Integrative Pet Vet column: Upset tummies and inflammatory bowel disease in cats
Integrative Pet Vet
Vomiting is a common occurrence in cats. Even healthy cats vomit occasionally. The challenge is deciding when the vomiting is just the periodic hairball or an indication of a more serious problem. There are numerous causes of vomiting in cats including hairballs, intestinal parasites, food allergies, ingesting inappropriate items like string or rubber bands, diabetes, kidney disease, cancer and thyroid disease.
Vomiting and diarrhea are the most common signs in cats with inflammatory bowel disease (IBD). Loss of appetite and weight loss may occur, but some cats develop a ravenous appetite. IBD is the result of long-term (chronic) inflammation or irritation of the gastrointestinal tract (stomach and intestines). Cats of any age can be affected, but middle age and older cats are more often have IBD. With IBD, inflammatory cells move into the wall of the stomach and/or intestine. Over time this can result in thickening of the wall and reduced ability to properly digest and absorb food.
The signs of IBD are related to the portion of the digestive tract involved and the severity of the inflammation. If the inflammation is in the stomach or first part of the small intestine, chronic vomiting is the likely sign. Lower small intestine involvement could lead to weight loss, and if the large intestine is affected, diarrhea can occur. Complicating the presentation is the possibility of multiple areas of the digestive tract being affected.
Currently, IBD is thought to be the result of complex interactions between diet, intestinal bacteria populations (intestinal flora), the immune system, and other environmental factors like stress and anxiety. Some authorities speculate that there may also be genetic abnormalities of the immune system that contribute to IBD in cats.
Diagnosis generally involves an extensive workup with blood tests, stool examination for parasites and other abnormalities, feline leukemia test, thyroid tests, measurement of blood folate and B12 levels, X-rays and maybe an ultrasound. Trial feeding of a hypoallergenic diet may be used to rule out food allergies. The extensive workup will either give a clear diagnosis or rule out many of the potential causes of the signs of illness.
While this workup excludes the other causes of vomiting and diarrhea, conclusive diagnosis of IBD requires obtaining a biopsy of the affected portion of the digestive tract. Obtaining biopsies of the digestive tract is not appealing to everyone because it involves anesthesia and an endoscopic procedure or abdominal surgery. However, many feel that abdominal ultrasound can provide enough supportive evidence to conclude that the problem is IBD.
Once the conclusion is reached that IBD is present, therapy can be initiated. At this time, there is not a single best treatment, so it is likely that several different therapies or combinations of therapies will be tried before the best treatment for that individual cat is determined.
Therapies include use of hypoallergenic or novel protein diets, probiotics, and increased soluble fiber. Herbs like slippery elm (see previous article: Slippery elm often used for digestive problems, Sept. 22, 2017) and marshmallow have been used for IBD problems. Amino acids like L-glutamine can be helpful to support the cells lining the small intestine. Vitamin B12 supplementation may be necessary.
The liver is often overworked in situations where there is inflammation in the intestines making liver support valuable. The herb milk thistle may be of benefit. Use of drugs like the antibiotic metronidazole and prednisolone can be important if there is a poor response to other approaches.
Management of stress and anxiety can involve changes in the environment such as increased enrichment and activity. Products like Rescue Remedy, the calming pheromone Feliway, or nutriceutical products designed to promote calming can be valuable. Nutritional and glandular support of the adrenal glands aid the cat’s ability to manage stress.
If you have questions or concerns about your cat and IBD, contact your veterinarian.
Ron Carsten, DVM, PhD, CVA, CCRT was one of the first veterinarians in Colorado to use the integrative approach, has lectured widely to veterinarians, and has been a pioneer in the therapeutic use of food concentrates to manage clinical problems. He is also the founder of Colorado Animal Rescue (CARE). In addition to his Doctor of Veterinary Medicine, he holds a PhD in Cell and Molecular Biology and is a Certified Veterinary Acupuncturist and Certified Canine Rehabilitation Therapist. He practices integrative veterinary medicine in Glenwood Springs.
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