GI STASIS ARTICLE I WROTE!

[tanlover14]

I thought everyone may be interested in an article I did on the research of GI stasis complete with medical research.  

Hope this helps you all who do not have these resources available!   I found a lot of the information interesting after doing the research as more and more research and studies are becoming available for rabbits! 

Note: While I have spent extensive time researching GI Stasis, I know it is still a topic that can be very controversial in the rabbit community. Opinions differ greatly. I am not a veterinarian, and this is not medical advice to be used in place of professional medical advice. This post is, instead, to serve as a roundup of the latest and most up-to-date research concerning GI Stasis in rabbits.

If you own, or have ever owned, a rabbit….you know the #1 worry of any rabbit parent is Gastrointestinal Stasis.  GI Stasis is commonly known in the bunny world as “The Silent Killer.”  It is what every bunny parent worries about and dreads.

Gastrointestinal stasis is when the motility of the gastrointestinal tract of a rabbit slows down, which begins to affect the gut flora of the rabbit.  GI stasis is not the CAUSE of illness but rather is the secondary effect of another underlying problem.  GI stasis, however, can become extremely dangerous very quickly and needs to be treated immediately.

Over my years as a rabbit owner, I have seen many people (vets included) fight over and hash out just what the proper treatment protocol is for GI stasis.  I have done a lot of previous research myself on this topic, with my vet’s help, and I have constructed some thoughts and ideas from previous studies and research done by exotic vets. This blog post will examine research from veterinary journals to discuss the most up-to-date research findings.

The Most Important Things You MUST Do: Fluid Therapy and Pain Management

Virtually all of the research I’ve read stresses the importance of fluids and pain management as the MAIN protocol for treating GI stasis and other gastrointestinal problems. For me, this means that as soon as I notice one of my rabbits isn’t eating properly — even if they seem just a little off — I begin administering fluids and a dose of Metacam.

Subcutaneous Fluids. Subcutaneous fluids, known by many as simply “Sub-Q’s”, involves giving your bun fluids under his or her skin. Your rabbit-savvy vet should be able to administer Sub-Q’s at the office, and if you have a lot of incidents of GI Stasis with your rabbits (or just a lot of rabbits, like me), your vet might be willing to provide you with the equipment to do it at home.

Pain Management. Metacam is a nonsteroidal anti-inflammatory drug (NSAID) for pets. It is prescribed in a liquid suspension to make it easy to give to your rabbit. It is proven to be very safe and effective in rabbits. Reducing the pain of GI Stasis is very important to getting your rabbit to start eating normally again.

Under the guidance of your own rabbit-savvy vet, you can learn how to administer subcutaneous fluids and Metacam so you can treat GI stasis as soon as the symptoms show.

Force Feeding: A Tough Decision

I won’t get too deep into force feeding here — though it can be very helpful, it can also be dangerous. Force feeding should only be done under the instruction and supervision of a rabbit-savvy veterinarian. With force feeding,  Critical Careis commonly used to force feed, and must be blended with water or other rabbit-safe ingredients. I often mix in pumpkin and some sort of rabbit-safe fruit juice to entice them to eat the mix!

Pineapple and Papaya: No Medical Basis

I see a lot of people advocate for pineapple or papaya as an alternative to helping GI stasis, particularly to help dissolve hair. I think it is important to know that there is no medical basis for pineapple juice or similar treatment:

Pineapple juice or proteolytic enzymes have been recommended as remedies for hairballs because they are reputed to dissolve hair.  Miller (1983) conducted an experiment in which they incubated rabbit hair for up to 3 days in papaya, proteolytic enzymes or pineapple juice.  The pH of the solution was adjusted to 2 with hydrochloric acid to mimic conditions in the rabbit stomach.  They found no difference between the treated and untreated control samples and the authors concluded that none of the enzyme treatments exhibited any ability to dissolve hair.

Varga, M. (2014). Textbook of Rabbit Medicine (Second ed., p. 317). Ossining, NY: Butterworth Heinemann Elsevier.

Another prevalent theory is that pineapple juice or papaya can help moisten hair or pellets, helping it move through the tract. However, Sub-Q’s serve this same purpose, but they allow you to avoid the juice’s sugar, which can have an adverse effect on the rabbit GI as well.

In short: there is little to no veterinary research supporting pineapple or papaya as a treatment for GI stasis.

Motility and Anti-Gas Drugs

Motility and anti-gas drugs are typically used to help treat GI stasis.  Lets look at each one and the research I have found regarding them (note I use the name below that they are most commonly known as).

Simethicone.  Simethicone is probably one of the most commonly used drugs to help aide in the treatment of GI stasis.  Simethicone is an anti-foaming agent that is typically used to treat bloat, pain, and discomfort caused by the accumulation of small gas bubbles in the gastrointestinal system. However, there is no evidence that simethicone works for GI stasis:

[Simethicone works] by decreasing the surface tension of gas bubbles, causing the gas bubbles to break or merge with other bubbles from the GI tract that can be more easily passed.

