How do you know if your cat has inflammatory bowel disease
Felineinflammatorybowel disease(IBD) is acondition inwhich a catsgastrointestinal(GI) tractbecomeschronicallyirritated andinflamed.
Inflammatory cells infiltrate the wallsof the GI tract, thickening them and disrupting the abilityof the GI tract to properly digest and absorb food. Catsof any age can be affected by IBD, but the disease occursmost often in middle-aged and older cats.
While the cause of IBD is unknown, current evidencesuggests that it arises from a complex abnormal interactionbetween the immune system, diet, bacterial populationsin the intestines, and other environmental factors. Basedupon similarities to IBD in people and dogs, geneticabnormalities of the immune system are also thought toplay a role in feline IBD.
IBD can take different forms depending on the region ofthe GI tract and the type of inflammatory cells involved. Ifthe stomach is inflamed, the condition is called gastritis. Ifthe small intestine is inflamed, its referred to as enteritis;and if the colon (large intestine) is inflamed, its calledcolitis. The most common form of IBD, termed lymphocyticplasmacytic enteritis, involves inflammatorylymphocytes and plasma cells invading thesmall intestine. Eosinophils are another typeof inflammatory white blood cell commonlyinvolved in feline IBD. They may be the predominant cell type on occasion, as in eosinophilicgastroenteritis, but they are more commonly part of a mixedpopulation of inflammatory cells. Two less common formsof IBD are neutrophilic IBD, which involves neutrophils, andgranulomatous IBD, which involves macrophages. In somecases, IBD may be accompanied by inflammation of otherabdominal organs, including the liver and pancreas.
Clinical Signs
Common signs of feline IBD include vomiting, weight loss,diarrhea, bloody stools, lethargy, and decreased appetite.These signs can vary in severity and frequency, and thepredominant signs depend on which parts of the GI tractare affected. For example, if the stomach or higher areasof the small intestine are inflamed, the cat may experiencechronic vomiting. Inflammation in the colon, in contrast, ismore likely to cause diarrhea, with or without blood in thestool.
Diagnosis
Making a diagnosis of feline IBD requires an extensiveworkup because many of the signs of IBD are commonlyseen with other diseases. Your veterinarian will likelyrecommend baseline blood work, fecal examinations,X-rays, or an abdominal ultrasound to check for metabolicdisease, feline leukemia, parasitic or bacterial infections,hyperthyroidism, and certain types of cancer. Intestinallymphoma, a form of cancer, can be particularly difficultto distinguish from IBD in cats. A veterinarian may alsomeasure the levels of the B vitamins B12 and folate in thebloodstream, as IBD can hinder the absorption of thesevitamins from the GI tract. A hypoallergenic food trial mayalso be conducted to rule out food allergy.
A definitive diagnosis of feline IBD requires an intestinalor gastric biopsy and evaluation of the tissue under amicroscope. A patient with IBD will have increased numbersof inflammatory cells in the intestinal wall (Figures 1 and 2). Thetypes of cells found will indicate what type of IBD is presentand help guide treatment. Gastrointestinal biopsies may beperformed using a flexible camera, called an endoscope,that is passed through the mouth or the rectum (Figures 3 and 4), or via abdominal surgery. Endoscopy is a less invasiveprocedure; however, surgery may be recommended for patients in whom liver or pancreatic disease is alsosuspected, so that these organs can be biopsied as well.Both endoscopy and surgical biopsy require generalanesthesia, and the associated risks must be consideredwhen deciding whether to perform these tests.
Treatment
A veterinarian will usually recommend treatment forintestinal parasites if this has not recently been done, and acombination of dietary modification and various medicationsas the first steps. There is no single best treatment, so yourveterinarian may need to try several different combinations ofdiet or medication to determine the best therapy.
