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Inflammatory Bowel Disease
The term inflammatory bowel disease refers to a condition that results when cells involved in inflammation and the bodies immune response infiltrate the lining of the GI tract. This infiltration thickens the bowel lining and interferes with absorption of nutirents and GI motility (the ability of the bowel to contract and propagate food).
With inability to contract absorb, the bowel’s function is disrupted. Chronic vomiting results if the infiltration is in the stomach or or upper small intestine. Liquid diarrhea with weight loss results if the infiltration is in the lower small intestine. Pudding-like stool, laden with mucus and/or fresh blood (colitis) results if the infiltration occurs in the large intestine. In the worst case scenario, the entire tract from top to bottom may be involved. Inflammatory Bowel Disease should not be confused with Irritable Bowel
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Occasional vomiting or diarrhea seems to be pretty standard for dogs and cats. After all, cats groom themselves and get hairballs, and dogs often lack dietary decscretion and eat things they aren’t supposed to. However, many owners notice that their pets seem to have vomiting or diarrhea more often than it seems they should. It is often subtle where one notices that one is cleaning up hairballs or vomit piles more frequently than with previous pets. Or there could be a sudden realization that one hasn’t seen the pet have a normal stool in weeks or months. Typically, the affected dog or cat doesn’t seem obviously sick, nothing worse than perhaps a little weight loss, and of course, the chronic vomiting and/or diarrhea. Inflammatory bowel disease accounts for a large percentage of this type of presentation in dogs and cats. Dogs with inflammatory bowel disease more commonly present with chronic diarrhea, and cats more commonly present with chronic vomiting, although both presentations regularly occur in both species.
Achieving a diagnosis of inflammatory bowel disease is multifactorial. It is first important that the veterinarian rule out all other possible systemic possibilities for the set ot clinical signs. This includes kidney disease, endocrine disease, liver disease, parasites and cancer just to name a few. Therefore, an inflammatory bowel disease work-up should always begin with a good thorough physical examination, blood chemistry, complete blood count, urinalysis, fecal flotation, and abdomenal x-rays.
Inflammatory bowel disease often does not show any abnormalities with these diagnostics. However, once all other systemic diseases have been ruled out, the veterinarian can begin to focus on resolving the inflammatory bowel disease.
The first consideration is to provide relief for the affected dog or cat. This consists of a course of metronidazole (an effective antibiotic with antidiarrheal properties) to treat diarrhea, and/or metoclopramide (an antinausea agent). Next, the patient should be placed on a hypoallergenic food trial, to rule out allergy to ingested protein sources. Many of these prescription diets exist for dogs and cats, two of the best being IVD and Hill's ZD Ultra. During the food trial the canine or feline patient cannot be fed anything else but the special diet.
At this point, if the dog or cat suspected to have inflammatory bowel disease improves with the medication(s) and does not ever have problems while on the hypoallergenic diet, then you have your solution - keep the pet on the diet. However, if improvement is temporary, but relapses once the medications have ceased, and you have been consciencious in feeding only the hypoallergenic diet, then more diagnostics need to be performed to formulate a long term treatment strategy. It is also improtant because there are other diseases that can primarily affect the GI tract of dogs and cats that can mimic inflammatory bowel disease that also escape detection by the aforementioned routine diagnostics. Examples of other diseases that can look just like inflammatory bowel disease include GI lymphoma , infection with a bacteria called H. Pylori, or hyperplasia.
The next mode of diagnostic that follows is endoscopy - colonoscopy for chronic diarrhea, or upper GI endoscopy for chronic vomiting. Endoscopy requires general anesthesia. Once the dog or cat is under, a scope with a camera on the end is fed into the GI tract. The GI tract can then be visualized by the veterinarian, looking for obstructive lesions such as masses, polyps, or plaques, as well as other lesions such as ulcers. If anything unusual is seen (or not seen), biopsy samples can be taken by the endoscope, and then submitted for cellular analysis.
If the a dog or cat is ultimately diagnosed with having inflammatory bowel disease and dietary management alone has failed, then medical management long term may be necessary. Some dogs and cats can be managed with daily maintenance metronidazole alone, but others require cotricosteroids to get the inflammatory bowel disease under control. In rare cases, the patient has to be placed on a drug that suppresses the immune system, such as azothiaprine.
By: Roger L. Welton, DVM
Founder, Web-DVM
President Maybeck Animal Hospital
Author Canine and Feline 101
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