Inflammatory Bowel Disease (IBD) in cats (Lymphocytic plasmocytic enteritis)

Gastrointestinal disorders are among the most common problems encountered in feline medicine. Most vomiting and diarrhoea episodes occur suddenly and resolve quickly. The causes are usually benign, such as eating an unfamiliar food, or being fed raw meat that the cat is unfamiliar with or is allergic too. Kittens who pass blood in the faeces are commonly intolerant to red meats but this intolerance tends to subside in time, and usually resolves itself after 6 months of age.

However, some patients may have vomiting and/or diarrhoea over a period of weeks to months. In the diagnosis of these chronic disorders, the first step is to rule out other causes by using blood tests, stool examinations, x-rays and possibly other tests. Veterinarians will want to ensure that the patient is not suffering from an illness such as chronic kidney failure, pancreatitis, or hyperthyroidism which can also cause vomiting and diarrhoea.

When all non-gastrointestinal illnesses are eliminated, the various gastrointestinal disorders need to be considered. Among these are Ollulanus tricuspis (stomach worm infection), Helicobacter infection (a bacterial infection of the stomach), inflammatory bowel disease, colitis, and intestinal lymphoma. Of these, inflammatory bowel disease (IBD) is by far the most common.

IBD is actually a group of gastrointestinal disorders, usually chronic in nature, which are characterized by an increase in the number of inflammatory cells found in the lining of the stomach or intestinal tract. These changes can affect the function of the organ involved. The causes of IBD are variable, and often no single cause can be identified in a given patient. The symptoms include chronic vomiting, diarrhoea, or both, and in some cases, weight loss and change in appetite. Some patients may defecate outside their litter box, especially if diarrhoea is present. The symptoms may be cyclical in nature, with the cat appearing to be normal at times. It is not unusual for these patients to be misdiagnosed as having hairballs.

A definitive diagnosis of IBD is only possible by intestinal biopsy, which is best accomplished using fiberoptic endoscopy. This technology allows veterinarians to diagnose and treat many gastrointestinal disorders more easily than in the past. The endoscope is an instrument that allows visualization of the stomach and intestinal tract through a flexible tube that is passed into either the patient's stomach or colon. The tube contains fiberoptic bundles that deliver bright light to its tip and transmit the images back into an eyepiece. Small, but adequate biopsies (about the size of this capital letter "O") can be taken using this instrument, thus avoiding surgery. The procedure is performed under a short general anaesthesia with most patients able to return home the same day. Since endoscopic procedures are minimally invasive (there are no surgical wounds to heal) and short in duration, they are less traumatic to the patient and recovery time is quicker.

Treatment

Once diagnosed, the disease can be controlled to prevent pain and discomfort to the cat. Treatment is also aimed at preventing possible complications of the disease, such as damage to the liver, malnutrition, ulcers, and in some cases, the future development of cancer. Many medications can be used to control IBD. These include prednisone (the treatment of choice in many cases), some antibiotics, and antiemetics (drugs that suppress vomiting). A new drug, budesonide (Entocort®) is currently being investigated for treatment of IBD in cats. Although it is a corticosteroid drug like prednisone, it is metabolised differently and may reduce the potential for long-term side effects that can be associated with corticosteroids. Once therapy is started, it is usually continued for two to three months, before attempts are made to decrease the amount of medication. In many cases, a hypoallergenic diet (such as Hills Z/D  or I/D diets) may be recommended to aid in control of the disease.

Any cat with unexplained vomiting or diarrhoea, especially chronic and intermittent in nature, should be examined for IBD. This disease is often overlooked and is under-diagnosed, leaving many cats to live in some measure of discomfort. With fiberoptic endoscopy, diagnosis is safe and minimally invasive. Treatment will not only avoid serious future complications, but will improve the cat's quality of life.