Chronic Vomiting & Diarrhea in Cats: Not So "Benign" Conditions!

I haven't posted in a good while. I guess my blog also went into "hibernation mode" together with the bears here in Alaska. It's time to wake up from winter slumber. And nothing better than a new, interesting research finding to make cat owners get out of their hibernation mode too in regards to pets that frequently vomit due to "hair ball" or other "normal issues".

In November 2013, the Journal of the American Veterinary Medical Association published a very well-designed study investigating the real reason some cats have chronic vomiting and/or diarrhea.  
[J Am Vet Med Assoc. Nov 2013 15;243(10):1455-61. Diagnosis of chronic small bowel disease in cats: 100 cases (2008-2012)].

The goal of the study was to find out if a diagnosis of chronic small bowel disease could be determined in a subset of cats that had chronic vomiting, small bowel diarrhea, weight loss or a combination of these. The study intelligently challenged the erroneous notion (maintained by lots of cat owners out there), that chronic/intermittent vomiting is a normal condition for cats.

The authors reviewed the medical records of cats from 2008-2012 presented to the veterinarian with clinical signs of chronic vomiting, chronic diarrhea, weight loss or a combination of these. In order to enter the study, cats had to meet the following 2 criteria: (A) clinical signs of gastrointestinal problems that included a history of vomiting 2 times per month (in the last 3 consecutive months), small bowel diarrhea of several weeks' duration and weight loss (0.5Kg or 1.1 lb) in the preceding 6 months. In addition, ultrasound exam should reveal thickening of the small bowel in 2 locations. Biopsy of the gastrointestinal tract was obtained when indicated. A total of 165 cats were eligible to enter the study. Surgery (for biopsy specimen collection) was performed on only 100 cats. Thus, 65 cats that were eligible to have a biopsy done but did not undergo surgery for that purpose were excluded from the study.

RESULTS:
The age of the cats ranged from 1-18 years old. The median and mean age for all 100 cats was about 11 years. Thirty-four cats were 12-14 years old. Thirteen were 15-18 years old. Thus, 47% cats were older than 12 years old! Only one out of 100 cats that entered the study had no abnormal findings on biopsy examination. The other 99 cats (99%) had various degrees of inflammation or cancer in 1 or more biopsy specimens analyzed. Forty-six cats (46%) cat intestinal cancer! In general, cats <8 years old usually had inflammation of the small bowel, whereas cats > 8 years old had cancer (intestinal lymphoma, adenocarcinoma or mast cell disease). See pictures below.

Remarkably, 26 cats in the study were brought to the vet for no obvious clinical problems. They were presented to the vet as part of a regular wellness examination. All of these 26 cats had signs of gastrointestinal disease; sadly enough the owners did not consider these signs to be of clinical significance. Most of these clients believed that the clinical signs were related to a "sensitive stomach", or "hair balls" or "anxiety/nervousness" or because these cats had always had these signs, thus they were deemed "normal" by the owners. All of these 26 cats had disease - either gastroenteritis, lymphoma (cancer) or mast cell disease.

The study highlights the fact that clinical signs of gastrointestinal problems that are apparently innocuous such as chronic vomiting or diarrhea, should not be ignored or considered "normal" by cat owners! About 26% of the cats that entered this study had clinical signs detected during regular wellness exams, meaning that most clients do not give these issues enough importance to justify bringing their pets to a vet for specific evaluation of the condition. Likewise, veterinarians should be more proactive by asking owners about signs of small bowel conditions, check body weight during wellness or other routine evaluations as opportunities to detect small intestinal disease. Vomiting more than 2 times per month in itself provides a good justification for an ultrasonographic exam of the gut for detection of gut wall thickening.

The massage that both cat owners and veterinarians should take home is that chronic small bowel disease often cause chronic vomiting/diarrhea and weight loss. Vomiting, in particular, should not be dismissed as a "benign" or "normal" event. Ultrasonography is a relatively inexpensive and non-invasive diagnostic tool that allows veterinarians to select cats from which biopsy samples should be collected and examined in order to provide a definitive diagnosis and appropriate treatment for these cats.