogs and there is no recommended prevention. It does not seem to be contagious from one dog to another, although dogs living together sometimes develop HGE at the same time, and some parts of the country have reported outbreaks of several cases. It’s most dangerous for small dogs, and although some veterinarians consider toy and miniature breeds between the ages of two and four the most typical HGE patients, males and females of all breeds and ages have been affected.

Hemorrhagic Gastroenteritis in Dogs

There are few, if any, hemorrhagic gastroenteritis warning signs. It is not usually accompanied by a fever. Diarrhea containing bright or dark red blood is the illness’s signature symptom. Vomiting, which usually accompanies the diarrhea, typically begins as mucus or bile and then becomes bloody. Affected dogs may eat grass and vomit that as well.

Because HGE in dogs can be fatal, prompt veterinary care is essential. Patients are not usually dehydrated when first examined, but dehydration can develop quickly, leading to hypotension (low blood pressure), an elevated red blood cell count, shock, blood clotting problems, or kidney failure.

Confirming Your Dog Has HGE

Hemorrhagic gastroenteritis is usually diagnosed by a process of elimination, since there are several other disorders that produce bloody vomiting and diarrhea.

Puppies and young dogs may develop these symptoms after eating slippers, leashes, or other foreign objects. Dogs of all ages can bleed from trauma injuries; the ingestion of toxic substances or contaminated food; gastrointestinal ulcers; colitis; infectious diseases such as parvovirus and coronavirus; infections from Campylobacter, Salmonella, Clostridium, Escherichia coli, and Leptosperosis bacteria; parasites such as whipworms, hookworms, cocciodiosis, and giardia; warfarin (rat poison); coagulation disorders; gastrointestinal cancer; and Addison’s disease (hypoadrenocorticism).

Because a comprehensive examination with complete blood count (CBC), biochemical profile, urinalysis, fecal examination, and bacterial cultures is both expensive and time-consuming, unless a specific cause can be quickly identified, such as a swallowed foreign object or parvovirus, the diagnosis is likely to be HGE. In addition to producing diarrhea that looks like raspberry jam, canine HGE patients appear tired and weak. Many have an elevated pulse and labored breathing.

HGE Treatment for Dogs

The treatment of HGE may or may not involve hospitalization, but it often includes the administration of fluids to prevent dehydration. Without sufficient fluids, the blood thickens and its flow through blood vessels may be impeded.

For patients treated early, subcutaneous fluids or even plain drinking water may be sufficient, but intravenous fluids are recommended to prevent “disseminated intravascular coagulation,” or DIC, a potentially fatal clotting disorder that occurs when the blood thickens and slows. Once DIC has begun, it is often irreversible.

Although HGE has not been shown to be caused by bacterial infections, parasites, fungal infections, viruses, or any other specific pathogens, many veterinarians prescribe medications that address these agents. In addition, patients may be given medications that treat ulcers, soothe the gastrointestinal tract, or prevent nausea, vomiting, or pain.

HGE recovery time for dogs is variable. The patient’s veterinarian may recommend that no food or water be given by mouth for one to four days to let the digestive system rest or that water be given in small amounts every few hours the first day and then in larger amounts as long as it doesn’t contribute to nausea and vomiting. Food is reintroduced slowly. A veterinarian may recommend that a new or different type of protein is fed to the dog in case the problem was related to the dog’s previous diet. Alternatively, a prescription pet food may be used until the acute phase of HGE has passed.

Is Hemorrhagic Gastroenteritis Seasonal or Regional?

Two weeks before Chloe’s symptoms began, she and I moved from New York to Helena, Montana. At 7 p.m. on a Monday in May, she vomited blood, and I drove her to the first veterinarian listed in the phone book who could see us. I used a plastic bag to gather a sample some of the bloody mucus that she vomited to show to the vet.

Heidi Wampler, DVM, took one look at Chloe and the bag of mucus and said, “This looks familiar.” Chloe’s pulse was fast but her temperature was normal, and when Dr. Wampler removed the thermometer, a pool of bright red diarrhea came with it.

