Rethinking clinical response criteria in trials of chronic enteropathy in dogs: what change is truly meaningful?

Abstract

Rethinking response criteria of treatment of chronic enteropathy in dog is necessary, as clinical activity indices are widely used as primary endpoints despite substantial variability in how “response,” “remission,” and “relapse” are defined. Across recent studies, response thresholds range from modest relative reductions (eg, ≥25%) to stringent targets (eg, ≥75%), absolute score cut-offs, shifts between severity categories, or binary resolution of clinical signs. This methodological heterogeneity undermines comparability between trials and complicates evidence synthesis. An often-overlooked contributor to this issue is the intrinsic variability of the Canine Inflammatory Bowel Disease Activity Index and the Canine Chronic Enteropathy Clinical Activity Index, particularly their limited inter-observer reproducibility for total scores and several core items. When commonly used response thresholds overlap with expected measurement error, apparent clinical improvement might reflect scoring variability rather than true change in disease activity. We therefore propose a pragmatic framework for response classification anchored in the measurement properties of these instruments. For research endpoints, an absolute change of at least 4 points (Δ ≥ 4) is suggested as a conservative minimal detectable change to reduce misclassification of responders and non-responders. In dogs with low baseline scores driven by 1 or 2 isolated abnormalities, an item-centered approach (Δ item ≥2) might be more appropriate, particularly for variables such as stool consistency or defecation frequency. Finally, transparent reporting of scoring conditions, prioritization of evaluator consistency, and integration of complementary outcomes, including validated health-related quality-of-life measures and longitudinal symptom tracking, might help better capture clinically meaningful effects.

Introduction

Clinical monitoring remains a cornerstone of disease assessment in dogs with chronic enteropathies (CE) and cannot be fully replaced by biological, imaging, or histopathological variables. The Canine Inflammatory Bowel Disease Activity Index (CIBDAI) and the Canine Chronic Enteropathy Clinical Activity Index (CCECAI) were developed in 2003 and 2007, respectively, with the aim of providing standardized clinical assessments of disease activity in dogs with signs of chronic gastrointestinal disease, using weighted scores based on the frequency and severity of selected clinical variables.^1,2

The CIBDAI was constructed using 6 clinical variables selected based on expert opinion and was initially reported to correlate with laboratory and histological findings.¹ The CCECAI subsequently expanded this framework by incorporating additional variables commonly altered in CE, including serum albumin concentration, pruritus, and the presence of peripheral edema or ascites. In addition to providing a continuous numerical score, both indices allow classification of disease activity into predefined severity categories (eg, not clinically relevant, mild, moderate, or severe disease). The CCECAI was further shown to have high sensitivity and moderate specificity for predicting disease refractoriness-related euthanasia when exceeding a threshold of 12 points.²

Methodological heterogeneity has become a critical issue

Since their introduction, both indices have been widely used in clinical research and practice to characterize disease severity, explore associations with biological or histological markers, and evaluate treatment response. Over the past 2 decades, they have become near-universal clinical endpoints in trials investigating dietary, microbiota-targeted, or immunomodulatory interventions in dogs with chronic enteropathies. These scores were initially conceived within a relatively simple conceptual framework: clinical severity could be quantified numerically, categorized into predefined activity classes, and compared longitudinally to assess response to treatment. In early studies published within the first decade after the introduction of the CIBDAI, treatment response was commonly defined as either a marked reduction in clinical activity, often exceeding 75% from baseline, or achievement of a final score consistent with not clinically relevant disease (≤3).^3–6 Implicitly, such changes were assumed to reflect clinically meaningful improvement.

