Management of Feline Immune Mediated Gastro-intestinal Diseases: Stomatitis and Inflammatory Bowel Disease

Stomatitis

Stomatitis is a common and often debilitating disease of cats. Lesions can range from mild inflammation to severe deep ulcerations and proliferative tissue affecting the gingiva, fauces, buccal mucosa and tongue. Most cats must be treated life-long and many undergo multiple tooth extractions in an attempt to maintain the cat’s appetite and control the oral pain. Despite aggressive therapy, some cats do not respond and are euthanized to due weight loss, pain and poor quality of life.

Causes

Histological evaluation of affected tissues generally reveals infiltrations of lymphocytes and plasma cells. The cause of the disease is unknown, but most likely is a combination of a precipitating infectious agent or agents and an abnormal, hyperactive, immune response. Feline calicivirus is the viral agent that has been implicated most frequently; others believe that oral gram-negative bacteria may play a role. Stomatitis is also more common in cats infected with feline leukemia virus or feline immunodeficiency virus. Bartonella henselae has been proposed as a cause of stomatitis, but recent studies suggest is an unlikely cause.
A complete blood cell count, serum biochemical panel, urinalysis, FeLV antigen test, and FIV antibody test should be completed to evaluate for systemic diseases associated with stomatitis. A dentistry should be performed and abnormal teeth repaired or removed. Biopsy for histopathological examination should be performed, particularly if a mass is present. Squamous cell carcinoma can sometimes appear similar to severe stomatitis. There is no indication for Bartonella or calicivirus tests because of poor predictive values.

Treatment

There is no one protocol that is effective for every cat. Antibiotics are generally used to control secondary infections. I use doxycycline liquefied in tuna flavoring (once daily at 10 mg/kg, PO) most frequently because of efficacy against normal flora, effect against B. henselae, and an anti-inflammatory effect. Clindamycin (once daily at 10 mg/kg, PO) is also an excellent choice because of penetration into bone. Long-term or pulse antibiotic therapy are required in some cats. Penicillins and metronidazole can also be effective because of their effect on anaerobic bacteria. Anti-inflammatory therapy is often used non-specifically. Oral administration of prednisolone is preferred, but injectable projects are often needed because of the difficulty associated with administering oral drugs. The cytotoxic agent, chlorambucil has been tried with variable responses in some cats. Interferon alpha has not been effective at Colorado State University. Coating the affected tissues with bovine lactoferrin by mixing with milk has about a 15% positive response rate. Piroxicam (1 mg/cat, PO) or meloxicam (0.1 mg/cat, PO) every two to three days can also be used to lessen oral pain and inflammatory. However, the cat must be monitored carefully for gastrointestinal and renal side-effects. Cyclosporine therapy has been beneficial for some cats. I use a starting dose of at least 2 mg/kg, PO, daily. Up to 42 days may be required for maximal response. Some cats can be maintained on alternate day therapy. Use of a hypoallergenic diet and omega 3/omega 6 fatty acid supplements is beneficial for some cats since the disease may be a dietary hypersensitivity. CO2 laser ablation has been effective for the treatment of some cats. Up to 80% of affected cats have a positive response to full mouth (behind the canines) extractions. [...]