Inflammatory bowel disease: overview in Cats (Felis) | Vetlexicon
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Inflammatory bowel disease: overview

ISSN 2398-2950


Synonym(s): IBD

Introduction

  • Most common cause of chronic vomiting Vomiting and diarrhea Diarrhea: overview.
  • Cause: any idiopathic inflammatory condition of the small or large intestine:
  • Signs: chronic gastroenteritis (diarrhea and vomiting), weight loss.
  • Characterized by infiltration of gastrointestinal tract with inflammatory cells including:
    • Lymphocytes.
    • Plasma cells.
    • Eosinophils.
    • Macrophages.
    • Neutrophils.
  • Diagnosis: idiopathic nature makes it a diagnosis of exclusion.
  • Treatment: dietary change, immunosuppressive therapy (prednisolone/azathioprine/chlorambucil).
  • Prognosis: good with appropriate treatment.
    Print off the owner factsheet on Inflammatory bowel disease  Inflammatory bowel disease  to give to your client.

Pathogenesis

  • Underlying cause unknown but immune mechanisms involving the response of the gut-associated lymphoid tissue (GALT) implicated:
    • Genetic factors, eg major histocompatibility type.
    • Specific defects in the immune system.
    • Mucosal and/or systemic infection (viral, bacterial or parasitic).
    • Abnormal or inappropriate antigen presentation.
  • Complement activation, mast cell degranulation and T-cell and macrophage activation   →   active inflammation.
  • Location and relative amount of inflammatory mediators depend on inciting factors and immune response   →   variable clinical and pathological presentations.
  • Possible progression from IBD to lymphoma Lymphoma  in some cases.
  • Hypersensitivity to luminal dietary or microbial antigens implicated.
  • IBD is often found concurrently with other diseases, such as cholangiohepatitis Liver: cholangitis, and Pancreatitis Pancreatitis. The concurrent occurrence of these three disorders in cats is termed "triaditis".

Signs

  • Chronic/recurrent vomiting.
  • Chronic/recurrent diarrhea Diarrhea: dietary (small or large intestinal).
  • Tenesmus, hematochezia, mucoid stools.
  • Anorexia Anorexia or ravenous appetite.
  • Weight loss.
  • Lethargy.
  • Unkempt coat.
  • Aggressive behavior.

Diagnosis

Hematology

Biochemistry

Hormone assay

Serology

  • FeLV antigen FeLV test and FIV antibody testing FIV test (may be part of panel when investigating weight loss).

Urinalysis

Fecal analysis

Therapeutic trials

  • For diet-responsive conditions (rarer in cats than in dogs).
  • For antibiotic responsive conditions (rarer in cats than in dogs).

Radiology

Ultrasonography

  • +/- thickened GIT Ultrasonography: GI system. Older cats with thickened muscularis layer more likely to have lymphoma than IBD (Zwingenberger et al, 2010).
  • Raised lymph nodes.
  • +/- hepatic/pancreatic abnormalities.

Endoscopy

  • To examine intestinal mucosa - often granular, friable lesions or erosions Flexible endoscopy      Gastroscopy.
  • May be normal - lesions can be microscopic.

Histopathology

  • Intestinal biopsy is the only method of definitive diagnosis. Endoscopic biopsy safest; surgical biopsy to assess muscularis and to sample pancreas/liver.
  • Biopsy several sites (6-15 depending on quality of biopsies) because signs do not always correlate with site of pathology. Biopsy of both duodenum and ileum increases likelihood to reach diagnosis.
  • Lymph node biopsy/aspirate Cytology: lymph node aspirate should be taken if lymphadenopathy Lymphadenopathy is detected.
  • Usually lymphocytic-plasmacytic or eosinophilic infiltrate predominates.
  • In chronic cases mucosal villus atrophy and fibrosis may be severe.
  • Sometimes difficult to differentiate lymphocytic inflammation with low grade small cell lymphoma Lymphoma. Assess immunohistopathology for immunophenotyping or polymerase chain reaction (PCR PCR (Polymerase chain reaction)  ) results for B and/or T cell clonality (Kiupel et al, 2011).
  • Liver and pancreas histopathology: lymphocytic-plasmacytic inflammation.