However, as the use of the CIBDAI and CCECAI has expanded, the criteria used to define “clinical response,” “partial response,” “remission,” or “relapse” have become increasingly heterogeneous. To explore this issue, we reviewed clinical trials published over the last 5 years (January 1, 2021 to December 22, 2025) involving dogs with chronic enteropathies, identified through the PubMed database using the keywords “dogs” and “enteropathy.” This search was intended to illustrate the diversity of response definitions rather than to constitute a systematic review. Among 52 studies that assessed clinical variables longitudinally, 28 (54%) explicitly defined response criteria in the Materials and Methods section. Across these studies, a striking heterogeneity was observed in the definition of clinical response. Criteria ranged from relative score reductions as low as 25% to thresholds exceeding 75%, absolute score cut-offs, shifts between predefined disease severity categories (eg, from “moderate” to “mild”), binary presence or absence of clinical signs, or even subjective clinician assessment (Table 1). In some studies, minimal absolute score changes were considered sufficient to classify dogs as responders, whereas others required near-complete resolution of clinical activity. Importantly, identical clinical tools were thus used to support markedly different interpretations of therapeutic efficacy, with response thresholds differing by several points or by more than 50% in relative change. This heterogeneity is therefore both methodological and interpretative, and is frequently compounded by a lack of explicit justification or reference to the measurement properties of the scoring systems themselves.

Table 1.

Overview of response criteria used in trials of chronic enteropathy in dogs.

Category of response criterion	Definition used	Publications using this criterion
Score percentage reduction (complete response/remission)	≥75% reduction in CIBDAI or CCECAI from baseline	7-13
Score percentage reduction (partial response)	Reduction in CIBDAI or CCECAI between > 25% and < 75%	7 ,  9,10,  12
Score percentage reduction (response)	≥25% decrease in CIBDAI or CCECAI	14-19
Final score ≤ 3 (clinical remission)	CIBDAI or CCECAI ≤ 3 at follow-up	8 ,  18,  20-26
Change in disease severity category	Improvement from severe/moderate to mild/insignificant	27 ,  28
Absolute score change (Δ score)	ΔCCECAI ≥2 or ≥ 3 used as response or relapse threshold	16 ,  15,  17,  18
Resolution of clinical signs (binary outcome)	Presence vs absence of GI signs	29-32
Composite definitions	Combination of score change (>50% reduction or value ≤ 3) + owner impression or clinician judgment	21
Subjective assessment	Response assessed at discretion of clinician reviewing records	33
Biochemical + clinical combined remission	Resolution of clinical signs + normalization of albumin	23
Ancillary criteria	Fecal score, body weight, appetite used as secondary outcomes	13 ,  22
Relapse definitions based on score increase	Increase ≥2 points or ≥ 30% from previous visit	34 ,  17,  18

In this context, we focus the subsequent analysis on score-based definitions of response, rather than on binary clinical outcomes or subjective clinician assessments. While the presence or absence of clinical signs and global clinical judgment remain central to everyday practice, they are inherently limited for comparative research purposes as they lack standardization and reproducibility. In contrast, structured clinical scoring systems such as the CIBDAI and CCECAI were specifically developed to quantify disease activity, capture gradations of clinical severity, and enable longitudinal assessment of change. Their widespread adoption in the literature further supports their use as a common analytical framework, provided that their interpretation is methodologically sound.

Recently, the ACVIM-endorsed consensus statement on the diagnosis and treatment of CE in dogs acknowledged the importance of standardized clinical outcome assessment and continues to support classification of treatment response based on percentage changes in clinical activity scores (<25%, 25%-75%, and > 75% improvement).³⁵ This framework represents an important step toward harmonization and provides clinicians and researchers with a practical approach for categorizing treatment outcomes. The present discussion complements this approach by focusing specifically on the measurement properties of the CIBDAI and CCECAI and on whether the score changes used to define these response categories consistently exceed the intrinsic variability of the instruments.

Taken together, these observations raise a fundamental question: how should established clinical scoring systems such as the CIBDAI and CCECAI be applied and interpreted to ensure that observed score changes truly reflect clinically meaningful improvement in dogs affected by chronic enteropathies?

