Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is inflammation of the intestine and is very common in cats.  The cause is unknown but may be due to the fact that the diet we feed cats is very different from the diet they originally ate in the wild.  Often IBD occurs with pancreatitis and hepatitis, and is referred to as triaditis.  Triaditis is common in cats because the accessory pancreatic duct is small, or as in most cases, absent.  In addition, the pancreatic duct connects to the common bile duct (part of the liver) before entering the small intestine allowing infection and inflammation to spread and affect all three organs.


The most common and sometimes the only sign of IBD is weight loss.  The following is a list of other signs that can be seen with IBD:


Vomiting

Diarrhea

Constipation

Decreased appetite

Increased appetite

Teeth grinding when eating (indicating nausea)

Lethargy

Sitting in a hunched position due to pain


Diagnosis of IBD can be difficult and often cats are treated empirically with medications.  The follow tests can be performed when suspecting IBD.


Various Fecal Tests: Rule out parasites as a cause.


CBC:  Measures white and red blood cells.  Often white blood cells called neutrophils and eosinophils are elevated with IBD, indicating inflammation.


Chemistry:  Measures values of the blood such as the kidney and liver values.  With IBD, the phosphorous can decrease and the BUN can elevate, but not always.  If the liver is inflamed, liver enzymes can increase as well.


fPLI and Cobalamin level:  Determines if the cat has pancreatitis and measures the cobalamin level.  This test requires 12 hours of fasting prior to drawing the blood.  The fPLI test is used to detect pancreatitis (which often occurs with IBD) but is somewhat lacking in sensitivity.  If it is positive, however, it accurately diagnoses pancreatitis.  The Cobalamin level is used to determine the level of Vitamin B12.  Often cats with IBD have a low vitamin B12 which must be treated.  We are less likely to perform the fPLI and Cobalamin level due to the expense and issues with accuracy, but rather treat empirically.


Utrasound: Determines if the intestine is thickened, and can identify moderate to severe pancreatitis and hepatitis.  It is a non-invasive procedure and usually does not require anesthesia.  It does not differentiate between intestinal inflammation and intestinal cancer unless a mass lesion is found and it is possible to do a fine needle aspirate.


Endoscopy:  An endoscopy can determine if the intestine is inflamed but it is not possible to visualize the entire intestinal tract.  It is possible to retrieve small tissue biopsies with the endoscope, however, and submit them for histopathology.  Diagnosis, however, often requires larger samples than an endoscopy can provide.


Exploratory Surgery:  This is the most accurate way to diagnose IBD and to differentiate it from other diseases.  The procedure does require anesthetic and is invasive. 


Treatment for IBD:


Poultry diet:  We recommend a poultry diet and to avoid foods that contain ingredients shown to cause intestinal inflammation in cats. These ingredients include: wheat, corn, soy, beef, lamb, and seafood.  Please see the following article:


https://sites.google.com/site/felinehealthcare/home/cat-food


Probiotic:  We recommend Fortiflora, an over the counter probiotic, that comes in sachets that can be added to wet food.  Probiotics are considered a supplement by the FDA, and are not tested to determine if they are effective, so you must be careful when choosing a probiotic.  A recent study determined that among veterinary probiotics, only two brands spelled everything correctly on the labels and contained the contents that were listed on the product labels.  


https://docs.google.com/viewer?a=v&pid=sites&srcid=ZGVmYXVsdGRvbWFpbnxmZWxpbmVoZWFsdGhjYXJlfGd4OjM0ZTA0MTQ3MGM4ZDRhOQ


Vitamin B12 injections (cobalamine):  Cats require a lot of vitamin B12, and intestinal inflammation prevents vitamin B12 absorption from the diet, which in turn causes vitamin B12 deficiency, leading to further intestinal inflammation.  To correct the deficiency, vitamin B12 is given every two weeks subcutaneously.  It is a very safe medication, easy to give, and not expensive.


Cerenia:  Cerenia is a medication that is used as an anti-inflammatory which works by blocking a neurotransmitter in the inflammatory cascade. Cerenia is labeled for dogs but commonly used in cats for nausea, vomiting, intestinal inflammation, bladder inflammation, allergic conditions, and arthritis. We have not seen any side effects, but according to literature it can cause twitching if overdosed.  The typical dosage for this medication is 4 mg once a day for 5 days and then every other day or twice weekly. It can be used with various other medications such as prednisolone to control inflammation. Due to the fact that the medication is bitter, we put it in gel caps so the cat does not taste the Cerenia.


Prednisolone:  Prednisolone is a steroid, which can be given to cats to decrease intestinal inflammation.  It is usually very effective, but of course there are side effects that can be rarely associated with Prednisolone.  


Mirtazapine:  Mirtazapine is an appetite stimulant that also has an added benefit of controlling nausea.


Metronidazole:  Is an antibiotic that is used for intestinal infections.  Not only does it have antibacterial properties, but also concurrent immune modulation properties.  The specific role of metronidazole in therapy of IBD, however, is still not completely known.

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