Porcine Proliferative Enteropathy in Pigs: Ileitis and Hemorrhagic Bowel Disease
- See your vet immediately if your pig has sudden bloody or black tarry stool, weakness, pale skin, collapse, or dies unexpectedly in a group setting.
- Porcine proliferative enteropathy, often called ileitis, is an intestinal disease caused by the bacterium Lawsonia intracellularis.
- Milder cases may cause poor growth, loose stool, and weight loss, while severe hemorrhagic cases can become life-threatening very quickly.
- Diagnosis often combines herd history, exam findings, fecal or intestinal PCR, and sometimes necropsy or tissue histopathology.
- Typical 2026 US cost range is about $150-$500 for exam plus basic testing in a straightforward case, and $500-$2,500+ when multiple pigs, lab work, fluids, hospitalization, or postmortem testing are needed.
What Is Porcine Proliferative Enteropathy in Pigs?
Porcine proliferative enteropathy is a contagious intestinal disease of pigs caused by Lawsonia intracellularis. You may also hear your vet call it ileitis, porcine intestinal adenomatosis, or, in severe bleeding cases, proliferative hemorrhagic enteropathy. The disease most often affects growing and finishing pigs, but young breeding pigs can also be affected.
This infection causes abnormal thickening and inflammation of the intestinal lining, especially in the ileum, and sometimes the jejunum, cecum, and colon. Some pigs have mild or even subclinical disease with reduced growth and feed efficiency. Others develop diarrhea, chronic weight loss, or sudden hemorrhagic bowel disease with weakness, pale skin, dark stool, and rapid death.
For pet pigs and small herds, this condition matters because it can look like many other causes of diarrhea at first. Early veterinary involvement helps your vet sort out whether the problem is ileitis, parasites, salmonellosis, swine dysentery, dietary upset, or another serious intestinal disease.
Symptoms of Porcine Proliferative Enteropathy in Pigs
- Loose to watery diarrhea, sometimes reddish-brown
- Blood-tinged stool or black, tarry manure
- Sudden weakness or reluctance to stand
- Pale skin or mucous membranes
- Poor growth or falling behind pen mates
- Weight loss or poor body condition
- Reduced appetite
- Dehydration
- Unexpected death in severe hemorrhagic cases
- Occasional abortion in affected pregnant gilts
Mild ileitis may show up as soft stool, slower growth, or a pig that looks thriftier than expected rather than dramatically sick. More severe disease can cause persistent diarrhea, progressive weight loss, or necrotic intestinal disease. The hemorrhagic form is the one that raises the most concern because pigs may become pale, weak, pass dark or bloody stool, and die with little warning.
See your vet immediately if your pig has bloody diarrhea, black tarry stool, marked weakness, collapse, pale skin, or rapid decline. If more than one pig in the group is affected, contact your vet promptly because herd-level testing and management may be needed.
What Causes Porcine Proliferative Enteropathy in Pigs?
The cause is Lawsonia intracellularis, a small gram-negative bacterium that lives inside intestinal cells. Pigs usually become infected through the fecal-oral route, meaning they pick up the organism from manure-contaminated environments, equipment, boots, water, or direct contact with infected pigs. Because the organism is common in many swine populations, exposure can happen even when a herd looks generally healthy.
Not every exposed pig becomes severely ill. Stress, mixing groups, transport, crowding, sanitation problems, and other intestinal infections can increase the chance that infection turns into clinical disease. Age also matters. The nonhemorrhagic form is commonly seen in growing pigs, while acute hemorrhagic disease is more often recognized in older growers, finishers, or young adults.
In small farms and pet pig settings, risk can rise when new pigs are introduced without quarantine, manure control is poor, or pigs share contaminated spaces. Your vet may also look for contributing problems such as diet changes, parasites, salmonella, or swine dysentery, because intestinal disease in pigs is often multifactorial.
How Is Porcine Proliferative Enteropathy in Pigs Diagnosed?
Your vet usually starts with the pig's age, history, group pattern, stool appearance, body condition, and hydration status. Ileitis can resemble several other pig diseases, so diagnosis is rarely based on symptoms alone. In a live pig, your vet may recommend fecal or rectal-swab PCR for Lawsonia intracellularis, along with other tests to rule out competing causes of diarrhea.