The absence of standardized response definitions when using these scores has important implications. It hampers meaningful comparison between studies, complicates evidence synthesis in systematic reviews and meta-analyses, and limits their usefulness for guiding clinical decision-making. Moreover, when combined with the intrinsic variability of these scoring systems, such heterogeneity raises concerns regarding the clinical relevance of some reported treatment responses.

This perspective does not intend to prescribe a universal method that must be rigidly adhered to, but rather to provide a framework for reflection on the optimal use of CIBDAI and CCECAI in clinical trials involving dogs with CE and to stimulate collaborative discussion on such a critical topic.

A core issue: intrinsic variability of scoring systems

Beyond heterogeneity in response definitions, interpretation of CIBDAI- and CCECAI-based outcomes must also account for the intrinsic variability of these scoring systems. Response thresholds are frequently applied without consideration of the measurement properties of the scores themselves, including repeatability and reproducibility.

In a dedicated reproducibility study, intra-observer repeatability and inter-observer reproducibility of both the CIBDAI and CCECAI were evaluated using anonymized, highly detailed consultation records, assessed twice at a one-month interval.³⁶ Agreement was considered acceptable when the following 3 criteria were simultaneously met: a Lin’s concordance correlation coefficient >0.81, a Bland–Altman bias within ±1 unit, and limits of agreement within ±1 unit for individual variables and ±2 units for the composite CIBDAI and CCECAI scores. Under these conditions, intra-observer repeatability was generally good, indicating that individual clinicians tended to score clinical activity consistently when reassessing the same case. In contrast, inter-observer reproducibility was limited for both composite scores and several key individual items, including fecal consistency, defecation frequency, and weight loss. The introduction of a standardized scoring guide, developed based on variability observed between 2 scorers, did not improve inter-observer reproducibility when tested among 4 additional scorers. Limits of agreement for total scores frequently exceeded ±3 points between observers, whereas they were restricted to approximately ±1.5-2 points for repeated assessments by the same observer. Limits of agreement for individual items frequently fell under 1-1.5 points between observers and for repeated assessments by the same observer.

This level of variability has direct implications for the interpretation of treatment response in clinical trials. For example, a dog with a baseline CIBDAI score of 6 (moderate disease activity) would be classified as a responder in several published studies after a 25% score reduction. In absolute terms, this corresponds to a decrease of approximately 1.5 points, resulting in a post-treatment score of 4. Such a change lies entirely within the documented range of inter- and intra-observer variability. In this context, apparent “clinical improvement” might reflect measurement noise rather than a true change in disease activity. Even larger relative thresholds, such as a 50% reduction (ie, a 3-point decrease), might still overlap with observed limits of agreement, particularly when multiple observers are involved.

These examples highlight a fundamental conceptual issue: when response thresholds overlap with the intrinsic variability of the measurement tool, their clinical meaning becomes questionable. Statistical significance alone cannot ensure clinical relevance if observed changes do not clearly exceed expected measurement error.

Importantly, reproducibility declined with increasing disease severity in our study. Agreement between observers was more frequently achieved in animals with mild clinical signs than in those with moderate-to-severe disease. This severity-dependent variability further challenges the validity of using small absolute or relative score changes as universal indicators of meaningful clinical response.

In most published clinical trials, the identity and number of individuals responsible for scoring the CIBDAI or CCECAI are not specified, making it likely that multiple clinicians contributed to score assessments over time. Given the limited inter-observer reproducibility observed, such practices might obscure true treatment effects. This concern is further amplified in studies where owners are partially or fully involved in score assessment, as these indices were not designed as owner-reported outcome measures and non-veterinarian assessments might introduce additional variability.

The reproducibility data discussed here were obtained using anonymized and standardized consultation records, a design specifically chosen to isolate observer-related variability in score interpretation. This approach deliberately minimized contextual influences inherent to real-time clinical encounters, such as clinician-owner interaction, prior knowledge of the dog, or expectation bias, which are known to affect clinical judgment. As a result, this design likely underestimates the variability encountered in routine clinical practice, rather than exaggerating it.

