27/04/2021
Segments from ‘Inflammatory bowel disease – diagnosis and treatment’
Gerard Olivares and Mellora Sharman
* This article was originally published in Vet Times 48.12 (26 March 2018).
The term IBD has been adapted from human medicine, where disorders include Crohn’s disease and ulcerative colitis. The term chronic enteropathy (CE) has been suggested as more appropriate for veterinary use, as it recognises the difference between these diseases in most of our patients compared to human medicine1.
A diagnosis of CE usually involves careful evaluation of signalment, home environment, history, physical examination, clinicopathological findings, diagnostic imaging and histopathology of intestinal biopsies. CE is diagnosed in patients with chronic GI signs (longer than three weeks). Most often, these cases are presented with vomiting, diarrhoea and weight loss.
This is, perhaps, a particularly important consideration for cats, as concurrent inflammatory disease involving the liver or pancreas (feline triaditis) can be present and may contribute to clinicopathological findings.
Stable patients with chronic GI clinical signs and normal albumin concentrations can be given the option of empirical treatment trials, initially with diet. Dietary strategies may include use of hypoallergenic or novel protein diets, low-fat and easily digestible diets, or alteration of the fibre content.
A dietary trial with hydrolysed diet or antigen-restricted/novel protein source should be performed for a minimum of one to two weeks, depending on the frequency of clinical signs. Longer treatment trials may be needed for cases where less frequent, intermittent clinical signs are reported.
A single dietary approach is unlikely to suit all clinical cases, and the authors advise clients numerous dietary strategies may need to be tried before failure to respond to diet is concluded. A true dietary trial should always include a challenge phase, where relapse of disease is confirmed on introduction of the previous diet; however, many owners are reluctant to perform this step.
Concerns about long-term antibiotic use have prompted investigation of other methods of achieving the same results. The two main treatments with this aim are the use of probiotics, prebiotics and synbiotics, and faecal transplantation.