According to Dr. Wampler, dogs in the Helena Valley present these symptoms in spring and fall, when the ground is damp from snow melt or rain. She and her colleagues have tested affected dogs for the bacterial, viral, and parasitic infections listed above, and when dogs in multiple-pet households developed symptoms at the same time, as two dogs in a five-dog household did recently, they tested soil and water samples.

“But no matter what we test for,” says Dr. Wampler, “we can’t find a cause.”

When I spoke with Chloe’s previous veterinarian, Stacey Hershman, DVM, in Hastings-on-Hudson, New York, she said, “Hemorrhagic gastroenteritis is common in the spring in the Northeast, too. I have treated five dogs in the past two months. There is usually no known cause, and we give supportive care with subcutaneous or IV fluids and medications like metronidazole, which works well against anaerobic bacteria and parasites such as giardia, just in case they’re involved.”

Hemorrhagic Gastroenteritis in Dogs
Photo by Rick Steele

In the winters of 2004, 2005, and 2006, outbreaks of mild to moderately severe bloody diarrhea in dogs were reported to the Los Angeles County (California) Veterinary Public Health office. Because so many cases occurred near each other within a short time, researchers suspected that a contagious infection or food contamination caused the illness. However, extensive diagnostic tests conducted during each outbreak failed to reveal a connection.

In January 2009, the L.A. County Veterinary Public Health department reported a much higher than normal incidence of canine hemorrhagic gastroenteritis in the San Fernando Valley. They began collecting information about the diet and lifestyle of affected animals as well as the results of their physical exams, laboratory tests, and treatment protocols.

The department’s report explained, “If parvovirus is considered a possibility, a rapid in-clinic test on feces may be done first to make sure that is not the problem. Fecal tests for parasites are often performed. Blood tests often show that the dog has a very high red blood cell count and low protein levels as protein and fluid are lost into the gut. Sometimes additional tests such as fecal cultures are done, or radiographs of the abdomen are taken to check whether the dog has swallowed any unusual objects.”

Between January 1 and February 12, 2009, veterinarians at 13 Los Angeles County clinics reported 99 cases of bloody or watery diarrhea in dogs. Most of the patients (82) also had vomiting. Half recovered within five days and half took longer to recover or had a waxing and waning disease course. At least 29 cases required intravenous fluid treatment, while others required less intensive care. Most cases were treated with antibiotics and anti-nausea or anti-vomiting drugs.

No evidence links this disease outbreak to January’s recall of peanut butter products contaminated with Salmonella. Of the 12 Los Angeles County dogs with HGE who were checked for Salmonella, all tested negative. Tests for several other infectious agents were also performed but none were conclusive. There is no evidence that any food contamination played a role, because the affected dogs ate a wide variety of foods.

In almost 90 percent of cases reported, no other pet in the house had the same illness. HGE does not appear to spread easily from dog to dog, and it does not appear to spread from dogs to people. Whether HGE is a regional or seasonal illness remains speculative, but there does seem to be a connection in at least some parts of the country between HGE and certain times of the year.

In general, HGE strikes anywhere at any time. In most parts of the United States, it is a random rather than seasonal disorder. And it’s rare. If you’ve never heard of hemorrhagic gastroenteritis, you’re not alone. Even at its peak, the Los Angeles County outbreak affected less than a fraction of one percent of the county’s 1.9 million canines. But if your dog is one of its victims, HGE is an enormous problem.

Canine HGE Patients

Janet Tobiassen Crosby, DVM, has treated only one dog for HGE, and that was during her first year of veterinary practice. However, dozens of dog lovers across the country have described their pets’ bouts with HGE at her Veterinary Medicine Blog and online forums.

The patients’ breeds include Jack Russell Terrier, Beagle, Pembroke Welsh Corgi, Labrador Retriever, Pit Bull, Toy Fox Terrier, Miniature Dachshund, Golden Retriever, English Bulldog, Miniature Poodle, Miniature American Eskimo, Yorkshire Terrier, English Springer Spaniel, Maltese, Miniature Schnauzer, Bichon Frise, Shih Tzu, Chihuahua, Silken Windhound, and several mixed breeds.