Considerations for improving the use of scoring systems

Together, these observations suggest that current response definitions might overestimate treatment efficacy when they rely on score changes that fall within measurement error. Accordingly, we propose 2 complementary steps: (1) defining a minimal detectable threshold and (2) standardizing scoring conditions and reporting.

Defining a minimal detectable threshold

Interpretation of clinical response in CE trials could benefit from relying on an absolute change that clearly exceeds intrinsic measurement error. When CIBDAI and CCECAI are used as research endpoints, we suggest that an absolute change of at least 3 points (Δ ≥ 3) when assessments are performed by a single scorer, or 4 points (Δ ≥ 4) when multiple scorers are involved, could be considered the minimal threshold required to define a true change in clinical disease activity, whether improvement or worsening. This recommendation is supported by several considerations. First, these thresholds consistently exceed observed limits of agreement, calculated to represent the limits within which more than 95% of disagreement values would fall, aligning with the general principle that a change must exceed measurement error to be meaningfully interpreted. Second, the use of an absolute threshold would be simple to apply, easily interpretable, and would facilitate comparison across studies.

We would also suggest taking baseline disease severity into account. Application of a Δ ≥ 3 or 4 threshold would imply that dogs with baseline CIBDAI or CCECAI scores < 4 or 5 could not be included in trials using composite score–based response definitions. In dogs with low baseline scores (typically less than 3 or 4), total scores are often driven by one or 2 isolated items, most commonly stool consistency and defecation frequency. In such cases, clinically meaningful improvement, such as normalization of fecal consistency, could not mathematically reach a Δ ≥ 3 or 4 threshold despite representing a clear therapeutic benefit. In these situations, an item-centered approach might be more appropriate, focusing on changes in specific abnormal variables rather than on the total score. An absolute change of at least 2 points at the item level (Δ item ≥2) would be more likely to exceed measurement variability and might reasonably be considered indicative of a true clinical change. It is acknowledged that dogs with very low baseline scores composed exclusively of items scored as 1 might not meet these thresholds despite apparent clinical remission; however, such cases are expected to be infrequent and of limited influence on trial-level conclusions.

Taken together, we would recommend using a dual-level framework, such as Δ ≥ 3 (single scorer) or 4 (multiple scorers) for composite scores in moderate-to-severe disease and Δ item ≥2 for isolated abnormalities in low-score disease, to acknowledge the heterogeneous structure of the CIBDAI and CCECAI while preserving methodological rigor.

It is important to clarify that this recommendation does not imply that smaller score changes are clinically irrelevant at the individual dog level. Subtle clinical variations might indeed be meaningful in routine practice, particularly when interpreted longitudinally by the same clinician within a comprehensive clinical context. Therefore, the proposed absolute thresholds (Δ ≥ 3 or 4 points depending on the number of scorers) are not intended to define a minimal clinically important difference (MCID) in the strict sense.³⁷ Rather, they would represent a conservative estimate of the minimal detectable change that exceeds the intrinsic measurement error of the CIBDAI and CCECAI.³⁸ These thresholds would be anchored in measurement-error data, with Δ ≥ 3 primarily reflecting intra-observer repeatability and Δ ≥ 4 reflecting inter-observer reproducibility. While demonstrating that a change exceeds measurement error is a necessary prerequisite for clinical interpretability, it does not, by itself, establish dog-perceived importance. Anchor-based MCID determination, relying on external criteria such as global clinician assessment or owner-reported outcomes, represents a complementary but distinct methodological step that has yet to be formally established for these indices.³⁷ Until such data are available, use of measurement-error-informed thresholds could provide a pragmatic and methodologically defensible approach for response classification in research settings.

