The difference between IBD and IBS

jcat · Aug 9, 2013

There's often confusion between Inflammatory Bowel Disease and Irritable Bowel Syndrome

These are just a few articles that explain the difference, symptoms, diagnoses, treatments and diet that people might find useful.

INFLAMMATORY BOWEL DISEASE

Inflammatory bowel disease refers to the condition that results when cells involved in inflammation and immune response are called into the lining of the GI tract. This infiltration thickens the bowel lining and interferes with absorption and motility (the ability of the bowel to contract and move food). With abnormal ability to contract and abnormal ability to absorb, the bowel’s function is disrupted. Chronic vomiting results if the infiltration is in the stomach or higher areas of the small intestine. A watery diarrhea with weight loss results if the infiltration is in the lower small intestine. A mucous diarrhea with fresh blood (colitis) results if the infiltration occurs in the large intestine. Of course, the entire tract from top to bottom may be involved.

IRRITABLE BOWEL SYNDROME

Irritable Bowel Syndrome is a psychosomatic disease. This means that it is the activity of the mind that causes the symptoms. Most people do not have difficulty imagining having so much anxiety that diarrhea results. Chronic anxiety can similarly result in chronic diarrhea. This is basically what irritable bowel syndrome is all about. Intestinal biopsies are normal because there is nothing directly wrong with the large intestine.

The symptoms of large intestinal diarrhea can have many causes and IBS is afoot in about 10-15% of cases. It is important to rule out physical causes before blaming psychological reasons but if all tests are normal and treatment for physical problems is not yielding results, this is when a biopsy is helpful. Again, a normal intestinal biopsy rules in IBS.

Inflammatory Bowel Disease in Cats

Feline Irritable Bowel Syndrome vs Feline Inflammatory Bowel Disease

The Merck Veterinary Manual has more technical information:

Inflammatory Bowel Disease in Small Animals

goholistic · Aug 9, 2013

Thanks for this thread jcat! I'm sure it will be helpful for many people who think these two conditions are the same.

Is it safe to say that IBD in cats is an autoimmune disease much like Crohn's disease in humans?

When I was doing extensive research on these two conditions a couple of years ago, I came to believe that IBS can be caused by the mind, such as stress (just as you described above), but that it can also be a form of intolerance, or "instant rejection" as I like to call it. It's not inflammation, not an immune disorder, not an allergy...but just the body saying "I don't like that," much like human bodies rejecting greasy fast food or lactose, for example. Do you agree?

peaches08 · Aug 9, 2013

I never knew that the definitions differed from how we use them with humans, thanks for clearing that up!

franksmom · Aug 9, 2013

Thanks for the definitions Jcat. I do know there is a difference but the issue is most people do not have a definitive diagnoses if they did not do a biopsy to test for IBD. At least where I live this test is thousands of dollars and I just did not have the money after spending so much all ready in his treatment. My vet suggested my cat could have either IBS or IBD with his symptoms as his vomiting may be due to stress because he can be a nervous cat or could be caused by IBD because it seemed to be turning into a chronic condition and he did have inflammation on his X-ray. Through my research I have found the treatments are often the same and diet changes are usually suggested to both- that is why myself and maybe some other conflate the two terms. Even in the article you posted it mentions diet change for IBD and this is also what is often recommend for IBS even though some people think it is caused by stress ( in the article you posted she actually does use the human definition of IBS and its cause is a very hotly debated topic in human medicine and diet changes are always suggested). When people describe symptoms that are similar to my experience I like to say what has worked for me and I describe my cat as having IBS because I do not have a definitive diagnoses for IBD because I never got the biopsy though he may very well have it.

franksmom · Aug 9, 2013

GoHolistic said:
Thanks for this thread jcat! I'm sure it will be helpful for many people who think these two conditions are the same.

Is it safe to say that IBD in cats is an autoimmune disease much like Crohn's disease in humans?

When I was doing extensive research on these two conditions a couple of years ago, I came to believe that IBS can be caused by the mind, such as stress (just as you described above), but that it can also be a form of intolerance, or "instant rejection" as I like to call it. It's not inflammation, not an immune disorder, not an allergy...but just the body saying "I don't like that," much like human bodies rejecting greasy fast food or lactose, for example. Do you agree?

Yes my research also has shown the same thing cats with IBS are often treated with diet changes just like their human counterparts. Even the article that Jcat posted said IBS is caused by stress or something the cat ate. There is not the same inflammation with IBS but of course their is often sometimes inflammation and irritation caused by repeated vomiting and or diarrhea and this is why vets cannot diagnose IBD definitively from just an xray.

