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Cat Inflammatory Bowel Disease
Introduction
Inflammatory bowel disease (IBD) is a common disease of cats characterized by chronic, cyclic or intermittent anorexia, weight loss and bouts of vomiting and/or diarrhea, which may continue for years. The cause of this condition is unknown.
How Inflammatory Bowel Disease Affects Cats
Inflammatory bowel disease causes gastrointestinal upset and abdominal pain. It is most common in middle-aged and older cats, although younger cats can be affected as well. The most consistent clinical sign in cats suffering from IBD is anorexia, followed by weight loss, vomiting and watery diarrhea. Affected cats are thin and sickly, with poor body condition and a dull coat. They are frequently gassy as well. These clinical signs can wax and wane over time. Inflammatory bowel disease can be quite painful.
Causes & Prevention
Causes of Inflammatory Bowel Disease in Cats
IBD is characterized by thickening of the large and/or small intestinal walls which occurs as a direct result of an excessive inflammatory response. The exact cause of feline IBD is not known but is thought to be multi-factoral. Some combination of genetic predisposition, hypersensitivity to bacteria and/or food allergies is suspected. Regardless of the ultimate underlying inciting cause, the normal bacterial flora of the cat's gastrointestinal tract plays a major role in the inflammatory process associated with this disease. In cats, the condition has been associated with pancreatic inflammation (pancreatitis) and liver inflammation (cholangiohepatitis) in a syndrome termed "triad disease."
Preventing Inflammatory Bowel Disease in Cats
Since the cause of feline IBD is unknown, there is no realistic way to prevent this disease.
Special Notes
Feline IBD usually can be managed medically with a combination of oral anti-inflammatory, immunosuppressive, antibiotic and/or antiparasitic drugs. Some owners find it difficult to administer oral medications to their cats, and most cats dislike the process (and the taste of the pills) as well. Supportive care and a healthy, palatable and highly digestible diet are also important components of an effective management protocol. The attending veterinarian will adjust therapy based on the patient's individual needs and response to treatment. There is no "magic bullet," but with patience and consistency, most owners will be able to control IBD in their companion cats. Follow-up veterinary assessments are an integral part of case management.
Although not yet conclusively proven, it has been suggested that severe IBD in cats may progress to intestinal lymphosarcoma. There also is a reported association between feline IBD, inflammatory liver disease and pancreatitis.
Symptoms & Signs
Inflammatory bowel disease (IBD) is a common disorder in cats characterized by inflammation and thickening of the intestinal lining, together with classic signs of gastrointestinal distress.
Symptoms of Inflammatory Bowel Disease in Cats
Inflammatory bowel disease causes chronic, cyclic or intermittent gastrointestinal upset and abdominal pain. The symptoms may be mild at first but typically worsen with time. IBD is most common in middle-aged and older cats, although younger cats can be affected as well. Some reports suggest that Siamese cats - and purebred cats, in general - are predisposed.
The most consistent clinical sign in cats suffering from IBD is anorexia, followed by weight loss, vomiting and watery diarrhea, in that order. Affected cats are thin and appear sickly, with poor body condition and a dull hair coat. The vomitus from cats with IBD is usually frothy and flecked with bile; it rarely includes solid food. The diarrhea from affected cats often includes mucous and/or fresh blood, especially as the disease progresses. Some cats will eliminate inappropriately, outside of their litter box. Some cats will experience borborygmus (a rumbling noise caused by gas moving through the intestines) and flatulence, as well. These clinical signs commonly wax and wane over time.
Inflammatory bowel disease can be extremely painful. However, cats can be quite stoic, and the signs of pain are not always easy for owners to detect. Some cats will appear depressed or lethargic. They may resist being held or touched, or they may hide. Sometimes, they will have difficulty walking or even standing up.
Diagnosis & Tests
Inflammatory bowel disease (IBD) is a common feline gastrointestinal disorder that is fairly difficult to diagnose. Ultimately, an intestinal biopsy is normally necessary to definitively diagnose this condition, although sometimes even that is inconclusive.
Diagnosing Feline Inflammatory Bowel Disease
The results of routine blood tests and urinalyses are usually normal or inconclusive in cats with IBD, although these tests still are important to help the veterinarian rule out other causes of the cat's discomfort. Many veterinarians will recommend testing the cat's thyroid hormone levels and also testing for FeLV (feline leukemia virus infection) and FIV (feline immunodeficiency virus infection). Serum cobalamin and folate levels may also be evaluated to assess pancreatic and small intestinal function, especially in cats. Cobalamin is a cobalt-containing complex common to all members of the vitamin B12 group; folate (folic acid) is one of the vitamins of the B complex as well. Multiple fecal flotations should be done to rule out intestinal parasites as a causative or contributing factor.
Survey abdominal radiographs (x-rays) are typically normal or inconclusive in cats with IBD. Abdominal ultrasound can be used to screen for pancreatic disease, isolated gastrointestinal lesions (masses, ulcers) and thickening of the intestinal lining. A dietary trial should also be performed to rule out food allergies. If all of these diagnostic tools do not point to another primary disorder, IBD will move to the top of the list as the primary suspect.
To make a definitive diagnosis of inflammatory bowel disease, biopsies usually are necessary (although even these may not be 100% conclusive). Tissue samples can be collected surgically or endoscopically. Surgical exploration is the only way to collect full-thickness intestinal samples. Endoscopic samples should be taken from multiple areas of the intestinal lining. Both of these procedures are performed under general anesthesia. The tissue samples will be sent to the laboratory for microscopic examination by a veterinary pathologist, who will look for the hallmarks of exuberant inflammation that are present with IBD.
In some cases, the attending veterinarian may choose to treat IBD without taking biopsies, especially if all other likely causes of the cat's clinical signs have been ruled out. If the cat's condition improves with symptomatic treatment, the presumptive diagnosis of IBD is assumed to be correct.
