Inflammatory bowel disease or IBD in cats consists of the accumulation of inflammatory cells in the mucosa of the intestine. This infiltrate may be lymphocytes, plasma cells, or eosinophils. In cats, it is sometimes accompanied by inflammation of the pancreas and/or liver, then called feline triaditis. The clinical signs are the general ones of a digestive problem, although vomiting and weight loss frequently occur, unlike the chronic diarrhea that usually occurs in the canine species. A good differential diagnosis must be made between other pathologies that produce the same and the definitive diagnosis is obtained by histopathology. The treatment will be dietary and pharmacological.
Keep reading this article that we offer you from our site in which we address the issue of inflammatory bowel disease in cats, its symptoms, diagnosis and treatment.
What is inflammatory bowel disease in cats and what causes it?
Inflammatory Bowel Disease (IBD) is a chronic inflammatory disease of unknown origin of the small intestine Sometimes, it can also compromise the large intestine or stomach and be associated with pancreatitis and/or cholangitis, becoming known as feline triaditis.
In feline inflammatory bowel disease, there is an infiltration of inflammatory cells (lymphocytes, plasma cells or eosinophils) in the lamina propria of the mucosal layer of the intestine, which can reach deeper layers. Although the origin is unknown, there are three hypotheses about the causes of IBD in cats:
- Autoimmune alteration against the epithelium of the intestine itself.
- Response to bacterial, parasitic or dietary antigens of the lumen of the intestine.
- Failure in the permeability of the intestinal mucosa that causes greater exposure to these antigens.
Is there a breed or age predisposition in the development of feline IBD?
There is no specific age. Although it is seen more in middle-aged cats, younger and older cats can also be affected. On the other hand, there is a certain racial predisposition in Siamese, Persian and Himalayan cats.
Symptoms of inflammatory bowel disease in cats
When inflammation occurs in the intestine, the clinical signs are very similar to those of intestinal lymphoma, since, although this is usually more common in older cats, it is not exclusive. Thus, the clinical signs that a cat with IBD presents are:
- Anorexia or normal appetite.
- Weightloss.
- Mucous or bilious vomiting.
- Small bowel diarrhea.
- Large bowel diarrhea if also affected, usually with blood in the stool.
If abdominal palpation is performed, we may notice an increase in the consistency of the intestinal loops or enlarged mesenteric lymph nodes.
Feline Inflammatory Bowel Disease Diagnosis
The definitive diagnosis of feline IBD is by integrating a good history, physical examination, laboratory analysis, diagnostic imaging and histopathology of biopsies. A blood test and biochemistry, T4 screening, urinalysis, and abdominal X-ray should be performed to rule out systemic diseases such as hyperthyroidism, kidney disease, or a liver disease.
Sometimes a CBC of chronic inflammation with increased neutrophils, monocytes, and globulins is seen. If low vitamin B12 appears, it may indicate that the problem is in the final part of the small intestine (ileum). For its part, the abdominal x-ray can detect foreign bodies, gas or paralytic ileus. However, the abdominal ultrasound is the most useful imaging test, being able to detect a thickening of the intestinal wall, specifically the mucosa, and even measure it. It is not common in this disease for the architecture of the intestinal layers to be lost, as can occur in an intestinal tumor (lymphoma). You can also see an increase in the mesenteric lymph nodes and, depending on their size and shape, know if they are inflamed or if it is tumorous.
The definitive diagnosis and the differential with lymphoma will be obtained with the histopathological analysis of the samples obtained by endoscopy or laparotomy biopsy. In more than 70% of cases, the infiltrate is lymphocytic/plasmacytic, although it can also be eosinophilic with less response to treatment. Other much less likely infiltrates are neutrophilic (neutrophils) or granulomatous (macrophages).
Treatment for inflammatory bowel disease in cats
Treatment of IBD in cats is based on a combination of diet and immunomodulators and, if present, treatment of concomitant diseases.
Diet treatment
Many cats with IBD improve on a hypoallergenic diet within a few days. This is because it decreases the substrate for bacteria to grow, increases intestinal absorption, and reduces osmotic potential. Although the change to these diets can normalize the intestinal flora, it is difficult for them to reduce the pathogenic species that overpopulate the intestine. In addition, if there is concomitant pancreatitis, antibiotics should be administered to avoid infections in the bile duct or intestine due to the anatomical characteristics of the cat (feline triaditis).
If the large intestine is also affected, the use of high-fiber diets may be indicated. In any case, it will be the veterinarian who will indicate which is the best food for cats with IBD depending on their particular case.
Medical treatment
If a low amount of vitamin B12 is demonstrated, it should be supplemented at a dose of 250 micrograms subcutaneously once a week for 6 weeks. Subsequently, every 2 weeks another 6 weeks and then monthly.
metronidazole is effective as it is antimicrobial and immunomodulatory, but it must be used correctly to avoid adverse effects on intestinal cells and neurotoxicity. In this article we explain what metronidazole for cats is. On the other hand, corticoids are used, such as prednisolone at immunosuppressive doses. This therapy should be done, even if the diet change has not been made to observe if there is food hypersensitivity, in cats that present marked weight loss and digestive signs. Prednisolone therapy can be started at 2 mg/kg/24h orally. The dose, if improvement is seen, is maintained for another 2-4 weeks. If the clinical signs subside, the dose is lowered to 1 mg/kg/24h. The dose should be reduced until it reaches the minimum effective dose that allows symptom control.
If corticosteroids are not enough, other immunosuppressants should be introduced, such as:
- Chlorambucil at a dose of 2 mg/cat orally every 48h (cats over 4kg) or 72 hours (cats under 4kg). Complete blood counts should be done every 2-4 weeks in case bone marrow depression develops.
- Cyclosporine at a dose of 5 mg/kg/24 hours.
Treatment of mild inflammatory bowel disease in cats includes:
- Hypoallergenic diet for 7 days and evaluate the response.
- Metronidazole for 10 days at a dose of 15 mg/kg/24 hours orally. Reduce dose by 25% every 2 weeks until withdrawal.
- If they do not respond to the above, prednisolone should be started at 2 mg/kg/24h alone or combined with metronidazole, reducing the dose by 25% every 2 weeks until the minimum effective dose is achieved.
