Like each of you, we have been frustrated with the seemingly healthy cat that vomits twice a month or twice a week or twice a day. And like you and our clients, we have accepted these explanations for chronic vomiting: 1. He eats too fast. 2. She has a sensitive stomach. 3. They're just hairballs, and they are normal. 4. That's just the way he is, or, as one of our clients put it, "He's just a puker."
While buying one or more of these excuses, we kept asking ourselves if one of our human family members were vomiting this often, would we accept it or would we seek a diagnosis and proper treatment? No more excuses
With ultrasound we could look at a great deal of the small bowel instead of the inch or so of the duodenum that we sometimes could reach with an endoscope. It did not take long until a definite finding emerged—virtually every one of these cats had thickened small bowel walls. Suddenly it clicked. Chronic vomiting in cats is a small bowel disease, not a stomach disorder. It became clear that our gastric examinations and biopsies did not find the answer because we were looking in the wrong place.
These findings led us to the only logical next diagnostic step: full-thickness biopsies of several places in the small bowel. It was not long until the clouds parted, and we began to see things much clearer than ever before. After 100 cases, we put our findings together into a paper that was recently published in the Journal of the American Veterinary Medical Association (JAVMA).
These 100 cats, and about 200 that followed, have shown us conclusively that chronic small bowel disease presents as chronic vomiting, chronic diarrhea, weight loss, or a combination of these. Only one of the 100 cats in the study had normal biopsy findings, making this diagnostic approach a "must do." In addition to the one normal cat, we had diagnoses of chronic enteritis (usually IBD) in 49%, lymphoma in 46%, mast cell disease in 3%, and adenocarcinoma in 1%. Therefore, we tell clients that the most common disease is IBD, but lymphoma is clearly the second-most likely differential. In addition, the only way to differentiate between them is with surgical biopsies.
If you have a vomiting cat, please consult your veterinarian and ask for further workup- your kitty will thank you!
I'm busy working on my blog posts. Watch this space!