Inflammatory bowel disease is cats is a frustrating problem characterized by vomiting, diarrhea, weight loss and anorexia. Since other problems such as parasites, pancreatitis or cancer may cause the same clinical signs, a biopsy of the intestinal wall provides the definitive diagnosis. Patients with inflammatory bowel disease are reacting to something in their intestinal tract. This could be the protein in their food or parasites. In addition, some of the common bacteria living in the intestines may release inflammatory products. In response, the walls of the intestines fill with lymphocytes and plasma cells disrupting normal function.
Treatment of this disease is twofold, remove the offending allergens and dampen down the immune response. Cats with inflammatory bowel disease are dewormed and placed on a hypoallergenic diet. (For more details see prior post.) A combination of drugs are used to address the immune system, steroids to suppress the humoral immunity (B lymphocytes and plasma cells) and metronidazole for the cell-mediated immunity (T lymphocytes).
There is a debate in the veterinary community regarding steroids in cats, specifically whether prednisolone is better than prednisone. Both are glucocorticoids that function well to suppress the immune system. The difference lies in their metabolism. Prednisone is converted into prednisolone by the liver. Because cats are lacking glycuronyl transferase, some believe only prednisolone should be used in cats. Other veterinarians disagree and use the two drugs interchangeably.
Because of the side effects, some owners taper their cats off of the steroids too quickly before all the inflammation is gone. Please don’t do that! Tapering too quickly is very dangerous. Give the entire dosage schedule prescribed by your veterinarian and speak with them before making any changes. When it is time to taper the dosage of steroids, do so in a slow deliberate manner. The goal is to get the steroid down to the least possible amount while still controlling the symptoms.
In my experience, cats suffer far more reactions to the metronidazole than the steroids. These include weakness, lethargy, gastrointestinal upset, liver toxicity and neurologic disease. My own cat acted as though he was drunk after just one dose of this medicine. So be sure to watch closely for any changes in behavior while your pet is on this or any medication.
If the standard therapy is not controlling your pet’s symptoms, talk to your veterinarian. There are other medications such as leukeran and cyclosporine that can be used to control the disease.