PCR can confirm that Lawsonia genetic material is present, but that result has to be interpreted carefully because the organism is common in many herds. For that reason, your vet may pair PCR with herd history, response patterns, and, when available, necropsy findings. In some cases, especially when a pig dies or the diagnosis remains uncertain, intestinal tissue is submitted for histopathology and immunohistochemistry. Those tests can show the classic thickened intestinal lining and identify the organism in affected cells.
For pet pigs, a practical workup may range from a farm or clinic exam plus fecal PCR to a more complete herd investigation with multiple samples, postmortem testing, and treatment planning for exposed pigs. A straightforward diagnostic visit may cost about $150-$500, while a broader workup with several samples, lab interpretation, and necropsy or tissue testing may run $500-$1,500+ depending on region and how many pigs are involved.
Treatment Options for Porcine Proliferative Enteropathy in Pigs
Spectrum of Care means you have options. Here are treatment tiers at different price points.
Budget-Conscious Care
- Prompt exam by your vet
- Isolation of affected pig or group
- Hydration support and close monitoring
- Targeted fecal PCR or limited diagnostics
- Vet-directed herd medication plan when appropriate
- Environmental cleanup and manure control
Recommended Standard Treatment
- Full veterinary exam and treatment plan
- Fecal or rectal-swab PCR, with additional testing as needed
- Vet-directed antimicrobial therapy commonly used for Lawsonia cases
- Fluid therapy for dehydrated pigs
- Nutrition and housing review
- Monitoring of pen mates or herd contacts
- Follow-up testing or treatment adjustment if response is incomplete
Advanced / Critical Care
- Emergency stabilization for weak, pale, or collapsed pigs
- Hospitalization or intensive on-farm supportive care
- IV or aggressive fluid support when feasible
- Expanded diagnostics including CBC/chemistry where available
- Necropsy and histopathology for deaths in the group
- Immunohistochemistry or tissue confirmation
- Herd-level prevention plan including vaccination discussion with your vet
Cost estimates as of 2026-03. Actual costs vary by location, clinic, and individual case.
Questions to Ask Your Vet About Porcine Proliferative Enteropathy in Pigs
Bring these questions to your vet appointment to get the most out of your visit.
- You can ask your vet whether my pig's signs fit ileitis, hemorrhagic bowel disease, or another cause of diarrhea.
- You can ask your vet which tests are most useful right now: fecal PCR, bloodwork, necropsy, or intestinal tissue testing.
- You can ask your vet whether other pigs in the group should be treated, tested, isolated, or monitored.
- You can ask your vet what warning signs mean this has become an emergency, especially for bleeding or dehydration.
- You can ask your vet what treatment options fit my pig's condition and my budget, including conservative, standard, and advanced care.
- You can ask your vet how long recovery usually takes and whether growth or body condition may lag afterward.
- You can ask your vet whether vaccination makes sense for my herd or household pig setup.
- You can ask your vet what cleaning, manure handling, and quarantine steps will lower the chance of another outbreak.
How to Prevent Porcine Proliferative Enteropathy in Pigs
Prevention focuses on reducing exposure to infected manure and lowering stress that makes intestinal disease more likely. Good sanitation, regular removal of feces, clean water, avoiding overcrowding, and careful introduction of new pigs all matter. Quarantine new arrivals and talk with your vet before mixing them into an established group.
Because Lawsonia intracellularis is common in swine populations, prevention is often a herd-management issue rather than a one-time fix. Your vet may recommend improving pig flow, separating age groups, tightening boot and equipment hygiene, and reviewing feed or housing changes that may be adding stress.
Vaccination is also an option in some settings. In the US, licensed swine vaccines against Lawsonia intracellularis include both oral live and injectable products for healthy pigs, generally starting at 3 weeks of age or older. Vaccination does not replace sanitation and biosecurity, but it can be part of a practical prevention plan for herds with recurring ileitis. Your vet can help decide whether monitoring alone, management changes, vaccination, or a combination makes the most sense for your pigs.