IBD flare-ups and weaning off of Prednisolone

My 12 year old boy Cooper was diagnosed with IBD a little over a month ago via endoscopy. He may have had IBD for years for all we know, but it was recently triggered by a terrible GI virus that he got at the end of November from a kitten we adopted last fall (we have 5 cats plus the kitten, and all 5 cats caught some form of this virus  ). He had awful diarrhea the entire month of December, then loose stools all of January and into February. Finally, his stools started to normalize but then the vomiting started. We ran blood and discovered that his liver enzymes were slightly elevated. He was started on one month of Denamarin. His vomiting only increased after a few weeks, so an ultrasound and endoscopy were done in late March.  The ultrasound showed thickening in his intestines, so the endoscopy was ordered to check for IBD or lymphoma. He had gone down from 11.5 lbs in early December to 10 lbs in late March.

The endoscopy showed some thickening in his stomach and previous ulceration. So the vet thinks the acute vomiting was from an ulcer (I was reading later on the internet that prolonged periods of diarrhea can cause a build-up of stomach acid which can then lead to ulcers). They took several samples from his stomach and intestines to biopsy, all which came back normal. The vet was still concerned about the thickening in the stomach, because she couldn't get samples to biopsy from the bottom parts of it. She thinks it is likely just scarred tissue from the ulcer healing, but she also warned us that it could potentially be a mass that would need to be biopsied later via surgery.

So she started Cooper on 10mg of prednisolone for one month, plus pepcid 2x a day. After 2 weeks, we cut the dose down to 5mg a day because he started to vomit more frequently and the vet was worried the pred was causing his ulcer to come back. He did great on that dose and had no vomiting for 2 weeks! He then had one episode of just clear liquid vomit last Tuesday, but that was it. He went back for his 1-month check-up last Thursday. He had gained a pound and was back up to 11 lbs. His blood work came back all normal...normal kidney function, liver function, normal WBC, etc. His liver enzymes were back down! So she wanted us to cut his prednisolone down to 2.5 mg a day for 2 weeks and then check back in with her.

So Friday night, we gave him his first dose of 2.5mg. Saturday morning he threw up after breakfast. No vomit Sunday. Monday morning he threw up while waiting on his breakfast (this was during the hour between giving him his Denamarin and breakfast, he has to be fasted before Denamarin and then he has to wait an hour after getting it to eat). Monday night he threw up after eating dinner.

I left the vet a message last night and am waiting to hear back from her. 

To me, it seems we took his dose down too low too soon. So now he's having a flare-up I'm assuming. Anybody have any thoughts? Would the reduced prednisolone dose cause a flare-up that quickly? We gave him 5mg last night in case. He has not thrown up yet today, but he isn't eating as much either. He seems to not feel that well.

As a side note - when we took him down from 10mg to 5mg, he was fine for 2 days, then had diarrhea for 2 days. He had not had diarrhea for over a month before that. We put him on a short course of metronidazole and within 2 days, his stools were normal again. I told the vet about this and she said that wasn't bad...that the prednisolone tapering probably just affected the flora in his gut. So doesn't that seem that maybe he just is a little more sensitive to shifts in his pred dosage?

I'm terrified about the potential mass in his stomach, but all his blood work was good...no signs of anything new developing. The ultrasound in March didn't show a mass, so it likely is just scar tissue. But the vet did say we would have to repeat the ultrasound if his vomiting started to get worse again to make sure there wasn't a growing mass in there.

What are your experiences with IBD flare-ups? Do you control them with increasing the dosage of their prednisolone if they are taking that?

Thank you for your help!

I am sorry that you and Cooper are going through this. IBD is such a tough disease in that it seems to present differently with each cat.

Generally, IBD is treated with dietary management and corticosteroids like prednisolone. Although prednisolone is generally well tolerated by cats, it is a trial and error to figure out the lowest dose that will control the symptoms. It does sound like maybe the dosage was reduced too soon. I would definitely talk to your vet about the dosage as well as possible side effects from long-term use of prednisolone, one of which is a risk of developing diabetes.

Sometimes, IBD can be managed solely with a change in diet. A single novel protein is sometimes recommended. Raw has been known to help IBD kitties as well. I would encourage you to check out www.ibdkitties.net which has a lot of great info.

I second the suggestion of examining his diet and making changes there. My cat was diagnosed with IBD a year ago and is completely managed by diet - we never had to touch steroids. We put him on raw and that resolved his symptoms, however we recently put him back on kibble and he's been doing fine on that too - my kibble criteria was that it be grain-free and as limited as possible. He is on Feline Caviar.

I don't know what to tell you specifically about the pred, other than it sounds like a big headache.