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At a glance
About: Inflammatory bowel disease (IBD) is a group of disorders caused by the infiltration of inflammatory cells into the mucosa of the gastrointestinal tract.
Causes: The exact cause is not understood, but some theories include parasites, genetic predisposition, certain gut bacteria, allergy or intolerance, which leads to the formation of antibodies which attack the mucosa.
Symptoms: Diarrhea, vomiting, lethargy, weight loss and anorexia (loss of appetite).
Treatment: Dietary modifications, corticosteroids or other drugs to suppress the immune system and in some cases, antibiotics.
World IBD day: 19th May.
Inflammatory bowel disease is a group of disorders caused by the infiltration of inflammatory cells (white blood cells) in the mucosa of the gastrointestinal tract. It can affect both the upper and lower intestinal tract.
- Colitis – Inflammation of the large intestine.
- Enteritis – Inflammation of the small intestine.
- Enterocolitis – Inflammation of the large and small intestine.
- Gastritis – Inflammation of the large and small intestine as well as the stomach.
IBD’s are classified according to the type of inflammatory cell infiltrating the gastrointestinal wall.
- Lymphocytic-plasmacytic enterocolitis – The most common form of IBD. Lymphocytes (a type of white blood cell) and plasma cells (antibody-producing cells) are the predominant types of inflammatory cells present in the mucosa of the small and large intestine.
- Eosinophilic Enterocolitis – The second most common form of IBD, eosinophils are present in the stomach, small intestine or colon,
- Granulomatous (Regional) enteritis – Macrophages in the lower small intestine and colon.
IBD is the leading cause of chronic vomiting and diarrhea in cats. It can affect cats of any age, although it occurs more often in middle-aged to older cats. Persistent inflammation results in fibrosis (formation of scar-like fibrous tissue), poor digestion and absorption may also result.
The cause of IBD is still unknown although evidence suggests that it could be the result of certain bacteria, dietary allergy or intolerance, genetic influence and parasites causing cats to produce antibodies that attack the digestive tract.
There is increased attention towards the role of gut microflora (gut microbiome). These are a group of micro-organisms that live in the gut and has many roles such as inhibiting pathogens, metabolic function, assisting the immune system, regulating the production of antibodies.
Several diseases which include digestive disorders are now being linked to gut microbiome due to an inappropriate immune response, an overgrowth of certain bacteria or reduced diversity of gut microbiome. While still in its infancy, this area of medicine is one which many researchers believe shows great promise for several medical conditions.
Clinical signs vary depending on the region affected and may include:
- Diarrhea (possibly outside the litter tray)
- Smelly feces
- Blood or mucus in the stool
- Loss of appetite or increase in appetite
- Borborygmus (rumbling sound due to gas in the intestines)
- Weight loss
The veterinarian will perform a physical examination of your cat upon which may show weight loss, dehydration, thickened intestinal loops upon palpitation. He will also obtain a medical history from you.
There are many other conditions which may produce similar symptoms to IBD so your veterinarian will wish to rule these out. Other conditions include parasites, neoplasia, hyperthyroidism, diabetes, salmonellosis, campylobacteriosis, chronic renal failure, liver disease, chronic pancreatitis.
- Baseline tests: Biochemical profile, complete blood count, and urinalysis to evaluate the overall health of the cat and check kidney and liver function as well as blood sugar levels, which can indicate diabetes.
- T3 and T4 tests: These blood tests measure levels of T3 & T4 hormones, which are secreted by the thyroid gland, elevated levels occur in cats with hyperthyroidism.
- Fecal examination/fecal flotation: To look for the presence of parasitic worm eggs or giardia cysts.
- FIV and FeLV tests: To determine a secondary disease is present.
- X-rays/ultrasound: These imaging techniques don’t help diagnose IBD but are useful to rule out other medical conditions such as cancer. Ultrasound may see evidence of a thickening of the intestinal wall.
- Biopsy/histopathology: The only definitive way to diagnose IBD. Increased numbers of plasma cells, lymphocytes, eosinophils, and neutrophils are present in the intestinal wall. The types of cells present will provide a diagnosis of which type of IBD the cat has.
As pancreatitis can run concurrently with IBD, your veterinarian may also wish to run one (or more) of the following tests;
- fTLI (feline Trypsin-Like Immunoreactivity): This test measures the concentrations of trypsin-like proteins in blood serum.
- fPLI (feline Pancreatic Lipase Immunoreactivity): A measure of feline pancreatic lipase (an enzyme secreted by the pancreas which breaks down fat) immunoreactivity in serum.
The goal of treatment is to identify and treat the cause, where possible as well as manage symptoms. Treatment requires a multimodal approach, which may include the following:
- A highly digestible, low-fat diet containing a novel protein.
- Metamucil (psyllium) to add bulk to the feces.
- Probiotics to promote healthy gut bacteria.
- A high fibre diet in cats with colitis.
- Corticosteroids: Prednisone is the drug of choice (as well as dietary therapy) for all types of
inflammatory bowel disease. These drugs have anti-inflammatory and immunosuppressive properties.
- Antibiotics: Metronidazole is an antibiotic with anti-inflammatory properties and can be used along with diet therapy to help manage IBD.
- Other immunosuppressive drugs: Azathioprine (brand name Imuran) is an immunosuppressive drug which can be used in combination with corticosteroids. There can be side effects; it is therefore only used as third-line therapy in refractive (unresponsive to diet and corticosteroids alone) IBD. Cats on this drug should have a CBC every week for the first month and every 2-3 weeks while the cat is on the drug.
- Sulfasalazine: This anti-inflammatory medication is the drug of choice for lymphatic-plasmacytic colitis.
Fecal microbiota transplant (FMT):
Fecal transplants are still very new and not readily available yet, but interest in this therapy is growing. It shows great promise for helping cats with digestive issues such as inflammatory bowel disease. A healthy donor with a healthy and diverse microbiome provides a stool sample. This is introduced to the host cat in several ways such as colonoscopy, endoscopy, enema or pill to restore a diverse microbiome.
 The Cornell Book of Cats