Inflammatory bowel disease (IBD), also known as diet or food-responsive diarrhea, food intolerance or food allergy, antibiotic-responsive diarrhea, small intestinal bacterial overgrowth, protein-losing enteropathy, and lymphangiectasia, is a catch-all term used to describe a syndrome of chronic stomach and intestinal disorders as the result of inflammatory in the gastrointestinal (GI) mucosa.
More recently the term chronic enteropathy has been used. Although the exact cause is poorly understood, many believe genetic factors, interactions of dietary antigens, and microflora in the intestine with the local immune system may affect the lining of the GI tract.
IBD is categorized on the cellular level by the type of inflammation present. This is based on the result of biopsies. Categories of IBD include lymphoplasmacytic (most common), eosinophilic, and granulomatous.
Symptoms Canine and Feline Inflammatory Bowel Disease (IBD)
Clinical signs of Inflammatory Bowel Disease in dogs and cats may include:
- Vomiting
- Diarrhea
- Lack of appetite (anorexia)
- Weight loss
- In cats, an increased appetite with weight loss has been reported
Diagnosis of Canine and Feline Inflammatory Bowel Disease (IBD)
Diagnosis of IBD in dogs and cats will be based on a combination of history, clinical signs and test results. Your veterinarian will ask you lots of questions about your dog or cat including information about the diet, medications and any possible exposure to parasites.
There are a variety of approaches to the diagnosis of IBD. Depending on the severity of your pet’s sign, your veterinarian may recommend these options prior to additional diagnostic tests.
- Food trials. In stable patients with a normal albumin protein levels in the blood and without weight loss, a food trial using a hypoallergenic diet (novel or hydrolyzed protein diets) may be recommended. Clinical studies report that 40 – 60% of dogs and cats with chronic enteropathies respond to an elimination or hydrolyzed diet, which supports the value of a food trial in the treatment of IBD.
- Empirical deworming with a dewormer medication such as fenbendazole and a course of antibiotics such as metronidazole or tylosin may be considered before pursuing further diagnostics.
Various diagnostics tests are considered when evaluating patients with IBD include:
- Routine bloodwork including a Complete Blood Count (CBC) and biochemical profile (chemistry profile)
- Fecal examination to look for parasites
- Cobalamin (Vitamin B12 levels) and folate (Vitamin B9) levels
- Serum Trypsin-Like Immunoreactivity (TLI) to evaluate for pancreatic disease
- Pancreatic Lipase Immunoreactivity (PLI)cto evaluate for pancreatic disease
- Fecal alpha-protease inhibitor to evaluate for intestinal protein loss
- Abdominal ultrasound
- Histopathology is the gold standard for the diagnosis of IBD
- Endoscopy is the most practical and least invasive method of obtaining biopsies for histopathology
- Full thickness biopsies by laparotomy or laparoscopy are useful in differentiating IBD from lymphosarcoma
- Newer diagnostic tests, immunohistochemistry, flow cytometry, T-cell clonality assay, and PARR (PCR antigen receptor rearrangement) which can be performed on endoscopic biopsy are also helpful in differentiating IBD from the cancer lymphosarcoma. Standards for describing and grading endoscopic biopsies for IBD have been developed by the World Small Animal Veterinary Association Gastrointestinal Standardization Group.
Your veterinarian will want to evaluate for obstructive, metabolic, infectious, and neoplastic disease of the gastrointestinal system when evaluating patients with chronic vomiting, diarrhea, and weight loss.
Treatment of Canine and Feline Inflammatory Bowel Disease (IBD)
Therapy for IBD in dogs and cats may include:
- Corticosteroids remain the cornerstone of treatment of dogs and cats with IBD. The dosage and duration of therapy is based on severity of clinical signs, the type and severity of inflammation, clinical response, and drug tolerance. The dose is tapered based on response over 6-12 weeks. Budesonide is an orally administered corticosteroid with high topical activity in the gut with low systemic activity.
- Dietary therapy. In dogs with a protein losing enteropathy and lymphangectasia, a low fat gastrointestinal diet is recommended.
- Cobalamin (Vitamin B12) is important in many metabolic processes and low levels may result in a delayed or lack of response to appropriate therapy. Cobalamin is supplemented once a week for 6 weeks then on an as needed basis.
- When a poor response to corticosteroids, elimination diet, and antibiotics is seen, additional immunosuppressive drugs such as azathioprine, cyclosporine, chlorambucil, and sulfasalazine (colitis) are indicated.
Prognosis with Canine and Feline Inflammatory Bowel Disease (IBD)
Some dogs and cats with IBD require either dietary management or medical therapy throughout their lives. Although IBD cannot be cured, the goal of treatment is to control the clinical signs with the lowest dose of medications possible. If reoccurrence of clinical signs is seen, re-institution or adjustments of medical therapy may be needed. Only a small number of dogs and cats with IBD are non-responsive to therapy.