Their stories illustrate the frustration, confusion, fear, and loss that HGE produces, for many of these dogs were desperately ill and some of them died. If the reports share a common message, it’s a plea for fast action.

“Time is of the essence,” agrees Dr. Crosby. “Because there are so many possible causes of vomiting or diarrhea, the best thing you can do is call your veterinarian immediately. HGE has a high survival rate when patients receive aggressive support therapy, and a pet that has observant caretakers (the situation just happened and they responded right away) has a much better chance than pets that have been sick for days. It also helps if the dog is in good health to begin with and at a good weight. Age can be a factor, too, with young to middle-aged dogs bouncing back faster. Like other illnesses, HGE is hardest on pets that are in poor shape to begin with.”

One HGE survivor whose story appears on Dr. Crosby’s forum is Helios (Ch. Talisman’s Light of Helios SRC IC), a Silken Windhound with racing and coursing titles who lives in Walnut Creek, California, with Joyce Chin. In May 2008, when he was one and a half years old, Helios became lethargic and vomited bloody foam.

“He wasn’t interested that morning in playing with the pups,” says Chin, “and he’s always playing with the pups. Since he’s always so happy and on the go, it was a dramatic change. He developed bloody diarrhea and was in the vet clinic on IV fluids and IV antibiotics for almost a week. He’s better now and has regained the weight he lost, but he really could have died. I’m so glad we were around to catch it. It would have been very hard to lose him, he’s such a happy part of the family here. When he was in the hospital, all the hounds were looking for him.”

Hospital stays can be expensive. Just ask Heidi Hansen, who lives in San Anselmo, California, with her eight-year-old, 100-pound yellow Lab, Herbie.

“Herbie’s HGE symptoms started at about 5 a.m. on a Sunday last April,” she says, “and by 9 a.m. he was in the hospital. He stayed there for three days and needed albumin transfusions. The total HGE treatment cost $5,620.”

Fortunately, Herbie survived his ordeal. “He’s better now,” says Hansen, “but he’s slower than before. This took a lot out of him. He had blood loss once before, so he has had a tough time.”

What Causes HGE?

So far, the cause of hemorrhagic gastroenteritis has eluded everyone, but the search goes on.

Enterotoxigenic Clostridium perfringens is the most commonly suspected agent in HGE cases because specific strains of Clostridium have been associated with hemorrhagic gastroenteritis in both dogs and cats. This common inhabitant of soil, air, dust, and manure is found in the water of lakes, streams, and rivers, and it is a contaminant in many types of commercially prepared foods.

Toxins associated with Clostridium bind to the intestinal epithelial cells of infected animals, increasing membrane permeability. However, since Clostridium in dogs is a normal inhabitant of the intestinal tract, no one knows whether it’s involved. Some veterinarians suspect that allergies may play a role, but no one has been able to find a specific allergen that has caused HGE in any patient.

Is diet a factor? Some veterinarians and Internet resources blame raw food, home-prepared diets, and “people food” for HGE, but the evidence doesn’t support those claims, either. Most HGE patients have eaten commercial pet food all their lives. This doesn’t mean that diet isn’t a factor, but it’s one that hasn’t been proven. “One common contributing factor,” says Dr. Crosby, “may be stress or hyperactivity. I wonder if this might help explain why smaller dogs are over-represented.”

The stress theory makes sense to me. For a month before we moved, Chloe lived with packing boxes and confusion. Her morning routine was interrupted when I tripped on a log while hiking and broke my right wrist. Thanks to friends, the packing got done, but I wasn’t able to drive, take Chloe for hikes, or prepare her usual dinners. We switched to a dehydrated food for convenience, and she did well on it as she has in the past while traveling or staying with friends.

After the moving van departed, my fiancé, Stephen, drove us 2,300 miles with Chloe and Pumpkin (a red tabby cat) on my car’s back seat. Waiting for us in Helena was our new roommate, a Cairn Terrier. Seamus is a sweet dog but he guards food and toys. While Chloe gets along with everyone, settling into her new home made May a stressful month.

