References
Nutritional management of feline chronic enteropathy
Abstract
Feline chronic enteropathy covers a heterogeneous range of conditions, including food responsive enteropathies, inflammatory bowel disease and antibiotic-responsive diarrhoea. Dietary management can be extremely helpful, both as a diagnostic and therapeutic tool, when managing many of these patients. A high proportion of cats with chronic enteropathy are thought to be either food-sensitive or food-responsive, and appropriate nutritional support can help to optimise the short- and longer-term management of gastrointestinal disease. Three key dietary options exist: highly digestible gastrointestinal diets, hydrolysed diets and novel protein diets. Highly digestible diets and help to reduce exposure to dietary antigens, minimise complications associated with undigested food and aid nutrient absorption. Novel protein diets, based on a protein source a cat has not previously eaten, or a hydrolysed diet, where protein sources have been reduced in size to below the molecular weight of most food allergens, can help support cats with an underlying food sensitivity (allergy or intolerance), and may also benefit individuals in cases where a true food sensitivity does not underlie the clinical signs. Improvements with appropriate dietary intervention can be dramatic and rapid, with resolution of clinical signs within 2 weeks. This article explores the rationale for each of the three types of diet that can be considered for a diet trial, and the current evidence supporting their use. It also briefly covers recommendations for diet introduction and advice to support clients when considering a diet trial.
The term ‘feline chronic enteropathy’ covers a heterogeneous range of conditions of different aetiologies, including food-responsive enteropathies, corticosteroid-responsive inflammatory bowel disease and antibiotic-responsive diarrhoea (Makielski et al, 2019). Management of any feline chronic enteropathy is not complete without consideration of appropriate dietary support, which may completely resolve the cause and consequent clinical signs in some instances (such as where a dietary allergy is present). However, even in cases where diet is not the cause of the chronic enteropathy, appropriate nutritional support as an adjunct to other therapy is essential to optimise the long-term management of gastrointestinal disease. Diet can also be extremely useful as a diagnostic tool in some cases. The main dietary options for cats with chronic enteropathy and the evidence supporting their use, are explored in this article.
Most forms of feline chronic enteropathy are thought to involve a complex interplay among host genetics, the intestinal microenvironment (primarily bacteria and dietary constituents) and the immune system (Allenspach, 2011). However, distinguishing the underlying cause of the clinical signs (whether food-responsive enteropathies, corticosteroid-responsive inflammatory bowel disease, antibiotic-responsive diarrhoea or other) can be difficult, even aft er undertaking diagnostics including gastrointestinal (GI) endoscopy, biopsy and histopathological review of the GI tissue. A number of cats with chronic enteropathy may have disease in other organs in addition to the intestines, particularly the liver and/or pancreas (so called ‘feline triaditis’). Clinical signs oft en overlap in chronic enteropathy and all forms commonly present with persistent and recurrent gastrointestinal signs, including chronic diarrhoea (diarrhoea present for 2–3 weeks or longer) in clinical practice. Differentiating whether the diarrhoea is small or large intestinal in origin can help identify differentials and guide the approach to diagnostic investigations and potential management strategies. Many cases of chronic enteropathy also present with chronic vomiting.
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