…However, the mechanism of action should be taken in consideration. In most cases of GI stasis, excessive gas production is present in large amounts and not necessarily in the form of small, frothy bubbles. As simethicone works to break small bubbles or merge smaller bubbles into a larger bubble to expel from the body, it may not be as effective in cases of rabbit GI stasis.

…Other studies have had similar findings. One showed both simethicone and the placebo having improvements in symptoms, with simethicone being no more effective than the placebo.

Watson, M. (2014). Therapeutic Review: Simethicone. Journal of Exotic Pet Medicine, 23(4), 415-417. Retrieved March 7, 2015, from http://www.exoticpetmedicine.com/ar…4/fulltext

Cisapride.  Cisapride is commonly used as a gastrointestinal agent that is used to enhance the motility in the upper GI tract of the rabbit. The use of Cisapride in treatment of GI stasis remains very controversial between veterinarians due to the potential cardiac side effects that have been observed.

It was widely used for years until numerous reports linked its use to prolonged QT intervals and other serious cardiac arrhythmias (torsades de pointes) in human patients, leading to its withdrawal from the market in July 2000. Although this rare but serious side effect has been replicated in vitro in rabbit hearts and canine cardiac Purkinje fibers, it has not yet been reported in vivo in dogs, cats, or rabbits.

…The current standard of care for exotic patients with GI disease, namely in rabbits presenting with GI stasis, includes cisapride in the protocol.

…Cisapride may have a synergistic effect in rabbit when used in combination with a H2 receptor antagonists, leading to enhanced motility when both drugs are used in combination.

…Most studies discussed in this review had been published in the years before the withdrawal of cisapride from the market and were animal model studies used for human benefit. Currently, as there has been much anecdotal evidence of the successful use of cisapride in exotic animal patients, it may be beneficial to conduct additional research studies on its usefulness for the treatment of various GI conditions in exotic small mammals, birds, and reptiles.

Wangen, K. (2013). Therapeutic Review: Cisapride. Journal of Exotic Pet Medicine, 22(3), 301-304. Retrieved March 7, 2015, from http://www.exoticpetmedicine.com/ar…0/fulltext

In other words, the conclusion is that there has been limited research for cisapride in exotics. Cisapride is used for GI stasis, but the research is limited and/or inconclusive on its efficacy and safety.

Reglan.  Reglan is a medication that is commonly used to act as a muscle stimulant in the upper GI tract. However, there are very few reliable studies discussing the effects of Reglan in GI stasis:

Although metoclopramide has been reported as a prokinetic agent, no pharmacokinetic or pharmacodynamic data in rabbits are available to validate its use in this species.

Huynh, M., & Pignon, C. (2013). Gastrointestinal Disease in Exotic Small Mammals. Journal of Exotic Pet Medicine, 22(2), 118-131. Retrieved March 7, 2015, fromhttp://www.exoticpetmedicine.com/ar…8/fulltext

After discussing the use and effects of Reglan with my personal vet, I made the decision to only use Reglan as an appetite stimulate during GI stasis episodes. It has been noted in humans that long-term Reglan use can cause a condition known as Tardive Dyskinesia.

Key Takeaways: What You Need to Know for Treating GI Stasis

1. With your vet, construct a treatment plan from start to finish for the possibility of GI episodes.  This will make you prepared and able to begin treatment as soon as you notice symptoms rather than waiting until you can get your rabbit into your vet.

2. Fluid therapy and pain management are the NUMBER ONE fighters to GI stasis!  Know how to administer Sub-Q’s and always have pain meds (like Metacam) on hand!

3. Force feeding can be helpful, but don’t do it without consulting with your rabbit-savvy vet.

4. Many other methods of treatment have little to no research showing them as being both safe and effective treatments.

A reminder: this site is not to be used in place of veterinary care. This post is to help bunny parents get to know some of the different reasons there are mixed thoughts on what the proper protocol is for treating gastrointestinal stasis in rabbits.  Please only use this information to discuss a treatment plan with your exotic vet for the future care of any GI stasis episodes with your own buns!

[LBJ10]

Wow, very thorough! Would this be something we could post to the blog?

[Deleted User]

Good for you TL! I have this saved to my bookmarks – lets hope ‘I’ (Henry) never needs it……

Thank you!

[dewey]

Thanks for posting your article and the subQ video! My rabbit has had GI stasis several times now and it can be very frightening. Also, liked the subQ video. I subQ my rabbit a few times a week for chronic kidney disease, but I watched the video to see if I could pick-up some tips and I did!

[LongEaredLions]

I vote we pin this. What a helpful article, TL!

[Bam]

Great, Tanlover!!!

I wish Swedish vets would read this. It’s as if they believe metacam will turn the bunny into a junkie or sth. It’s certainly not standard protocol for GI stasis here. I had to beg and beg for some when my Yohio was sick (Gi stasis due to dental issues).

[Author]

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