Occasionally, your cat may experience occasional vomiting and soft or watery stools. If this happens, check to see if they are eating, drinking, and behaving normally and, if not, you should contact your primary care veterinarian for advice.
In some cases, the condition may improve within a day or two and no special treatment is needed. If your veterinarian is concerned, they may recommend scheduling an appointment for a thorough physical examination. However, if your cat stops eating or drinking, lays around the house, hides from people, cries as if in pain, or behaves differently than normal, you should act promptly to have your cat seen by a Board-Certified veterinary specialist, an urgent care facility, or an emergency hospital.
If the vomiting or diarrhea (or both) do not improve after two weeks, your cat may have inflammatory bowel disease (IBD), which is also called chronic enteropathy (CE). Weight loss and lack of appetite are also frequently seen. There are several possible causes of IBD/CE. Your primary veterinarian can perform diagnostic tests to rule in or rule out some of the underlying diseases. If routine tests do not determine the exact cause, additional in-depth testing may be necessary. In these cases, your veterinarian may recommend referral to a veterinary specialist to assist in the diagnosis and management.
Several types of Board-Certified veterinary specialists have the knowledge and experience to help cats with signs of IBD/CE. Most often, a Board-Certified Small Animal Internal Medicine Specialist (SAIM) will be the initial specialist to accept a referral from your primary veterinarian. Examples of other veterinarians that can help with your cat’s care include Board Certified Nutritionists, radiologists, and pathologists.
This specialist will review the history, medical records, and results of the diagnostic tests and treatments your cat has received so far. They will then perform a careful physical examination and consider the various causes that have not yet been ruled out. They will recommend an approach that may include more advanced testing, hospitalization, and/or new treatments. You will be able to ask questions and have a discussion about next steps before approving the plan.
As every cat is a unique individual, there are no absolute rules for diagnosing and treating IBD/CE. There are some general guidelines, but the following is not intended to be medical advice or specific recommendations.
A first step in determining the cause is to differentiate between primary gastrointestinal (GI) disease (affecting the stomach and intestines) and secondary diseases including kidney disorders, endocrine imbalances (such as diabetes or increased thyroid hormone), or cancer. The results of laboratory tests and imaging (x-rays, ultrasound) can often distinguish between primary and secondary causes.
Your veterinarian may recommend obtaining biopsy samples from the GI tract. This can be done in several ways such as needle aspiration, endoscopy, colonoscopy, and/or abdominal surgery. Results from biopsies can help distinguish cancer (such as intestinal lymphoma) from inflammation. The treatment plan can then be targeted toward the likely cause.
The intestinal inflammation that is common in cats with IBD/CE may be a result of a sensitivity or intolerance of their food. It can be a reaction to a single ingredient, multiple ingredients, or the nutrient balance of the overall diet. Therefore, it is reasonable to perform one or more dietary trials. Many research studies have shown that at least half of cats with IBD/CE will improve with a change in diet. Your primary veterinarian or specialist may suggest feeding a hydrolyzed protein or novel protein therapeutic diet. Other options include highly-digestible, limited-ingredient, higher-fiber, and/or higher-protein diets. Improvement with a diet trial can be seen as quickly as 2-3 days but more commonly takes up to 2-3 weeks. If cats do not like the new diet, there are many others to choose from that have different ingredients, flavors, and textures. A Board Certified Veterinary Nutritionist can be very helpful in evaluating cats’ current diets and providing detailed information about dietary trials. They can provide short- and long-term follow-up care and are able to adjust the diets and feeding plans as needed.
Medications can be used to treat GI inflammation. As with dietary trials, it may take one or more therapeutic trials to determine which drugs, if any, help with the condition. Many treatments are given orally, including tablets and capsules, and for cats that are difficult to medicate there may be powder or liquid alternatives. Your veterinarian may use a compounding pharmacy to change the medication into a form that your cat will accept. Appetite stimulants are available that can help encourage cats to eat. Dietary supplements such as probiotics, fiber, vitamins, etc. may be helpful but should only be used as prescribed or recommended by your veterinarian.
Cats may never be cured of IBD/CE but they can go into remission where some of the treatments may be reduced or discontinued. One of the main goals of treating IBD/CE is to stop any ongoing weight loss and encourage your cat to start eating to regain a normal body weight. A reduction in the episodes of vomiting and/or diarrhea is also a sign of improvement. Cats that respond to treatment often become more like themselves and have a better quality of life. The special diets and/or medications and supplements may have to be continued for an extended period of time to maintain disease remission. It is important to continue seeing your primary veterinarian and/or specialist at regular intervals to monitor your cat’s health. By partnering with your primary care veterinarian and a Board-Certified veterinary specialist, you can provide your cat with the best chance of living a long, healthy life