And while HGE doesn’t seem related to pathogens, I can’t help but notice a coincidence of timing. For most of her life, Chloe has consumed one or two tablespoons of coconut oil every day, a supplement whose medium-chain fatty acids help destroy viruses, harmful bacteria, parasites, yeast, and fungi. She also received probiotics, which are the body’s first line of defense against many agents of infection, along with supplements that improve digestion and the assimilation of nutrients. But during and immediately after our move, I forgot or was at best inconsistent. When Chloe’s immune system most needed a boost, it wasn’t getting one.

Because a small number of dogs develop HGE more than once, one of my goals is to protect Chloe from future episodes. Even though the HGE experts say there is no way to do this, anything that strengthens her immune system sounds like a good idea! Stress relief is another strategy we’ll employ to keep her healthy. The passage of time and a comfortable daily routine are already helping to reduce Chloe’s stress.

Hemorrhagic Gastroenteritis Home Treatment for Dogs

Not all HGE patients are hospitalized and not all of them need IV or subcutaneous fluids. Dr. Wampler sent Chloe home with medication and instructions to call during the night if she continued to vomit or if her symptoms grew worse. In her favor, Chloe was five years old, athletic, and otherwise healthy.

The directions on how to treat HGE at home were relatively simple. Dr. Wampler warned us that Chloe would probably have diarrhea without realizing it and that we might want to confine her to keep things tidy. I put layers of towels in Chloe’s crate and changed them twice during the night when they became soaked. Owners who describe how they discovered their dogs in what looked like a slaughterhouse or excecution scene aren’t exaggerating. HGE can be a huge and malodorous mess.

That night we gave Chloe small amounts of water but no food. According to Small Animal Clinical Nutrition, a veterinary textbook edited by Michael S. Hand, et al, the best foods for patients with acute vomiting and diarrhea are those that do not produce “excess dietary acid load.” Foods that normally produce alkaline urine are less likely to be associated with acidosis than foods that produce acid urine. Grains are alkalizing foods, while meat is acidifying. As a result, according to this theory, foods that are high in grain may be more comfortable than meat-based diets for dogs with gastrointestinal distress.

Another theory is that high-fiber foods, such as canned foods prescribed for dogs with diabetes, may be helpful during the acute phase of HGE. Dr. Wampler give us four cans of a high-fiber prescription food to help Chloe make a comfortable transition back to solid food.

Her appetite came back the next morning but she vomited the small amount she swallowed and lost interest in food for the rest of the day. The towels in her crate didn’t need to be changed, but she released alarmingly red diarrhea in the backyard. The one encouraging sign was her thirst, for she drank increasingly large amounts of water that stayed down.

By Wednesday, 48 hours after her first symptoms, Chloe’s appetite was back and she was on the mend. By Friday, she was her tail-wagging self again, producing normal bowel movements and ready for hiking. She was delighted to resume her regular diet and has been thriving ever since.

Keeping HGE in Perspective

Hemorrhagic gastroenteritis is a serious illness, but most dogs will never develop its symptoms. Still, because it progresses so quickly and is potentially dangerous, being able to recognize those symptoms and act on them can prevent another dog from HGE death. If your dog – or any dog – is bleeding from both ends, don’t wait. Get immediate help. With rapid treatment the story should, like Chloe’s, have a happy ending.

CJ Puotinen is a freelance writer and a longtime contributor to WDJ. She is also author of many books on holistic health, including Natural Remedies for Dogs and Cats. She recently moved to Helena, Montana from New York.

