Those frustrating vomiting cats!
1. He eats too fast.
2. She has a sensitive stomach.
3. They're just hairballs, and they are normal.
4. That's just the way he is, or, as one of our clients put it, "He's just a puker."
While buying one or more of these excuses, we kept asking ourselves if one of our human family members were vomiting this often, would we accept it or would we seek a diagnosis and proper treatment?
No more excuses
These findings led us to the only logical next diagnostic step: full-thickness biopsies of several places in the small bowel. It was not long until the clouds parted, and we began to see things much clearer than ever before. After 100 cases, we put our findings together into a paper that was recently published in the Journal of the American Veterinary Medical Association (JAVMA).1
These 100 cats, and about 200 that followed, have shown us conclusively that chronic small bowel disease presents as chronic vomiting, chronic diarrhea, weight loss, or a combination of these. Only one of the 100 cats in the study had normal biopsy findings, making this diagnostic approach a "must do." In addition to the one normal cat, we had diagnoses of chronic enteritis (usually IBD) in 49%, lymphoma in 46%, mast cell disease in 3%, and adenocarcinoma in 1%. Therefore, we tell clients that the most common disease is IBD, but lymphoma is clearly the second-most likely differential. In addition, the only way to differentiate between them is with surgical biopsies.
A new hope
Understanding chronic small bowel disease is the most significant thing that has happened in our practice since the introduction of feline leukemia virus vaccine in 1985. Not only has there been a huge boost in income, but now we are able to help cats that were here-to-fore doomed to a lifetime of disease that we did not know how to diagnose or treat. As you read our JAVMA article, we hope you see how this study can impact your patient care and your practice. And see a diagnostic and therapeutic algorithm for chronic vomiting in cats.
Gary D. Norsworthy, DVM, DABVP (feline)
1. 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;243(10):1455-1461.
DON'T MISS the related links below, including a diagnostic and treatment algorithm to help you help cats with chronic vomiting, a client handout for owners of cats with chronic vomiting to help them understand the severity of the problem, and a slideshow to help your diagnostic work-up in cats with chronic vomiting.