Issue 27.1 - July 2017

Gastroenterology

Other articles from the previous issue

Feeding behavior in cats

Feeding behavior in cats

We all need to eat to survive. But for humans, eating can be much more than a simple task to be undertaken on a daily basis; our mealtimes allow us to rest and relax, and perhaps catch up with friends or family as we enjoy our food. But from a cat’s point of view, eating is not quite the same, as Jon Bowen explains.

Breed and diet-based disease in dogs

Breed and diet-based disease in dogs

When faced with a dog that has a severe problem it can be easy at times to overlook the significance that breed plays in susceptibility to a disease. Giacomo Biagi offers a brief overview of some common breed-related problems where diet can play a major role.

Prevalence of chronic gastrointestinal signs in cats

One of the most frequent reasons for cats to be presented to a veterinarian is because of vomiting and/or diarrhea; in this short paper the authors offer some basic statistics on cats that present with typical gastrointestinal signs.  

 

Introduction

Many owners will consider their cat’s vomiting or diarrhea to be “normal” – some clients may not even report it when asked “anything going on at home?” – but because of the many potential causes of chronic gastrointestinal (GI) signs ( 1 ) ( 2 ) ( 3 ), it is important to ask owners specifically about the occurrence of vomiting and diarrhea, including characteristics such as frequency, appearance, and consistency, as well as at-home care and health, and to assess appropriateness of diagnostic work-up (e.g., bloodwork, ultrasound). This paper examines the prevalence of chronic vomiting and diarrhea in adult cats in the United States.

Methods of analysis

The health records of all cats aged 12 months and above when presented to a Banfield Pet Hospital from January 1, 2008 through December 30, 2012 for a veterinarian consultation were screened to identify those whose owners reported chronic (i.e., at least 1 month duration) vomiting or diarrhea. The cases were categorized clinically as follows: Chronic diarrhea only – no vomiting within 30 days of the visit; Chronic vomiting only – no diarrhea within 30 days of the visit; and both chronic diarrhea and vomiting – with both conditions recorded within 30 days of each other. Because some cats may have presented multiple times over the study period with different clinical signs, they may be included in more than one case category. Cats that were diagnosed during the same calendar year with hairballs or GI parasites were excluded from the survey.

The prevalence of these signs was estimated and classified by age; young adult (1-3 years of age), mature (3- 10 years) and geriatric (10-25 years), with any cat recorded as older than 25 years omitted, as this was a likely indication of inaccurate recording of birth date. Prevalence and relative risk (RR; estimated by the prevalence ratio) of each of the clinical presentations of chronic GI signs were estimated, comparing mature and geriatric adults relative to young adults.

Results

During the study period, over 1 million adult cats visited Banfield Pet Hospital (Table 1): of these around 2.0% (21,142) were reported to have chronic vomiting and/or diarrhea. Cats more commonly presented with chronic vomiting only (14,039), followed by chronic diarrhea only (4,469). Approximately 1,967 cats (9.3%) presented with more than one clinical sign during the study (e.g., chronic vomiting only and then presenting more than 30 days later with chronic diarrhea only). In all categories, young adult cats consistently had lower prevalence than the mature and geriatric cats. Risks for chronic GI signs in mature and geriatric adults (Table 2) are significantly greater when compared to young adults, with geriatric cats far more likely to develop chronic GI signs compared to young adults. Across all case categories, mature adults had 1.4-4.0 times the risk and geriatric cats 3.1-18.5 times the risk of young adult cats.

Age group Number of adult cats seen Total number of affected cats Chronic vomiting only Chronic diarrhea only Both chronic vomiting and diarrhea
Young adult 376,576 2,528 (0.7%) 1,411 (0.4%) 904 (0.2%) 75 (0.0%)
Mature adult 514,082  8,099 (1.6%)  5,579 (1.1%) 1,731 (0.3%)  414 (0.1%)
Geriatric adult 256,214 10,728 (4.2%)  7,177 (2.8%)  1,882 (0.7%)  943 (0.4%) 
Total 1,041,887 21,142 (2.0%)  14,039 (1.4%) 4,469 (0.4%) 1,426 (0.1%)
Table 1. A breakdown of the total number of affected cats presenting with chronic GI signs (vomiting and/or diarrhea) between 2008-2012. Some cats will have appeared in more than one clinical category and/or age range during the 5-year study period.
Age group Total number of affected cats Chronic vomiting only Chronic diarrhea only Both chronic vomiting and diarrhea
Mature adult 2.4 (2.2-2.5) 2.9 (2.7-3.0)  1.4 (1.3-1.5)  4.0 (3.2-5.2)
Geriatric adult 6.2 (6.0-6.5) 7.5 (7.1-7.7)  3.1 (2.9-3.2) 18.5 (14.6-23.4) 
Table 2. Risk ratios of mature and geriatric adult cats with chronic vomiting and/or chronic diarrhea, relative to young adults. 95% confidence intervals for the risk ratios are shown in parentheses.

Discussion

Our findings are consistent with other reports that note chronic enteropathy is more common in older cats ( 2 ). The prevalence estimates of chronic GI signs reported here are likely underestimates of the true level of occurrence, given the likelihood of under-reporting of the condition by the owner and/or veterinary staff.

A cursory examination of the medical diagnoses for a selection of affected cats from the study suggests that diagnostics beyond a minimum database (i.e., complete blood count, chemistry panel, thyroid) may not have been performed in many cases. After chronic kidney disease and hyperthyroidism, the most common diagnoses were (non-specific) vomiting, gastritis, enteritis and gastroenteritis. This may in part reflect a lack of concern about the clinical signs and need for diagnostic evaluation or, alternatively, the financial burden to definitively identify an underlying etiology.

This analysis found that although the prevalence of chronic GI signs was not very high, they were not uncommon in a population of adult cats seen at primary veterinary practices. Given that there are a number of potential causes for chronic enteropathy in cats, including parasites, neoplasia, and food intolerance, it is important for the clinician to delve deeper into client-reported clinical signs to ensure early disease detection and optimum health management of the cat, including other diagnostics, proper medications and dietary changes, in order to improve the quality of life for both the cat and the owner.

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