15 COMMENTS

  1. I have noticed you don’t monetize whole-dog-journal.com, don’t waste your traffic,
    you can earn extra bucks every month with new monetization method.
    This is the best adsense alternative for any type of
    website (they approve all websites), for more info simply search in gooogle:
    murgrabia’s tools

  2. Hello, my dog is recovering from HGE, he’s 13 years old and a mixed of labrador and cocker, he’s the most healthy dog you can imagine. But yesterday morning he wasn’t feeling himself, I can tell, he vomited once and after four hours it came the blood. We were lucky my sister was at home, he also had bloody diarrhea and after that, he went straight to the vet. He spent just a few hours there with an IV and lots of fluids, now he’s eating a sensitivity canned meat and I can tell he has recovered his appetite. It was so scary but now he’s fine, still recovering but fine.

  3. Sparky had HGE and it took months and many, many tests and $4000 and the loss of 6 pounds. Two stays in the Vet School Hospital. He finally started pooping straight red blood clots. They finally put him on Metronidazole and prednisone. Now he has recovered. They all had been treating him for an ulcer.

  4. My little Irish terrier developed HGE at the age of nine months. Since weaning, she was on Stella and Chewy meals, probiotics, colostrum, Fresh vegetables and home-cooked treats. Suddenly one day she vomited a pool of blood and collapsed onto her side. The vet was so sure I had let her eat something that didn’t show up on x-rays but I knew this was not so. Anyway, A few weeks later the same thing happened again. The vet each time placed her on sucralfate, metronidazole, and IV fluids. A month later we made the move from El Paso Texas to Northern Virginia. It was spring. Within days, the little dog started pooping what looks like raspberry jam and vomiting right red blood. Pools of it from both ends. A couple of weeks later the same thing happened. It got to be more frequent until it finally happened the day after she was released from the hospital. So Over several months time she had eight episodes and the last few were life-threatening. She required dexamethasone injections and hospital stays of 1 to 3 days. finally scopes were done at both ends. The walls of her small intestine were bruised and raw. The pools of blood she had been pooping originated in her small intestine, made its way out the large intestine, (which showed no inflammation) and exited her rectum. That’s how much she was bleeding! The sonogram from earlier episodes showed the large intestine inflamed, along with one kidney and part of the liver and part of the pancreas. And of course the spleen and lymph nodes. We would never have known that her problem was an autoimmune disease had we not had further testing done. In repeated cases, what we believe to be HGE could actually be autoimmune related. My little girl is now almost 7 years old, is still taking a low dose of prednisone, and has only very mild episodes a couple of times a year. in order to reduce the prednisone dose, I began giving her a blend of medicine on mushrooms which balance the immune system, and a tablet of blended Chinese herbs to cool the body. I am very careful with her diet, giving her a combination of raw and home-cooked food, and in addition to probiotics she receives a food-based vitamin blend, glandular organ powder, coconut oil, sea vegetable powder, Hydrolyzed collagen, and sometimes missing Link. She receives a good healthy variety of foods this way, and good nutrition. If you know anyone who’s dog has repeated HGE episodes, please ask them to consider that it could be auto immune related.

  5. 14 years ago we rescued a dog with acute and chronic HGE symptoms. My first vet spent hundreds with no conclusive diagnosis and no treatment advice. I changed vets. When I told my next vet I thought there were emotional triggers attached he basically said that wasn’t possible and I was nuts. I spent the next few years carefully observing her symptoms and yes, there definitely were emotional triggers, like when a foster puppy that she had closely bonded to was adopted, and when I went to a training seminar for the weekend even though my husband and the other dogs were home with her the whole time. I also discovered through trial and error with processed foods and homemade diets that she’s allergic to grains. Over time, with homeopathy and sitting with her on my lap (she’s a big pit mix) and petting her, talking softly and rubbing her tummy that we could back off the symptoms. She even learned to put her front paws on my stomach in the middle of the night and stare into my face to wake me up to tell me she didn’t feel well. So we got up, sat on the bathroom floor, and backed it off until she could get back to sleep. The incidents became less frequent and her last flare up was over 5 years ago. Now she is symptom-free. Any vet-prescribed products, antibiotics and over the counter human meds never once worked. But she may be unique and I have never been given a clear diagnosis from any of our vets.

