IBD - experience with gastric emptying issues?

[__caitlin]

Hey all - I'm back with another senior cat with multiple chronic conditions. Partially posting to see if anyone has any insight I haven't thought of, and partially to see if anyone else is as frustrated as I am with the overall healthcare system and how rudimentary our understanding of these illnesses still is.

My baby Cephas is about 16 and is the littermate sister of my cat, Max, who died of IBD->LCL a few years ago (I cannot thank you all enough for your support during that time - it made a world of difference as it was my first time dealing with this illness). Cephas has epilepsy (almost her whole life now), was recently diagnosed in Aug 2023 with early stage CKD -- and then diagnosed in Dec 2023 with IBD.

She has a bit of an unusual symptom profile which has made this very confusing and difficult to manage. Summarizing here:

• She started overgrooming in 2021, seemingly triggered by a food allergy, and never stopped no matter what I would try. She seems to be allergic to beef and fish for sure, but still grooms while eating other proteins. Blood tests, ultrasounds, everything were always normal, but I never did another ultrasound after early 2022.
• Because of suspected food allergy, she ate RAWZ food for years. In 8/2023 after the CKD diagnosis, I took a chance on a renal support diet + put her on Renadyl.
• She starts to get a little bloated; new vet suspects SIBO + wants to screen again for IBD given how her brother died. She has no other gastrointestinal symptoms.
• Ultrasound in 12/2023 now shows pancreatic inflammation, and her PLI si high; intestines are normal. I'm now realizing she probably had low-grade IBD for all these years and it was never caught.
• In Jan/Feb, she goes through a lot of changes: we start prednisolone; because of suspected SIBO, I put her back on RAWZ Turkey (because it has 0 carbs) + stopped the probiotic; we also increased her Phenobarbital epilepsy meds, because she's been having more frequent seizures.
• She stops overgrooming almost as soon as we start prednisolone.
• The bloating doesn't go away. In March, she has another ultrasound that shows all the swelling is from her stomach. Her intestines are now normal-to-mildly thickened (but still apparently within normal range), and pancreas situation hasn't changed. Because they don't see any obvious obstruction, they diagnose her with motility issues from the IBD and prescribe cisapride.

Well, I've been trying the cisapride for a few days now and it seems to have no effect. This is in addition to Miralax 2x/day. I am really at a loss for what to do. Her vet is very conscientious but can't really give answers; for any symptom, there are 3-5 different possibilities; we just keep trying different things. Her phenobarbital may be exacerbating the gastric issues (but I don't want her to have more seizures!); the RAWZ food may be harder to move through the system (but what about the suspected SIBO? it's hard to find another low carb food with ingredients she isn't allergic to, that isn't horrible for her kidneys that meets this criteria). Does the cisapride need time to work, or does she possibly have some obstruction that the ultrasound couldn't see that's it's actually making worse?

Throughout all this, she eats consistently and poops around 1x/day. The bloating is persistent but doesn't seem to bother her. I feel she's in a weird spot because she doesn't have traditional gastrointestinal symptoms, and she is still healthy enough that it looks like nothing super serious is happening so to a vet who only sees her 1x/month, she seems relatively stable. But from my perspective, I'm sitting here frustrated that I've put her on all these medications and rather than getting better, her symptoms seem to have only progressed / been switched out for new ones.

tl;dr - does anyone have any experience with the motility issues with IBD, and found any solutions if the cat doesn't respond to cisapride?

 

[stephanietx]

My IBD kitty deals with bloating. We give him Simethicone drops (baby gas drops) twice a day when it's really bad. This is the ones we buy.

Amazon.com

 

[lisahe]

I can't answer your question directly but I can say that our (now retired) vet offered a motility drug (she didn't say what it was) for one of our cats some years ago because Edwina occasionally barfed a combination of acid, digested food, and fur during the night. The vet thought the nature of the vomiting likely indicated a motility issue. I refused the drug because I was convinced the problem was more general... basically, that Edwina came to us with what I thought of at the time as pre-IBD. She had food sensitivities even as an adolescent and I suspected her digestive system was worsening.

