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Management and prognosis:
· IBD: If dietary or antibiotic trials fail, or in severely affected cats, immune suppressive therapy is the mainstay of IBD treatment. It is best initiated when histological evidence of intestinal mucosal infiltration is available, but could also be the final option of the empirical treatment sequence started with dietary trial and antimicrobials. Prednisolone is generally adminis- tered at a dose of 2 mg/kg PO (once daily or divided into two daily doses) for 2 weeks. Once the clinical signs have been controlled for 2 weeks or longer,
the dose is reduced by one-quarter to one-half every 2 weeks. The final goal is to maintain the cat on the lowest effective dose, or even to consider discontinu- ation of steroid treatment if feasible. Refractory cases are usually treated with chlorambucil. Chlorambucil, an alkylating agent, is generally used in combination with prednisolone at a dosage of 2 mg PO per cat every other day (in cats > 4 kg body weight) or every 3 days (in cats < 4 kg body weight) and then tapered to the lowest effective dose. Alternately, a pulse treatment with administration of chlorambucil at 20 mg/m2 body surface area (BSA) q14 days can also be used (for most cats the BSA is between 0.25 and 0.3 m2). A CBC should be checked 2 weeks after initiation of treat- ment for signs of myelosuppression. In one study, 80% of 7 cats with IBD treated with diet and prednisolone had a positive response to treatment. Cats with severe histological lesions or eosinophilic inflammation may be more difficult to manage. In addition, failure to respond to treatment may indicate refractory IBD or lymphoma. Owners must understand that feline IBD is a disease that can be managed, but not cured.
· Treatment of small cell alimentary lymphoma (EATL type II) with prednisolone and chlorambucil is associat- ed with a good rate of complete remissions, and sur- vival times between 16 and 30 months depending on the study. Recommended doses are identical to those listed above for the treatment of IBD. When a cat comes out of remission after having initially responded to prednisolone and chlorambucil, it is advised to reini- tiate the treatment at the full doses for both drugs. If the cat does not come into remission during induction, alternative protocols include lomustine (CCNU) and prednisolone, cyclophosphamide and prednisolone, COP (cyclophosphamide, vincristine or vinblastine and pred). However, it is recommended to consult with an oncologist or refer the cat prior to starting these more intensive rescue treatments. Large cell lymphomas
are associated with a much less favorable response and survival (a few months). Surgical removal may be a pre-requisite in the presence of intestinal masses ob- structing transit. Generally, protocols such as COP or CHOP (COP + doxorubicin) are initiated. Consultation with or referral to an oncologist is advised.
· It has been demonstrated that cobalamin (vitamin B12) deficiency may be a consequence of feline gastroin- testinal disease due to decreased absorption in the ileum with IBD or EATL type II. Hypocobalaminemia is easily be confirmed by evaluation of serum cobalamin concentration. B12 deficient cats may experience a delayed recovery, or treatment failure after immune suppressive therapy. Cobalamin may be administered SC at 250 m g SC per cat (see http://vetmed.tamu. edu/gilab for full treatment protocol) or orally (0.25 mg/ cat PO q24h).
Further reading:
Jergens AE and Allenspach K (2016): Feline inflammatory gastrointestinal disease. In: Little SE: August’s Consultation in Feline Internal Medicine. Vol. 7, p.129-138
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