    • Cheryl, I just want to acknowledge what an amazing and caring person you are and that your girl came to you for a reason. In this case anyway, it’s clear that love really is the best medicine! My experience with pit bulls and pit mixes is that they can be very emotionally sensitive dogs and G.I. upset is not uncommon in our household full of regulars and rescues when someone gets adopted out or the suitcases come out of the garage. I have been giving massages almost nightly to my pitties for the past five years and it has noticeably reduced unwanted health and behavioral episodes in my pack. They patiently wait and even initiate soothing activities among themselves like grooming, chewing on a bone, or sharing a toy, until it’s their turn to get a massage. It has also cut down on training times as they seem to be able to relax and listen better, and they retain more information. Let’s hear it for the power of a healthy diet, homeopathy, and a good, old-fashioned belly rub!

  6. HGE is terrifying!!! Have had dogs all my life, but thankfully none with HGE…Pancreatitis yes, but not HGE. Pancreatitis IS life threatening, and Dx was missed by 2 veterinarians. Thankfully 3rd one knew immediately. Mny thx to WDJ and all of u who share your experiences on this website so others have information to recognize specific illnesses & respond appropriately!

  7. Blame GMOs. It is doing it to humans too. A study was done on pigs where one set of pigs were fed a diet of gmo grain and the other regular grain. On slaughtering the intestines of the gmo grain fed pigs were inflamed and bleeding. The pigs fed normal grain (didn’t say whether treated with pesticides or not) intestines looked healthy and normal. Gastroenterologists say they are seeing the same thing in their patients since the introduction of GMOs into the human diet. Studies have found that GMOs irreversibly change the digestive track. This is not hypothesis. This info is based on actual studies. Search it. Plenty of powerful people know the dangers of GMOs yet allow Monsanto to experiment on humans and animals. Monsanto is one of the biggest lobbyist groups in Washington. They have politicians of both parties in their pocket. Nothing we can do to get this poison out of the diet of humans and animals. Pandora’s box has been opened.

  8. My little girl Katie suffered from acute haemorrhagic colitis in August 2015, at age 9, and was successfully treated in hospital with IV fluids and antibiotics. I do recall her having a completely bloody diarrhea at the ER; I checked the notes and realized she had also been vomiting. I don’t know how close she came to dying, but it was likely close. Thankfully she responded to treatment and was home after 2 1/2 days. It was the only time in her life that she was truly ill, until she was diagnosed w transitional cell carcinoma in May 2018, and from which she died 13 mos later after successful chemotherapy to prolong her quality of life.

  9. My little girl Katie suffered from acute haemorrhagic colitis (essentially HGE) in 2015, at age 9, and was successfully treated in hospital with IV fluids and antibiotics. I recall her pooping pure blood at the ER; I checked the notes and realized she had also been vomiting, although I don’t recall that. She likely came to dying then, but thankfully she responded to treatment and was home after 2 1/2 days of hospitalization. It was the only time in her life that she was truly ill, until she was diagnosed w transitional cell carcinoma in May 2018, from which she died just 3 mos ago.

  10. I’m in Australia and have recently had the misfortune of having my beautiful 1yo bichon frise X boy Oscar come down with HGE and it was absolutely terrifying to see my energetic pup suddenly wake up one morning vomiting and within an hour had a lot of blood in his vomit and his chin was soaked from him drooling nonstop. Luckily it came on on a weekday morning, so I only had to wait an hour till our vet opened, and at first she thought it may be an obstruction but wasn’t sure, so she gave him some IV fluids, anti nausea and pain meds, as his belly was really sore, said to keep an eye on him to see if he improved and if not to bring him back that afternoon. But the plans changed when, as I was paying her bill, I heard Oscar whimper and looked down to a LOT of dark blood that he’d just released out his backside. I honestly thought I was going to lose him which was absolutely awful. To my surprise tho, when the vet saw my face and came round the counter to look at what had just happened, she said “well this changes things” and proceeded to say he had HGE and went and got some antibiotics for him. Thankfully he responded really well to the antibiotics and is now back to his happy and healthy self

LEAVE A REPLY

Please enter your comment!
Please enter your name here