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INFILTRATIVE BOWEL DISEASE IN THE CAT
What does this mean?
Depiction of the delicate layers of the intestine in health. (Small intestine)
The small intestinal tract is a remarkable organ. It has to neutralize acid from the stomach, apply digestive enzymes and emollients, absorb and conduct away the microscopic nutrients, and move its contents from one end of our body to the other. There is also the matter of housing a variety of bacteria without allowing them to access the interior of our bodies, immunological reactivity, hormonal activity and response, and more. Its layers must act as a barrier as well as a gateway plus it must have muscle strength for both tone as well as motion. Proper function depends in part on normal thickness of all the delicate layers.
Obviously none of this is a good thing.
FIXING IT DEPENDS ON KNOWING THE NATURE OF THE INFILTRATION
There are two common diseases that involve infiltration: Intestinal Lymphoma and Inflammatory Bowel Disease (“IBD”). Both diseases involve infiltration of the delicate bowel by lymphocytes. In the case of lymphoma, these are malignant cancerous lymphocytes. In the case if inflammatory bowel disease, they are active lymphocytes reacting inappropriately to an immunological trigger (such as a food or bacterial waste product). Biopsy is necessary to distinguish these two diseases and distinguishing the two conditions allows for the most effective treatment.
Treating Inflammatory Bowel Disease
The possibly good news here is that because both conditions involve lymphocyte infiltration, there is a great deal of overlap in therapy so it is possible to make up a treatment plan that will “cover” both possibilities with reasonable chance of success. This not optimal but provides a route to inexpensive therapy.
DIAGNOSTICS START WITH ULTRASOUND
Diagnostic Considerations with Abdominal Ultrasound:
Biopsy by Endoscopy or Surgery
If ultrasound findings are not specific and the diagnosis remains ambiguous, in a perfect world, referral for endoscopy or even surgery follows, biopsy samples are taken, and a tailored therapy can initiate or at least informed decisions can be made. Not every patient is stable for anesthesia, however, and not every owner is financially able to pursue a specialized procedure. There is controversy about whether full thickness biopsy samples (which can only be obtained through surgery) are worth the invasiveness of surgical exploration. Endoscopy allows the surface of the bowel to be viewed from the inside of the intestine so that a biopsy sample can be taken from a specific site. Endoscopy is vastly less invasive and the American College of Veterinary Internal Medicine has indicated that endoscopy is the preferred method of sampling.
As with ultrasound, there is a great deal of overlap in findings between lymphoma and inflammatory bowel disease as both conditions involve lymphocyte infiltration. PCR testing and Immunohistochemistry can be used to distinguish the two conditions once a tissue sample is obtained. (Cancer cells by definition stem from one cell gone cancerous and thus the entire group of lymphocytes involved in the disease will share genetic markers while inflammatory infiltrates come from a group of cells and will show much more genetic variability.)
Having a confirmed diagnosis allows for accuracy in prognosis and precision in treatment and may be well worth the expense of this extra step.
Treatment When We Are Not Sure Which Condition is Present
Because there is a great deal of overlap between the treatment for IBD and the treatment for lymphoma, a therapy plan can be designed that covers both possibilities reasonably well. Typically this involves some kind of corticosteroid, possibly some kind of immunosuppressive medication, and possibly special diet, probiotics and nutritional supplements. Response to medication is generally rapid (with in a week) for IBD though it can take up to two weeks and a common lymphoma statistic is that 75% will achieve remission within three weeks regardless of protocol. Longer remissions can be obtained with more tailored protocols but this way a reasonably priced therapy is possible.
Ultrasound can be arranged at our hospital or through a local imaging center.
Referral for endoscopy can be obtained from your veterinarian.
Page posted: 9/7/2017