Dietary Management
Because dietary allergens can play a role in IBD,your veterinarian may recommend a food trial usinghypoallergenic diets. These diets contain protein orcarbohydrate sources that the cat has never eaten before.Rabbit, duck, or venison-based diets are common initialchoices.If symptoms do not improve with a hypoallergenic diet, thenyour cat may benefit from diets that are high in fiber, low infat, and easily digestible. It may take several weeks, or evenlonger, for cats to improve after a diet change. During anyfood trial, all other food sources, including table scraps,flavored medications, and treats must be eliminated.
Medical Treatment
Metronidazole may be recommended along with dietarymodification as the first medical therapy. Metronidazole hasantibiotic, anti-inflammatory, and antiprotozoal properties,and is usually fairly well tolerated, although some cats maylose their appetite when given this drug.
If dietary modification or metronidazole are not effective,corticosteroids, which are potent anti-inflammatory andimmune-suppressing agents, may be recommended, eitheralone or in combination with metronidazole. Cats shouldbe monitored closely while they are on corticosteroids, asdiabetes and immune suppression are among their potentialside effects. Nonetheless, cats tend to tolerate these drugswell as long as they receive them at an appropriate dose.
Cats usually take corticosteroids orally, starting with a higher dosethat is gradually reduced over several weeks. In cats that wonttake medication orally, or in cases in which vomiting is severe, yourveterinarian may give the medications as an injection.
If none of these medications successfully controls the symptoms ofIBD, more potent immunosuppressive drugs, such as chlorambucilor azathioprine, may be necessary. These drugs can suppressproduction of white blood cells, red blood cells, and, lesscommonly, platelets, in the bone marrow. A veterinarian mustcarefully monitor cats taking these drugs.
As GI bacteria may play a role in the development of IBD, newertherapies include prebiotics, which are substances that promotecertain bacterial populations, and probiotics, which are bacterialstrains that promote GI health. The addition of soluble fiber, suchas psyllium, to the diets of cats with inflammatory colitis may behelpful, and supplementation with folate or vitamin B12 should beprovided if an affected cat is deficient in these B vitamins.
Prognosis
IBD can often be controlled so that affected cats are healthy andcomfortable. However, even with proper management, symptomsmay come and go. Keeping the disease in check requires strictcompliance with dietary and medical therapies. Vigilant monitoringby the veterinarian and owner is also critical, so that relapses canbe assessed and the dosing of long-term medications can beadjusted.
Updated April 2018
Inflammatory Bowel Disease (IBD) in Cats: Causes, Symptoms, and Treatment
Inflammatory bowel disease is actually a group ofgastrointestinal(GI) diseases for which no single cause is known. Also known as IBD, inflammatory bowel disease in cats results in the inflammation of the stomach, small intestines, and/or large intestines.
This can be a frustrating disease to diagnose and treat, but cats can have a great quality of life and live a long time with the appropriate treatment.
Heres what you need to know about IBD in cats, from symptoms and causes to diagnosis and treatment.
What Causes IBD in Cats?
Though no single cause is known, more than one cause of IBD in cats is usually suspected. These include:
Hypersensitivity to bacteria
Food allergies that may include meat proteins, food additives, artificial coloring, preservatives, milk proteins, and gluten (wheat)
Genetic factors
Symptoms of Inflammatory Bowel Disease in Cats
Symptoms of IBD in cats usually are chronic and occur with increased frequency over time (daily, weekly, or monthly). Here are some symptoms of inflammatory bowel disease in cats:
How Do Vets Diagnose IBD in Cats?
Your veterinarian will take a detailed history and ask you questions about the duration and frequency of symptoms.
A complete physical examination will then be conducted, followed by routine laboratory tests, including:
Complete blood count
Biochemistry profile
Urinalysis
Fecal analysis
Although these tests do not definitively diagnose IBD in cats, they are noninvasive and help rule out other diseases (such as kidney disease, elevated thyroid levels, and liver disease) where the symptoms can be identical to IBD.
The results of these routine laboratory tests are often normal. In some patients,anemiaand an abnormally high number of white blood cells (as in infections) may be present. In cats with IBD, abnormal levels of proteins and liver enzymes may also be found. Your veterinarian may also conduct tests to check the functioning of your cats small intestine.
