IBD: Diagnosis, Types and Treatment

Inflammatory bowel disease (IBD) in dogs and cats is likely due to a variety of diseases that result in an accumulation of inflammatory cells within the lining of the stomach, small intestine, large intestine or a combination of these areas.

IBD upsets the dog digestive system to varying degrees and is usually classified according to the types of inflammatory cells present and the location affected. The causes of IBD are not well known, but are suspected to be a result of an abnormal response by the body to certain intestinal bacterial or dietary antigens (proteins).

Clinical Signs

The signs seen with IBD vary with the severity of the disease and the location affected.

Animals with IBD involving the small intestine usually present with:

Animals with IBD involving the large intestine (chronic colitis) usually present with:

Diagnosis

IBD can’t be diagnosed on physical examination, history, fecal checks, radiographs or laboratory work. These tests, however, are necessary to help rule out other diseases that may present with similar clinical signs, i.e., parasitic infections, intestinal foreign bodies, liver disease, kidney disease, metabolic diseases and cancer.

Blood studies are also helpful to assess the metabolic status and screen for concurrent problems. Some dogs with severe IBD may have low protein levels in their blood due to loss of proteins through their intestines (protein-losing enteropathy). This finding may severely worsen the long-term prognosis for the patient.

Intestinal and stomach biopsies are ultimately necessary for a diagnosis. These can be obtained either endoscopically or surgically. The ultimate recommendation of endoscopic or surgical biopsies is made based on history, clinical signs, laboratory findings and diagnostic imaging studies.

The pathologist’s evaluation of biopsy samples will confirm the presence of IBD, specify the type of cellular infiltrate involved, stage the severity of the disease, and help to establish a treatment plan and prognosis for your pet.

Types of IBD

Treatment

Dietary

The goal of dietary management is to reduce the antigenic stimulation of the gastrointestinal tract’s immune system and to meet your pet’s nutritional requirements in an easily digestible form. This may be done with homemade diets (using recipes we provide you) or one of several commercially available diets.

Diet therapy is often critical in achieving control of these diseases. In some patients, a limited-ingredient diet with unique protein sources may be required.

Medications

The goal of drug therapy is to “settle down” the immune response by suppressing the inflammation caused by the infiltration of cells into the gastrointestinal tract. Several types of anti-inflammatory drugs are used as the initial medications depending on the type of inflammation present. In patients with more severe disease, a combination of immunosuppressive medications may be prescribed.

Prednisone and prednisolone are the primary anti-inflammatory drugs used because of their degree of effectiveness, as well as their low cost and wide availability.

Depending on the cause of the disease, most pets will show improvement in gastrointestinal signs within one to two weeks of starting appropriate therapy.

The primary side effects seen are dose related and include:

These can result in weight gain, agitation, restlessness and mood changes. These changes will resolve as the dose of the corticosteroid is reduced over the course of therapy.

Prednisolone is preferred in cats because many cats cannot adequately convert prednisone to prednisolone, the active anti-inflammatory ingredient.

Budesonide is a newer corticosteroid medication having largely local effects on the lining of the intestine with minimal absorption into the body. Budesonide may not be effective in dogs or cats with severe inflammatory bowel disease. Side effects are much less than those seen with other corticosteroid medications. Some patients, however, have side effects similar to those of prednisone or prednisolone. Budesonide is expensive, and the dosing of small pets requires recompounding of the medication.

These are all antibiotics with or without weak anti-inflammatory effects. Dog during taking medicine from male vet These drugs may be used alone or in conjunction with other more potent anti-inflammatory drugs. These antibiotics may modulate or alter bacterial populations within the intestine, and may allow a lower dose of the other anti-inflammatory medications to be used. They may be used alone in animals suspected to have antibiotic-responsive diarrhea.

Results

Some pets may require either long-term dietary management or low-dose medical therapy throughout their lives. Though IBD cannot be cured, the goal of treatment is to control the clinical signs without the need for medications. If any of the signs are seen, medical therapy may need to be re-instituted. Please contact your veterinarian before restarting any medication with your pet.