Differential diagnosis

Treatment

  • Diet:
    • Reduce antigenic load, increase fiber.
    • Highly digestible, gluten free diet.
    • Moderate fat restriction.
    • May supplement with medium chain triglycerides Fat.
    • Feeding prescription antigen-restricted or hypoallergenic diets may help.
    • Supplementation with folates and cobalamin may be required.
  • Prednisolone Prednisolone 0.5-2.0 mg/kg (in severe cases) BID PO for 2 weeks, then tapering dose.
  • In refractory cases chorambucil Chlorambucil (2 mg total dose EOD), cyclosporine   Ciclosporin (5-10 mg/kg SID/BID).
  • Antibiotics - to reduce antigenic load, eg metronidazole Metronidazole 7-15 mg/kg PO BID, oxytetracycline Oxytetracycline, tylosin Tylosin  Therapeutics: antimicrobial drug.Metronidazole may suppress cell-mediated cellular responses in addition to its antiprotozoal and antibacterial effects; it is also mutagenic and not recommended >2 weeks.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Lalor S, Schwartz A M, Titmarsh H et al (2014) Cats with inflammatory bowel disease and intestinal small cell lymphoma have low serum concentrations of 25-hydroxyvitamin D. JVIM 28 (2), 351-355 PubMed.
  • Burke K F, Broussard J D, Ruaux C G et al (2013) Evaluation of fecal α1-proteinase inhibitor concentrations in cats with idiopathic inflammatorybowel disease and cats with gastrointestinal neoplasia.​ Vet J 196 (2), 189-196 PubMed.
  • Kiupel M, Smedley R C, Pfent C et al (2011) Diagnostic algorithm to differentiate lymphoma from inflammation in feline small intestinal biopsy samples. Vet Pathol 48 (1), 212-222 PubMed.
  • Scott K D, Zoran D L, Mansell J et al (2011) Utility of endoscopic biopsies of the duodenum and ileum for diagnosis of inflammatory bowel disease and small cell lymphoma in cats. JVIM 25 (6), 1253-1257 PubMed.
  • Bailey S, Benigni L, Eastwood J et al (2010) Comparisons between cats with normal and increased fPLI concentrations in cats diagnosed with inflammatory bowel disease. JSAP 51 (9), 484-489 PubMed.
  • Jergens A E, Crandell J M, Evans R et al (2010) A clinical index for disease activity in cats with chronic enteropathy. JVIM 24 (5), 1027-1033 PubMed.
  • Zwingenberger A L, Marks S L, Baker T W et al (2010) Ultrasonographic evaluation of the muscularis propria in cats with diffuse small intestinal lymphoma or inflammatory bowel disease. JVIM 24 (2), 289-292 PubMed.
  • Trepanier L (2009) Idiopathic inflammatory bowel disease in cats. Rational treatment selection. J Feline Med Surg 11 (1), 32-38 PubMed.
  • Sturgess K (2005) Diagnosis and management of idiopathic inflammatory bowel disease in dogs and cats. In Practice 27 (6), 293-301 VetMedResource.
  • Guilford W G, Jones B R, Markwell P J et al (2001) Food sensitivity in cats with chronic idiopathic gastrointestinal​ problems. JVIM 15 (1), 7-13 PubMed.
  • Simpson K W, Fyfe J, Cornetta A et al (2001) Subnormal concentrations of serum cobalamin (vitamin B12) in cats with gastrointestinal disease.​ JVIM 15 (1), 26-32 PubMed.
  • Baez J L, Hendrick M J, Walker L M et al (1999) Radiographic, ultrasonographic, and endoscopic findings in cats with inflammatory bowel disease of the stomach and small intestine - 33 cases (1990-1997). JAVMA 215 (3), 349-354 PubMed.
  • Willard M D (1999) Feline inflammatory bowel disease: a review. J Feline Med Surg (3), 155-164 PubMed
  • Weiss D J, Gagne J M & Armstrong P J (1996) Relationship between inflammatory hepatic disease and inflammatory bowel disease, pancreatitis and nephritis in cats. JAVMA 209 (6), 1114-1116 PubMed.
  • Hart J R, Shaker E, Patnaik A K et al (1994) Lymphocytic-plasmacytic enterocolitis in cats: 60 cases (1988-1990). JAVMA 30 (5), 505-514 VetMedResource.
  • Tams T R (1993) Feline inflammatory bowel disease. Vet Clin North Am 23 (3), 569-586 PubMed.
  • Jergens A E, Moore F M, Haynes J S et al (1992) Idiopathic inflammatory bowel disease in dogs and cats: 84 cases (1987-1990). JAVMA 201 (10), 1603-1608 PubMed.

Further Reading