An important limitation of these recommendations is that they are currently based primarily on the reproducibility data generated in a single study.³⁶ Although these findings provide the first available estimates of measurement variability for the CIBDAI and CCECAI, independent studies performed in different populations, clinical settings, and observer groups will be necessary to confirm, refine, or challenge the proposed thresholds.

Standardizing scoring conditions and reporting

Beyond defining response thresholds, appropriate use of CIBDAI and CCECAI in clinical trials requires clear reporting of scoring conditions. Given the limited inter-observer reproducibility of these indices, we would highly recommend that studies explicitly state who performed clinical scoring and whether assessments were conducted by a single evaluator or multiple clinicians over time. Whenever feasible, longitudinal scoring should be performed by the same veterinarian, as evaluator consistency is a key determinant of score reliability.

The involvement of owners in scoring CIBDAI and CCECAI should be avoided. When use of a single evaluator is not feasible, standardized training, calibration procedures, and periodic double-scoring of a subset of cases might help mitigate inter-observer variability and improve interpretability of outcomes. The use of a structured and detailed standardized form for clinical data collection, particularly in settings where multiple clinicians are involved in case management, could also help reduce inter-observer variability and improve data consistency (example provided in Supplementary material 1).³⁶

Finally, whether a single scorer or multiple scorers are involved, we would encourage the community of canine gastroenterology researchers to use a standardized scoring guide. Such a tool did not fully resolve inter-observer variability in our preceding study, but different observers assessed the score before and after the introduction of the guide, precluding any clear conclusion on the presence or absence of benefit brought by its use.³⁶ Also, adopting a scoring guide might promote a more uniform and transparent approach to scoring assignments. We propose in Table 2 a more detailed scoring guide than we previously used.

Table 2.

Proposed standardized scoring guide for CIBDAI and CCECAI.

Criterion	Score	Interpretation	Scoring guidance
Attitude/activity	0	Normal	The score should reflect a deviation from the dog’s pre-disease status over the preceding 3 weeks. The alteration must be attributable to the gastrointestinal disease rather than a concurrent condition.
	1	Slightly decreased
	2	Moderately decreased
	3	Severely decreased
Appetite	0	Normal	This encompasses the quantity of food ingested and any changes in eating patterns, such as increased meal duration or frequency, or selectivity for specific ingredients or types of food over the preceding 3 weeks.
	1	Slightly decreased
	2	Moderately decreased
	3	Severely decreased
Vomiting	0	Normal	Scoring should be based on the mean frequency over the preceding 3 weeks. Dogs vomiting less than once per week should be scored as 0, unless vomiting is the primary clinical concern, in which case a score of 1 may be considered.
	1	Mild (1×/week)
	2	Moderate (2-3×/week)
	3	Severe (>3×/week)
Stool consistency	0	Normal	Use the Purina Scale Fecal Score (PSFS) and assign scores based on the mean fecal score over the preceding 3 weeks. A score of 0 corresponds to a PSFS of 1–2, 1 corresponds to a PSFS of 3–4, 2 corresponds to a PSFS of 5–6, and 3 corresponds to a PSFS of 7.
	1	Slightly soft feces
	2	Very soft feces
	3	Watery diarrhea
Stool frequency	0	Normal	Scoring should be based on the mean daily frequency over the preceding 3 weeks.
	1	Slightly increased (2-3×/day) or fecal blood, mucus or both
	2	Moderately increased (4-5×/day)
	3	Severely increased (>5×/day)
Weight loss	0	None	Estimate the percentage of weight loss attributable to the disease by comparing current body weight to pre-disease weight. Consider body condition score, muscle loss, presence of ascites or edema, and any dietary restriction that may affect interpretation.
	1	Mild (<5%)
	2	Moderate (5-10%)
	3	Severe (>10%)
Ascites and peripheral edema	0	None	Mild ascites is only detected once using diagnostic imaging. Mild peripheral edema can be palpated but not seen at distance. Moderate ascites is detected with positive wave sign on clinical examination. Moderate edema can be seen at distance. Severe ascites is associated with abdominal enlargement. Severe edema causes discomfort to the dog.
	1	Mild ascites or peripheral edema
	2	Moderate amount of ascites/peripheral edema
	3	Severe ascites/pleural effusion and peripheral edema
Pruritus	0	No pruritus	Occasional itching occurs less than 3 times a week. Regular itching occurs more frequently. Assessment should represent the frequency over the preceding 3 weeks.
	1	Occasional episodes of itching
	2	Regular episodes of itching but stops when the dog is asleep
	3	Dog regularly wakes up because of itching