I'm glad we didn't put her on the drug. Her problem did turn out to be inflammation and what is now presumed IBD. She had (inflamed) chunks of her stomach surgically removed in 2022 and has been doing pretty well since then, particularly well after we started giving her Adored Beast's Feline Gut Soothe last year. She no longer vomits the way she did when the vet offered the motility drug. FGS (and Vet's Best Hairball Relief tablets) also eases our other cat's constipation. Egg Yolk also helps lots of cats' constipation (though it wasn't very helpful for us!). Slippery elm bark syrup can be helpful, too. Our cats' symptoms sound very different from your cat's and I feel fortunate that some natural remedies, particularly Gut Soothe, have been so useful.

Every cat is different and, thus, mysterious in its own way so I guess what I'm saying is that -- based on our experience, which is so different from yours! -- I'd be cautious about depending on the motility drug for long, particularly in a case where nobody really knows what to do because the cat's situation is so unusual. Then again, we've been very, very fortunate that our cats have responded remarkably well to gentle herbal remedies... which, I found because nobody knew what to do. I'm also very fortunate that our vets have been supportive (or at least indifferent!) about using them.

 

[mrsgreenjeens]

To the original poster, I'm a little confused, because SIBO typically causes loose stools, yet your girl is on Miralax, which is for constipation, and you said she poops around once per day. WHY is she on Miralax? Is she constipated or not? If so, why do they suspect SIBO? AND, again, typically, for SIBO the treatment is specific antibiotic, yet you made no mention of her being put on ANY antibiotics. Was she ever put on them, or not? One of my cats had a bacterial overgrowth recently (similar to SIBO but not called that) and the "fix" was to have him eat the highest fiber food we could find, plus adding S. Boulardi with MOS. It worked very well, but he did not have IBD or any pancreatic issues.

 

[__caitlin]

To the original poster, I'm a little confused, because SIBO typically causes loose stools, yet your girl is on Miralax, which is for constipation, and you said she poops around once per day. WHY is she on Miralax? Is she constipated or not? If so, why do they suspect SIBO? AND, again, typically, for SIBO the treatment is specific antibiotic, yet you made no mention of her being put on ANY antibiotics. Was she ever put on them, or not? One of my cats had a bacterial overgrowth recently (similar to SIBO but not called that) and the "fix" was to have him eat the highest fiber food we could find, plus adding S. Boulardi with MOS. It worked very well, but he did not have IBD or any pancreatic issues.

I appreciate you asking because I was confused too! No, she's never had diarrhea. Right now, she does have mild constipation but it's unclear whether it's from decreased motility from IBD, or from the RAWZ food, or both.

The vet suspected SIBO during that small window of time that her only symptom was mild bloating, prior to the decreased motility diagnosis. Because I was feeding her probiotics at the time, the vet theorized it could be bloating from a bacterial imbalance, but didn't think it was serious enough to put her on antibiotics with all the other stuff she has going on.

That's basically it. After the decreased motility diagnosis, I even asked the vet "So does this mean it was a motility issue and not SIBO?" And she told me no, mild SIBO could still be a possibility. So I don't really know what to think anymore except that I somehow have to concoct a magical diet for her that addresses all these issues. It is a bit maddening.

 

[silent meowlook]

Hi. IBD doesn’t always cause diarrhea. It can also cause constipation.

With what is going on with your cat and her Comorbidities, CKD, epilepsy, pancreatitis, she needs to see a specialist. Ask for a referral to a board certified veterinary internal medicine veterinarian asap and they should be able to help you. There is just too much going on here for a regular vet to be of much help.

 

[lisahe]

Hi. IBD doesn’t always cause diarrhea. It can also cause constipation.

With what is going on with your cat and her Comorbidities, CKD, epilepsy, pancreatitis, she needs to see a specialist. Ask for a referral to a board certified veterinary internal medicine veterinarian asap and they should be able to help you. There is just too much going on here for a regular vet to be of much help.

I so agree with S silent meowlook 's suggestion. We brought a cat to an internal medicine vet last week and it was well worth the visit (and money), despite not reaching a definitive diagnosis. Sometimes seemingly small things that come up can help explain a larger issue.

Fingers crossed, C __caitlin