what nutritional approach is recommended during acute diarrhea in dogs — withhold food or early enteral feeding?

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Early enteral feeding is recommended over food withholding in dogs with acute diarrhea. Dietary modification is one of the most common treatments for acute diarrhea in dogs, used in 66% of cases in one UK population, and nutritional management has demonstrated superiority over metronidazole as a treatment strategy for noninfectious acute colitis.68 A highly digestible diet accelerates clinical resolution compared to a standard control diet. Dogs fed a prescription highly digestible diet showed 1.6 times better resolution rate, with 2.3 fewer days of low fecal consistency in dogs that clinically improved within 9 days (98% resolution on the digestible diet vs. 66% on control).4 This magnitude of effect is classified as moderate and clinically relevant by the ENOVAT guidelines.4 Dietary fiber also contributes to clinical improvement. A high-fiber diet (4.54% soluble and 15.16% insoluble fiber as fed, compared to 0.6% soluble and 5.33% insoluble in the control) improved fecal scores in dogs with acute large bowel diarrhea.4 Powdered cellulose supplemented at 0.5 g/kg/day showed a trend toward improved fecal scores on day 1.4 Nutritional management outperforms metronidazole for noninfectious acute colitis and is the second treatment strategy — after fecal microbiota transplant — shown to improve both clinical outcomes and fecal microbiome parameters over metronidazole.8 Dogs with poor or absent appetites were excluded from the key nutritional management trial, so if inappetence is persistent, assisted enteral nutrition should be considered.8 For dogs requiring hospitalization, early enteral nutrition (EN) is preferred over parenteral nutrition (PN). In dogs hospitalized with acute pancreatitis, early EN decreased time to voluntary food intake and improved gastrointestinal food tolerance.9 EN delivered proximal to the pylorus via esophagostomy tube in dogs with severe acute pancreatitis resulted in fewer vomiting and regurgitation episodes and fewer catheter-related comp