Abdominal Ultrasound
An abdominal ultrasound is likely to be recommended to rule out other diseases not found in blood work (such as pancreatitis or cancer). It can also help vets assess the stomach and intestinal wall thickness, which can be significantly thicker in cats with IBD.
Stomach Biopsy
Your veterinarian may recommend biopsies of your cats stomach and intestines. This can be done with surgery or with endoscopy. Biopsies are the only way to definitively diagnose IBD and determine the extent of the disease.
Once a diagnosis is made, a tailored treatment plan will be created for your pet.
Treatment and Prognosis for IBD in Cats
In most cats, IBD cannot be cured but can be successfully managed. However, even after complete recovery, relapses are common.
Major goals of treatment are:
Diet trials, immunosuppressive drugs, and antibiotics are key components of the therapy for inflammatory bowel disease in cats. Additionally, cobalamin is given in some cats to counteract deficiency of this nutrient.
Food Trials
Dietary management is another essential component of therapy, with hypoallergenic or novel protein diets being the most recommended. It usually takes two to four weeks or so to see if your cat responds to such a diet.
It is not uncommon to try several types of diets, so it could take several months to see if the diet is effective.
During the diet trial, only use the prescribed food. Avoid giving your cat treats, tuna, or anything flavored, including medications (talk to your vet about medications).
Keep a journal of the symptoms prior to and during a diet trial for your veterinarian to see if any difference is noted.
Antibiotics and Supplements
In some cases, a change in diet alone is not enough to treat your cats IBD, and medications are needed.
The most common medications used in the treatment of IBD are drugs that suppress the immune system, such as steroids. Your vet may prescribe antibiotics if your cat has diarrhea. In some cases, multiple medications may be necessary.
The goal of IBD treatment is to minimize the symptoms so your cat can have a great quality of life. Once that is reached, the medications will be tapered by your veterinarian to the lowest effective dose possible. In some cases, cats cannot be completely weaned off of medications and require lifelong medications.
Whats the Outlook for Cats With IBD?
The short-termprognosisin most cats with IBD is excellent. Be patient with the forms of treatment suggested by your veterinarian, and strictly adhere to their diet recommendations.
In most cases of IBD in cats, living a long and happy life is likely. The sooner the diagnosis is made and treatment is started, the better chances your cat has to recover.
In more severe cases, cats can have a difficult time responding to treatments, or could not respond at all, and the prognosis is poorer for these cats.
Featured Image: iStock.com/Peter Sterling
Irritable Bowel Syndrome in Cats (IBS)
What is Irritable Bowel Syndrome in Cats?
Irritable bowel syndrome (IBS) in cats is typically an acute (severe and sudden) onset episode of gastrointestinal distress.
Episodes of IBS in cats often occur in response to a stressful event, an intolerance or allergy to some component of the cats diet, or a change in the normal function of the colon.
What Is the Difference Between IBS and IBD in Cats?
While IBS in cats is severe and sudden inflammation of the gastrointestinal tract, IBD (inflammatory bowel disease) in cats is a syndrome characterized by chronic (long-term) inflammation of the mucosal lining of the intestinal tract.
IBD is usually the result of an underlying disease process such as a bacterial imbalance, food allergies or intolerances, or other genetic factors.
Definitive diagnosis of IBD requires biopsies of the stomach and intestinal tract via laparotomy (exploratory surgery) or endoscopy (investigation with a long, flexible tube).
Cats with IBD typically have thickened intestinal walls due to the chronic inflammatory response. Cats with IBS typically have normal biopsy results.
Symptoms of IBS in Cats
The most common symptoms of IBS in cats include:
Cats may also experience:
The episodes of IBS may be frequent, severe, or poorly managed.
Causes of IBS in Cats
While a definitive cause of IBS in cats is unclear, IBS typically occurs in response to a stressful event, such as:
IBS can also come from a dietary intolerance or allergy, or a change in the normal function of the bowel.
How Veterinarians Diagnose IBS in Cats
Your vet will do a physical examination, review your cats medical history, and ask about any recent potential stressors when diagnosing your cat with IBS.
