Intestinal disease dilemmas

A four year old male neutered domestic short hair was referred for further investigation of progressive diarrhoea, vomiting and inappetence of 3 months duration.

The cat was bright, there had been some weight loss. Physical examination was unremarkable. Blood tests revealed mild eosinophilia. B12, folate and tests for pancreatic function were all within normal limits. Ultrasound demonstrated mild diffuse thickening of the small intestinal walls, mainly affecting the muscularis layer where the change was prominent. Endoparasite treatment was undertaken and a hypoallergenic food trial commenced.

There was a transient good response, but the signs recurred after 2 months. Laparotomy and full thickness intestinal biopsy was recommended but the owner declined. Metronidazole treatment was commenced, but no response was seen. Endoscopic biopsies from the small intestine demonstrated moderate lymphoplasmacytic to eosinophilic inflammation. Prednisolone therapy was introduced, and the signs and eosinophilia resolved.

The dose was tapered to the lowest possible, and the cat remained stable for 3 years although it was not ever possible to withdraw treatment altogether.

After 3 years, signs recurred over a period of two weeks, and the patient was essentially anorexic. Physical examination and blood test results were unremarkable. Ultrasound was unchanged from the previous scan. There was a poor response to various supportive medications. Repeat biopsies were discussed, and the owner consented to full thickness intestinal biopsies which were undertaken by the referring vet. These demonstrated mild mixed inflammation with both neutrophils and eosinophils involved. No neoplastic cells were seen. A diagnosis of inflammatory enteropathy, most likely inflammatory bowel disease, was confirmed. Once wound healing was complete, the patient stabilised with a temporarily increased prednisolone dose, the introduction of a second immunomodulatory medication, and some short-term appetite stimulants. He has so far been well controlled for a further 3 years.

Feline patients with intestinal disease always present some dilemmas. Whether to biopsy, and whether to undertake this via endoscopy or more invasively at surgery to gather full thickness samples, is the subject of much debate given the difficulties in differentiating benign, malignant but responsive, and malignant non-responsive disease. I have had to negotiate the anguish of this decision-making process myself with one of my own cats. This, and the many years’ experience I have had with a great variety of feline patients and their owners, is immensely helpful in guiding each individual to the right decision for their circumstances and preferences.