Many of us who share our homes with feline family members also share the common experience of hearing the dreadfully unmistakable sound of our cats vomiting a hairball. Unfortunately, many of us also share the nauseating experience of inadvertently stepping (always barefoot) on the muculent product of this expulsion. Hairballs and their accompanying messes blotch and brand our homes, serving as a universal calling card for our feline companions. Hairballs are so familiar that cat aficionados worldwide accept hairballs as the intrinsic but forgivable debt of befriending a cat.

Frequent vomiting, including vomiting of hairballs, is not normal for people, dogs, giraffes, chinchillas or any other mammal on Earth. Why then do we accept frequent vomiting as a normal behavior of cats?

Regardless of the presence or absence of a hairball, frequent vomiting is never a normal behavior of cats. Chronic or recurring vomiting is a symptom of disease. While vomiting may be associated with many different diseases, it is often a sign of disease within the gastrointestinal system.

Several individual diseases associated with vomiting are included within the umbrella of feline gastrointestinal disease. Some of these diseases may occur separately or together as a syndrome. The most common of these diseases is inflammatory bowel disease (IBD). While the exact prevalence of inflammatory bowel disease is unknown, it is considered to be one of the most neglected chronic diseases of cats. Recognizing the symptoms of IBD is the first step in helping your veterinarian diagnose and treat your cat.

Clinical Symptoms of Inflammatory Bowel Disease

The three most common presentations of IBD are vomiting, diarrhea and vomiting with diarrhea. While vomiting and diarrhea may be the most noticeable signs of inflammatory bowel disease, they are often just the tip of the iceberg. Symptoms may include the following:

• Vomiting
• Diarrhea with or without blood or mucus
• Weight loss
• Decreased or increased appetite
• Constipation
• Flatulence
• Bloating
• House soiling
• Dull hair coat
• Abdominal pain or tenderness
• Overgrooming of the abdomen (sometimes a sign of pain)
• Lethargy

Cats with IBD may only experience one symptom, while other cats may experience many. Symptoms may appear, improve and then worsen. Gradual unintentional weight loss over weeks or months is common, but many families may not observe any symptoms at all.

While cats of any age, breed or gender may be affected, IBD is most often reported in middle-aged adult cats, 5 to 8 years of age and older.

Diagnosing Feline Inflammatory Bowel Disease

The signs of IBD are often non-specific, meaning they may be associated with systems other than the gastrointestinal system. Because of this, establishing an IBD diagnosis is complicated, making it important to follow a stepwise diagnostic plan to rule out problems other than IBD.

Your veterinarian will likely begin with laboratory testing to perform a thorough assessment of all body systems. These initial laboratory tests may be combined with abdominal radiographs to help rule out acute causes of clinical symptoms, such as foreign body obstruction. Additionally, your veterinarian may recommend a diet trial to rule out food allergy as well as a thorough deworming to rule out gastrointestinal parasites.

If initial diagnostics do not reveal an underlying cause of your cat’s symptoms, specialized blood tests and an abdominal ultrasound become important diagnostic components.

The final step in diagnosing feline IBD is analysis of the intestinal tissue samples (aspiratesmatter that has been drawn from the body by aspiration or biopsies). Most veterinarians recommend this step after previous diagnostics fail to reveal the underlying problem. Several options exist for this tissue collection, so the advantages and disadvantages of each method should be discussed with your veterinarian.

Treating Inflammatory Bowel Disease

Treatment of IBD focuses on reducing the number of inflammatory cells abnormally present in the delicate intestinal lining. Disease may be managed long-term with a combination of steroid therapy, antibiotics, anti-nausea medications, a hypoallergenic diet, vitamin supplementation and probiotics. Most cases respond favorably to long-term management, and quality of life may be maintained for years.

If you think your cat may have gastrointestinal disease but aren’t quite sure, ask your veterinarian. As many of the common symptoms, like vomiting and diarrhea, may only occur intermittently, consider weighing the cat monthly and keeping a journal to document your observations. Together, you and your veterinarian can decipher these symptoms and assess the likelihood of IBD. Achieving a diagnosis and creating a treatment plan will not only improve your cat’s quality of life but will also save your home and feet from the unwanted gift of vomited food or hairballs.

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References:

1. Baral RM. Diseases of the intestines. In: Little SE, ed. The cat: clinical medicine and management. St Louis: Elsevier, 2012;466-496.
2. Baral RM. Approach to the cat with diarrhea. In: Little SE, ed. The cat: clinical medicine and management. St Louis: Elsevier, 2012;459-465.
3. Norsworthy GD, Estep JS, Kiupel M, et al. Diagnosis of chronic small bowel disease in cats: 100 cases (2008-2012). J Am Vet Med Assoc 2013;10:1455-1461.
4. Day MJ, Bilzer T, Mansell J, et al. Histopathological standards for the diagnosis of gastrointestinal inflammation in endoscopic biopsy samples from the dog and cat: A report from the world small animal veterinary association gastrointestinal standardization group. J. Comp Path 2008;138:S1-S43.