IBS is often a diagnosis of exclusion, so diagnostic tests, including CBC/blood chemistry, a fecal exam, urinalysis, serologic testing (FeLV/FIV), abdominal X-ray and/or ultrasound, may be ordered to eliminate other conditions.
The veterinarian might also recommend intestinal biopsies to rule out other inflammatory, fungal, or neoplastic (abnormal cell growth) conditions.
Cats with IBS may show increased spasticity (muscle stiffening) of the colon and more mucus inside the colon if a colonoscopy is performed.
However, biopsies of the stomach and intestinal tissues are usually normal in cats with IBS.
How Veterinarians Treat IBS in Cats
Stopping the diarrhea and abdominal pain are key treatment goals for cats with IBS.
To help your cat, your vet may administer:
Intravenous fluids to restore hydration
Antidiarrheal medications
Stool softener to resolve constipation
Antispasmodics to control colon spasms
In severe cases of IBS, some cats may benefit from a short course of corticosteroids (prednisolone), antibiotics, and pre/probiotics to help relieve their symptoms.
Dietary management, stress management, and medical intervention are important long-term components for your cats recovery from IBS.
Feeding Cats With IBS
Cats with IBS should be offered an easy-to-digest, high-fiber, low-fat diet to restore normal gut health and promote the return of normal, healthy stools, such as:
Recovery and Management of IBS in Cats
You can supplement your cats diet with probiotics to maintain a healthy bacterial flora in the gut.
Diet Elimination Trial
Cats with a suspected dietary intolerance may also benefit from a diet elimination trial, which means placing your cat on a diet of a new protein they have never tried before.
Specific protein intolerances may be identified with an elimination diet, although you will need to monitor your cat for several weeks to see improvement in your cats overall physical condition and gastrointestinal health.
Managing Stress
Stress management is also critical for your cat to avoid recurrent bouts of IBS.
Medications that help with anxiety, along with calming collars, sprays or diffusers, and probiotic supplements added to the diet before or after the stressful event may lessen the severity and duration of your cats stress.
Lifestyle management should focus on eliminating or minimizing stressors in your cats daily routine. Support your cat before stressful events, such as travel, boarding, or visits from family and friends, to help minimize your cats stress response.
Also make sure that your cat with IBS has a nutritionally appropriate life-stage diet, regular human interaction, and daily exercise. These lifestyle elements are vital to promoting your cats mental health and well-being.
Irritable Bowel Syndrome in Cats FAQs
What can I feed a cat with irritable bowel syndrome?
Cats with IBS often respond and improve after transitioning to a hypoallergenic diet with a new protein if a dietary intolerance is suspected.
Easy-to-digest, high-fiber, low-fat diets (Hills w/d) have also been shown to improve overall digestive health and alleviate the constipation, excess gas, and diarrhea associated with IBS in cats:
Adding a probiotic supplement to the diet can also promote a return to and maintenance of good gut bacteria.
References
Craven, M., BVetMed, PhD, DSAM, DECVIM-CA, MRCVS. (n.d.). Irritable Bowel Syndrome - Does It Exist? The World Small Animal Veterinary Association. https://www.vin.com/apputil/content/defaultadv1.aspx?pId=12886&catId=57099&id=7054775
Ettinger, S. J., & Feldman, E. G. (1994). Diseases of the Large Intestine. In Textbook of Veterinary Internal Medicine (pp. 12501251). WB Saunders Co.
Sherding, R. G. (1994). Diseases of the Intestines. InSaunders Manual of Small Animal Practice(p. 710). American Animal Hospital Association.
Tiller, Jr, L., & Smith, F. W. K. (1999). Irritable Bowel Syndrome. In Blackwells 5 Minute Veterinary Consult Canine and Feline (pp. 746747). Lippincott Williams & Wilkins.
WRITTEN BY
Leslie Gillette, DVMVeterinarian
Dr. Leslie Gillette graduated from the University of Florida College of Veterinary Medicine in 1998.After 12 years of small animal...