Beyond clinical activity indices: integrating longitudinal and owner-reported outcomes

Standardized fecal scoring systems, digital signs tracking, and longitudinal data collection might further enhance outcome assessment of CE in dogs. Stool consistency and defecation frequency are inherently variable over time, and cross-sectional assessments are particularly sensitive to recall bias and subjective interpretation. Greater emphasis on prospective, repeated measurements might therefore improve reliability and better capture disease dynamics over time. In this context, emerging artificial intelligence-based approaches, including automated analysis of stool images or pattern recognition applied to repeated owner-collected data, could allow for longitudinal assessments and might subsequently hold promise for reducing evaluator-related variability. Although such tools require rigorous validation, they appear particularly relevant for clinical variables characterized by high temporal variability and limited inter-observer agreement.³⁶

Even when rigorously applied and methodologically standardized, clinical activity indices such as the CIBDAI and CCECAI capture only a portion of the disease burden experienced by dogs with chronic enteropathy. By design, these indices focus on selected signs of gastrointestinal disease and provide a clinician-centered assessment of disease activity, but they do not fully reflect the broader influence of the disease on daily functioning and overall well-being. Clinically meaningful improvement might involve enhanced vitality, improved behavior, reduced discomfort, or greater stability over time, even in the absence of complete resolution of gastrointestinal signs. Conversely, apparent remission based on gastrointestinal signs alone might coexist with treatment-related adverse effects, stress associated with treatment administration, or reduced overall quality of life.

In human gastroenterology, particularly in chronic inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis, the integration of patient-reported outcomes (PROs) has become an essential component of clinical trials.³⁹ Symptom-based instruments such as PRO2 and PRO3, and health-related quality-of-life (HRQoL) instruments like the Inflammatory Bowel Disease Questionnaire, are now frequently incorporated as endpoints to capture treatment effects from the patient’s perspective and to assess broader physical, emotional, and social dimensions.^40,41

Translating these concepts to veterinary gastroenterology requires adapting the source of dog-centered information, making owner-reported outcomes the closest analogue to human PROs.⁴² This reliance on the owner makes their perspective even more critical, as treatment benefit cannot be fully dissociated from its broader influence on the owner, including treatment burden, financial cost, and constraints on daily and social life. These dimensions, which might influence treatment adherence and long-term success, are not captured by traditional clinician-reported activity indices.

Validated HRQoL instruments could offer a complementary, dog- and owner-centered perspective that focuses on overall functioning rather than isolated clinical variables.⁴³ Integrating owner-reported outcomes such as quality-of-life tools alongside clinical activity scores might provide a more comprehensive assessment of treatment response and help distinguish statistically detectable changes from those translating into meaningful benefit for both the animal and its owner.³⁷

Conclusion: toward necessary standardization

Clinical activity indices such as the CIBDAI and CCECAI have played a central role in advancing both research and clinical management of CE in dogs. Their widespread adoption reflects their practical utility and historical importance. However, growing heterogeneity in how these scores are applied, interpreted, and reported has become a major limitation. Response definitions that fail to account for intrinsic score variability, thresholds overlapping with measurement error, and insufficient reporting of scoring conditions collectively undermine both comparability across studies and the clinical relevance of reported outcomes.

