Colitis

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• Rare in cats (usually part of generalized IBD).
• Signs: increased frequency of defecation with tenesmus; stools often with blood and mucus.
• Causes: food intolerance, infection, abrasives, idiopathic.
• Diagnosis: colonoscopy, histopathology.
• Treatment: depends on causes, (dietary modification, sulfasalazine, antibiotics +/- corticosteroids).

• Fecal tenesmus and urgency.
• Increased frequency of defecation, often with diminished volume.
• Stool accompanied by blood and mucus.

• +/-vomiting and small bowel disease.
• +/-weight loss.

• Idiopathic - perhaps immune-mediated response to antigens such as bacteria or diet, eg lymphocytic-plasmacytic colitis.
• Bacterial - proposed on basis of response to antibiotics, eg pathogens - Salmonella spp and Campylobacter spp or commensal spp.
• Other infectious causes include:
  • Protozoa - Giardia, trichomonas.
  • Fungi, parasites; whipworms in cats are rare and usually asymptomatic.
• Abrasives, eg excessive hair ingestion or other foreign materials.

• Mucosal damage abnormal motility failure to absorb fluid from feces; also decreased intestinal transit time increased frequency of defecation.
• Inflammation stimulation of goblet cells to produce mucus.
• Rectal inflammation urgency to defecate.

• Variable, often no inciting factor recognized.

• Tenesmus.

• Fecal tenesmus.
• Increased frequency of small volume feces.
• Blood and mucus present with feces.

• Defecating indoors or fecal urgency.

• +/-vomiting and small bowel disease.
• +/-weight loss.

• Rule out neoplasia/polyps as cause of blood in stool.
• Rule out perianal disease as cause of tenesmus.

• Multiple biopsies of mucosa - even if grossly normal.
• Biopsies reveal infiltration of inflammatory cells in lamina propria and decreased numbers of goblet cells.
• Severe cases exhibit fibrosis.
• Increased inflammatory cells in certain forms of colitis, eg lymphocytic-plasmacytic colitis.

Other

 Small rigid colonoscope to examine colon.

• Colonoscopy collection of mucosal biopsies.
• Mucosa may appear grossly normal or marked erythema and ulceration present.
• Mucosa often friable with bleeding during endoscopy.
• Strictures uncommon.
• Rectal cytology to identify fecal leukocytes.
   Correct preparation essential for successful endoscopy: starvation 24-48 h prior to endoscopy, oral cleansing solutions , multiple warm-water enemas (soapy enemas may induce iatrogenic colonic irritation).

• Fecal flotation for ova and cysts.

• To identify Campylobacter jejuni or Salmonella spp .

2-D Ultrasonography

• Helps to detect intercurrent GI thickening or degeneration of ileocolic junction that may be cause of GI diarrhea.

• Eosinophilia /neutrophilia may be evident.

Biochemistry

• Low serum protein , in some cases due to protein losing enteropathy.

• Inflammatory cell infiltrate in lamina propria, decreased number of goblet cells, erosion of superficial cells.

• Examination requires removal of ventral coxal bones by cuts cranially and caudally from each obturator foramen, to expose entire colon and rectum.
• Rule out compression by extramural masses. Save feces for bacteriology.

 Beware - adenocarcinoma can resemble fibrous stricture grossly.

• Fix colon plus multiple regions of gastrointestinal tract, serosal surface on card to avoid curling. Include colonic nodes.

• Colitis secondary to primary small bowel disease.

• Colonic/rectal neoplasia, eg lymphosarcoma /adenocarcinoma .

• Colitis secondary to pancreatitis .

• If acute, nothing per os for 24 hours followed by little and often feeding of hypoallergenic diet, such as lamb and rice.
• Chronic conditions may respond to either antigen-restricted diet . Moderately fermentable fiber, eg ispaghula, provides nutrient short chain fatty acids which may assist colonocyte metabolism.

• Diet; antigen-restricted, hydrolyzed or easily digestible high quality, fed frequently in small amounts.
• Treatment of underlying cause, eg elimination of parasites or infection.
• Prednisolone - preferred to sulfasalazine in cats.
• Metronidazole - antibacterial, antiprotozoal and immunomodulatory effects - short-term.
• Sulfasalazine 10-20 mg/kg PO BID or TID - combination of sulfapyridine and 5-aminosalicylate, linked by an azo bond which is broken by bacterial metabolism in the colon; sulfapyridine may act as a 'carrier' for 5-aminosalicylate which is thought to be the active component.
   Use sulfasalazine with caution in the cat because of potential salicylate toxicity.

• ?If refractory, may use prednisolone , concurrently with sulfasalazine .

• Fair - may require long-term treatment.

• Resolution of fecal tenesmus, fecal blood and mucus, etc within few days of initiating treatment.
• May still have increased frequency of defecation.
• Try to discontinue drugs after 3 weeks.

• Undiagnosed small intestinal disease.
• Poor owner compliance with dietary restriction.
• Failure to experiment with different drugs and regimes.

• Recent references from PubMed.
• Simpson J W (1998) Diet and large intestinal disease in dogs and cats. J Nutr 128 (12 Suppl), 2712-2722 PubMed.
• Dennis J S et al (1993) Lymphocytic/plasmacytic colitis in cats - 14 cases (1985-1990). JAVMA 202 (2), 313-318 PubMed.
• Feinstein R F et al (1992) Chronic gastroenterocolitis in nine cats. J Vet Diagn Invest 4 (3), 293-298 PubMed.
• Shimada A et al (1992) Necrotic colitis associated with Entamoeba histolytica infection in a cat. J Comp Pathol 106 (2), 195-199 PubMed.
• Leib M S et al (1986) Suppurative colitis in a cat. JAVMA 188 (7), 739-741 PubMed.
• Nimmo Wilkie J S et al (1985) Colitis due to Bacillus piliformis in two kittens. Vet Pathol 22 (6), 649-652 PubMed.
• Nelson R W et al (1984) Lymphocytic-plasmacytic colitis in the cat. JAVMA 184 (9), 1133-1135 PubMed.
• Van Kruiningen H J et al (1983) The classification of feline colitis. J Comp Pathol 93 (2), 275-294 PubMed.

• E J Hall MA VetMB PhD, University of Bristol, Department of Clinical Veterinary Science, Langford House, Langford, Bristol, Avon BS18 7DU, UK. Tel: +44 (0)117 928 9280.
• Dr Phil Nicholls BVSc BSc PhD MRCVS MRCPath, Division of Veterinary and Biomedical Sciences, Murdoch University, Murdoch, WA 6150, Australia.
• Dr Kenneth Simpson BVM&S PhD, Dept of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA.

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