This is from the vet's handbook that you might want to bookmark. I had never heard of this so I looked it up. You also might want to go to the
The Dog Food Project - How does your Dog Food Brand compare? and ask for an individual session to help you with your little one.
Merck Veterinary Manual
Treatment:
Treatment of malabsorption involves dietary therapy, management of complications, and treatment of the primary cause (if identified). Management of EPI in dogs is relatively straightforward (see Exocrine Pancreatic Insufficiency). It should include feeding a low-fiber diet that contains moderate levels of fat or highly digestible fat, very digestible carbohydrate, and high-quality protein. Specific treatment involves lifelong supplementation of each meal with pancreatic extract. Powdered extracts (2 tsp/20 kg body wt) are preferable to tablets, capsules, and enteric-coated preparations. Fresh or frozen pancreas can be used as an alternative (100 g/meal for an adult German Shepherd). If response to pancreatic replacement therapy is poor, SIBO may be suspected, and the animal treated with oral antibiotics for ≥1 mo (see below). H2-receptor blockers, such as cimetidine at 5-10 mg/kg or ranitidine at 2 mg/kg, may be given 20 min before a meal to inhibit acid secretion and to minimize degradation of enzymes in the pancreatic extract, but their efficacy is questionable. Oral multivitamin supplementation should be considered as supportive therapy, but cobalamin (500 mg/mo) should be given parenterally. Dietary requirements of cats with EPI can generally be met by conventional commercial diets, but pancreatic replacement therapy is still needed, as well as parenteral cobalamin supplementation in cats with low serum cobalamin levels.
Effective treatment of small-intestinal disease depends on the nature of the disorder, but therapy may be empirical when a specific diagnosis cannot be made. In dogs with SIBO, a low-fat diet may help by minimizing secretory diarrhea due to bacterial metabolism of fatty acids and bile salts. Oral broad-spectrum antibiotic therapy with oxytetracycline (10-20 mg/kg, TID for 28 days) has been successful. Metronidazole (10-20 mg/kg, BID) and tylosin (20 mg/kg, TID) are effective alternatives. Repeated or longterm treatment may be necessary in dogs with idiopathic SIBO. Vitamin supplementation may be helpful, particularly cobalamin by injection (eg, 500 mg/mo for 6 mo) for dogs with cobalamin deficiency. Secondary SIBO usually resolves with appropriate management of the underlying disease, but idiopathic SIBO can be difficult to control, especially in German Shepherds, which are predisposed to developing the condition.
Dietary modification is an important aspect of the management of small intestinal disease in both dogs and cats. Diets generally contain moderate levels of limited protein sources and highly digestible carbohydrates (to reduce protein antigenicity, reduce osmolar effects, and improve nutrient availability), and low to moderate levels of fat (to reduce steatorrhea and decrease secretogogues). In addition, they are lactose and gluten free, may be fiber-restricted, and may contain increased levels of antioxidants, prebiotics (fructo-oligosaccharides), or omega-3 fatty acids. These additives are thought to modulate the inflammatory response and increase the health of the bacterial gut flora. Treatment with an exclusion diet consisting of a single novel protein source should be used as trial therapy when dietary sensitivity is suspected. In addition, intestinal inflammation is sometimes a manifestation of dietary sensitivity, and an exclusion food trial is also indicated in mild cases of inflammatory bowel disease. Boiled white rice and potato are suitable carbohydrate sources, while lamb or chicken are often used as a protein source, depending on the dietary history. Cottage cheese, horsemeat, rabbit, venison, or fish may be acceptable alternatives. Commercial exclusion diets may be generally less suitable than home-cooked diets for diagnosing food hypersensitivity in dogs, although not necessarily in cats; however, they are preferred for maintenance to reduce dietary imbalances. Protein hydrolysate diets may be most effective in eliminating dietary sensitivity. The exclusion diet generally does not need to be fed for >3 wk. Oral prednisolone (0.5 mg/kg, BID for 2-4 wk, followed by a reducing dose) may be useful in some animals with dietary sensitivity if the initial response to the exclusion diet is disappointing.
Treatment of idiopathic intestinal disease in dogs should initially attempt to eliminate or control an underlying antigenic stimulus that may be playing a primary or secondary role in the damage. This is particularly important if there is evidence of intestinal inflammation. Treatment should first involve the use of an exclusion or protein hydrolysate diet for suspected dietary sensitivity as described above. The diet should comprise digestible carbohydrate, (preferably rice, which is most digestible) and high-quality protein. Restriction of fat content may also be valuable and can minimize the secretory diarrhea that is a consequence of bacterial metabolism of fatty acids and bile salts. Oral prednisolone (0.5 mg/kg, BID for 1 mo, followed by a reducing dose) is indicated in cases of intestinal disease with an obvious inflammatory component, such as lymphocytic-plasmacytic enteritis and eosinophilic enteritis. Higher dosages (1-2 mg/kg, BID) may be indicated in more severe cases. In rare severe cases, it may be necessary to use azathioprine (2-2.5 mg/kg, SID).
Cats with inflammatory bowel disease have a higher incidence of dietary sensitivity than dogs, emphasizing the importance of a dietary trial with an exclusion diet. If this fails, treatment may be needed with oral prednisolone at a dosage of 1-2 mg/kg, daily for 2-4 wk, gradually decreasing until clinical signs resolve. Severe cases often require higher dosages and longterm therapy. Cats that do not respond may be given adjunct metronidazole (10 mg/kg, BID). The beneficial effect of metronidazole might be due to an inhibition of cell-mediated immune responses as well as to its anaerobic antibacterial activity. If remission is not maintained on this combination, other immunosuppressive drugs such as chlorambucil or azathioprine can be attempted, although the latter has many side effects in cats.
For treatment of cases of idiopathic villous atrophy, prednisolone, antibiotics, and an exclusion diet can be considered. In lymphangiectasia, a severely fat-restricted, calorie-dense, highly digestible diet is essential. Supplementation with fat-soluble vitamins is advised, and additional medium-chain triglycerides have been recommended as an easily absorbable fat source that bypasses the lymphatics, although their efficacy has recently been questioned. Prednisone therapy may be beneficial for its anti-inflammatory and immunosuppressive effects, especially if there are associated lymphangitis and lipogranulomas. The response to treatment is variable; clinical signs may sometimes abate for months or even years, but the longterm prognosis is grave. Giardiasis can be treated with metronidazole or fenbendazole, and histoplasmosis with itraconazole (cats) or ketoconazole (dogs), with or without amphotericin B. In cases of lymphosarcoma, treatment involves an appropriate chemotherapy regimen.