My dog is affected by IBD?

Inflammatory Bowel Disease CIBDAI-Scoring-System*

Please note that this questionnaire cannot and does not wish to replace a visit to your veterinarian.
The following modified CIBDAI* (Canine IBD Activity Index) is based on investigative results provided by Jergens, A. E. & Schreiner, C.A. 2003** and contains further clinically relevant symptoms of diverse importance:
You can complete this form voluntarily to enable possible contact, however, the provision of an email address is a requirement.

Name of owner
Telephone No.
Email Address (required)
Dog’s Name
Gender  female      male
Neutered   no      yes 
What do you feed your dog including all possible treats (even if only given occasionally)?

What medication does your dog take?

Does your dog suffer (continue to suffer) with one or more of the following symptoms?
Should symptoms occur, please describe how often and how strong these are (e.g. once a week):

Vomiting containing blood
Diarrhoea containing blood
Slimy faeces

Melena (black ‘tarry’) faeces
Faeces appear like small pellets strung together rather than long sausage-like appearance

Painful straining
Dog appears to be suffering from abdominal pain

Ravenous appetite
Loss of appetite
Weight loss no yes
Conspicuous noises or rumbling in the gut

Generally heightened agitation, sometimes also increased desire not to be approached or skittishness

Sometimes explosive bowel eliminations but not a large amount

Predominantly small amounts of faeces
Urge to also defecate at night
Recurring attacks, which increase gradually over time (years)

How often does your dog defecate? times a day
Did your dog’s general state alter during these bouts?

How would you describe your dog’s quality of life (fitness) at present?

Did your dog undergo tests for giardia?
If so, was there evidence of giardia?

  no      yes  
  no      yes
Were CRP values investigated?
If so, what level was determined (in µg/ml)?

  no      yes    CRP Value
Serum albumin level: (in g/dl)


Was a colonic endoscopy carried out?

  no      yes  
Which histologic diagnosis was made?


Are there any chronic intestinal problems in humans in the social surroundings of your dog?   no      yes  
Do you agree to the information you have provided to be passed on in a strictly confidential way for the purpose of scientific investigation?

  no      yes  
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*Breuer, E. M. 2007: Blutig-schleimige Durchfälle beim Hund: Ein Therapiekonzept, VETimpulse.
16.Vol. Ed.18, p.4
**Jergens, A.E. & Schreiner, C.A. 2003 A scoring Index for Disease Activity in Canine Inflammatory Bowel Disease.
J Vet Intern Med. 17: 291-297.