The saga continues...what to do next?

I'll try the short version: Mikey has a 3 year history of vomiting/bloody diarrhea. Three different vets all say IBD. He's 16 and has responded extremely well to injections of prednisolone once every 3-6 months. Except for now. He had an injection in early July, but still continued to vomit daily. In the past month, he has had x-rays, bloodwork (showed some elevated enzymes indicating pancreatitis, but he doesn't have any of the clinical signs). He was put on flagyl and pepcid, which maybe helped. He was still vomiting 4-5 times a week and it was dark brown with tinges of blood. The vets are aware.

Last week he was given another prednislone injection. The vomiting stopped for 6 days. We really thought we were out of the woods. It's once a day and a very small amount. But still dark brown. Vet suggested changing to a hypo-allergenic diet slowly (cat is on i/d diet now). Then the next step will be a sonogram. Endoscopy was mentioned, but because of the cat's age, they want to try less invasive first. They have a board certified vet who only does ultrasounds come into the office once a week.

If I didn't see the vomit, I would NEVER know this kitty was sick. He eats like he always did, plays, purrs, head butts us, normal bowel movements, everything else seems fine.

I just hate this, b/c it's not black and white.

The problem with IBD is it is one disease with multiple causes and there is no definitive way of diagnosing the causes without the intestinal biopsy (endoscopy) you mentioned. And because its invasive many vets take their best guess, try a treatment and if it works, voila they were right. If it doesn't they often move on to the next treatment.

There are still some other alternative treatments to the endoscopy, diet is one. Tylosin capsules (a type of antibiotic) is another. If Tylosin would work it would be easy and in my cat it controls the vomiting and the diarrhea just fine. But that doesn't mean it would work in yours. Has your vet discussed it though? It might be an option.

Severe IBD can result in weight loss and if yours is losing weight then it might be worth an endoscopy. But if he's just vomiting.....then maybe not.

Thank you for your reply. He hasn't lost any weight. Actually, I think he may have gained a little. His appetite is as robust as it has always been. I'll ask the vet about the Tylosin. Is that the same as tylan?
Does your cat also get the steroid injections? I figured those were the last resort for ibd and when it didn't work this last time, I didn't know what to do.