In this perspective, we highlight methodological features that would benefit from being considered to strengthen the use of clinical activity scores in CE trials. Key recommendations include the use of absolute score changes exceeding known measurement variability in moderate-to-severe disease (Δ ≥ 3 with a single scorer and Δ ≥ 4 with multiple scorers), cautious interpretation of item-level changes in low-score disease (eg, Δ item ≥2), transparent reporting of evaluator identity, and consistent longitudinal assessment whenever feasible. Integration of complementary outcome measures, such as validated HRQoL instruments and longitudinal monitoring tools, might further enhance dog- and owner-centered evaluation of treatment response. These perspectives are summarized in Table 3.

Table 3.

Recommendations for the scoring, reporting, and interpretation of serial CIBDAI and CCECAI assessments in clinical trials of dogs with chronic enteropathies.

Scoring	Whenever feasible, serial CIBDAI and CCECAI assessments should be performed by a single clinician throughout the study. Owners should not be involved in score assessment. The use of a structured and standardized clinical data collection form (see Supplementary material 1) and a standardized scoring guide (see Table 2) is strongly encouraged. In addition to clinician-reported scores, incorporation of owner-reported outcomes (eg, owner satisfaction and quality of life) may provide complementary information on treatment response and disease impact.
Reporting	Studies should explicitly report who performed score assessments, including whether evaluations were conducted by a single clinician or multiple clinicians over time.
Interpreting	Single evaluator	Baseline CIBDAI and CCECAI ≥4: response defined as a decrease of ≥3 points (Δ ≥ 3).
		Baseline CIBDAI and CCECAI < 4: response defined as an item-level decrease of ≥2 points (Δ item ≥2).
	Multiple evaluators	Baseline CIBDAI and CCECAI ≥5: response defined as a decrease of ≥4 points (Δ ≥ 4).
		Baseline CIBDAI and CCECAI < 5: response as an item-level decrease of ≥2 points (Δ item ≥2).

These recommendations are not intended to impose rigid constraints, but rather to promote standardization, transparency, and critical interpretation of clinical score–based outcomes. Adoption of such principles would improve interpretability of individual studies, enhance comparability across trials, and support more robust evidence synthesis. Ultimately, refining how clinical activity scores are used and reported will strengthen the credibility of research findings and contribute to better-informed clinical decision-making in dogs affected by chronic enteropathies.

Abbreviations

CIBDAI

Canine Inflammatory Bowel Disease Activity Index

CCECAI

Canine Chronic Enteropathy Clinical Activity Index

HRQoL

health-related quality-of-life

Author contributions

Tristan Méric (Conceptualization, Writing—original draft), Claire Verollet (Writing—original draft), Elodie Darnis (Writing—review & editing), Moez Rhimi (Conceptualization, Writing—review & editing), Juan Hernandez (Conceptualization, Supervision, Writing—review & editing)

Conflicts of interest

T.M.: Grants/Research–PhD fellowship funded by Phileo by Lesaffre. E.D.: Speakingengagements–American College of Veterinary Internal Medicine (ACVIM), Association Française desVétérinaires pour Animaux de Compagnie (AFVAC). J.H.: Grants/Research–Royal Canin, Hill’s Pet Nutrition, Nestlé Purina PetCare, Phileo by Lesaffre, Agria, Société Centrale Canine, ECVIM-CA Clinical Studies Fund, Morris Animal Foundation. Consultancies–Royal Canin, Hill’s Pet Nutrition, Nestlé Purina PetCare. Speaking engagements–Royal Canin, Nestlé Purina PetCare, Affinity Petcare, AFVAC.

Funding

This work was supported by Euro-Mediterranean society for microbiota in human & animal.

Off-label antimicrobial declaration

Authors declare no off-label use of antimicrobials.

Institutional animal care and use committee or other approval declaration

Authors declare no institutional animal care and use committee or other approval was needed.

Human ethics approval declaration

Authors declare human ethics approval was not needed.