The problem with all of this is that we just do not know enough about either problem in cats. Like I said most people who think their cats have IBD do not even know for sure because the only way to test for it is through a biopsy and even this test is not always certain. The first step in both IBD and IBS cats should in my option be to try a diet that is less apt to cause stomach discomfort. IBD cats may require more in depth treatment like steroids or B12 shots but many cats with even a definitive IBD diagnoses have been treated with raw or limited ingredient wet diets and other holistic treatments meant to help stomach discomfort.

franksmom · Aug 9, 2013

Here are the two petmd definitions and as you can see both have very similar symptoms (http://www.petmd.com/cat/conditions/digestive/c_ct_irritable_bowel_syndrome#.UgVgfBYTN8c) (http://pets.webmd.com/cats/inflammatory-bowel-disease-cats) but as Jcat points out the main difference is IBD an autoimmune disease but treatments are also often the same. I would be great if the biopsy was more affordable and there was better knowledge on how to treat both IBS and IBD in cats.

goholistic · Aug 9, 2013

Thanks for the info. It's also my understanding that IBD can mimic intestinal neoplasia (cancer). Would a biopsy confirm which one it is? I remember reading somewhere that sometimes even a biopsy cannot differentiate IBD cells from cancerous ones and symptoms are often treated the same (with steroids and such).

My Caesar has IBS, IBD, or possibly a GI cancer. We don't know for sure as he never had a biopsy, but his blood work was suspect last summer when he went a week without eating and had to be assist fed. He hasn't had a "flare-up" since, which could mean he's in remission (if IBD). He's doing well currently. (::knock on wood:

and maintaining his weight, but he's a very tiny cat with a history of vomiting, diarrhea and anorexia.

franksmom · Aug 9, 2013

Yes I have also read the biopsy is not always accuret. I too worried my guy had cancer but he is four and his bloodwork was perfect. He is also doing very well thank God. Though he did vomit once today but I found out my mother had been sneaking him temptation treats so I think that might be why- I made her throw them out. Even though he threw up he has eaten very well today and is super active. I am praying he will not vomit again!

jcat · Aug 10, 2013

One of the main problems does seem to be the lack of a definite diagnosis, because biopsies simply aren't always feasible, so vets will say "IBS" or "IBD". Another huge problem is that even if you do have biopsies done, you still don't know the cause(s) of IBD or IBS, so treatment is a bit by trial and error. What works for one cat won't work for another. It's so incredibly baffling, and there were times when cleaning the litter box reduced me to tears, or I had the feeling that absolutely nothing would help.

Our cat has an odyssey behind him, and it's doubtful that it's ever going to be completely over, although he's doing extremely well at the moment. We opted for extensive testing and got some answers (IBD), but the question is whether that ultimately makes a difference, except that I worry he'll eventually develop cancer (which unfortunately can be missed despite biopsies, since it's virtually impossible to cover the whole gastrointestinal tract). What caused it? Was there one trigger, or was it a combination of things? He can't tolerate poultry, grain or fatty meats. He had coccidia as a kitten and enterohemorraghic E coli when we brought him home from the shelter. Did one of them cause it, or are the food intolerance and infiltration signs that there's something wrong with his immune system? Could his habit of chewing plastic and paper have played a role in the development of IBD, or does he chew because he wasn't getting enough nourishment for months on end?

What has really helped him is a (German) presciption low-fat, grain-free unique protein canned diet (we're now up to four different meats [rabbit, kangaroo, reindeer & horse; the brands are Vet-Concept and Cat Sana]) with a tablespoon of rabbit and potato dry as a between-meal snack twice a day (the nutritionist says he could also get a TB of cooked potatoes or turnips instead) to slow down his digestion. He got a Spanish nutraceutical every day till two weeks ago (preferred over corticosteroids in Europe, but Entero-Chronic is only available in the EU). Some cats do very well on raw, but that's absolutely the wrong thing for him because of the fat content and history of E coli. Other cats do well on big brand-name gastrointestinal diets, but most contain poultry and/or grains, which he can't eat. That's what I mean by trial and error.

I guess the reason I started this thread is because I get so frustrated when I see threads about IBD or IBS and know that there's no one answer that will help, because every case is different, and what will help one cat might make another one worse.

denice · Aug 10, 2013

Yes IBD is frustrating and expensive, I have made contributions to multiple vet's kids college funds. My cat was only 18 monthes old when it started. He has unusual symptoms, vomiting bile and constipation, so it must be a foreign body. Six years, three vets, 2 hospitalizations, and several thousand dollars later I was still going through the same cycles. He would occasionally get over a flare on his own and I was told by one of those vets that fatty liver was not a concern because he wasn't overweight. I waited too long before taking him to a fourth vet and he had two types of hepatitis one being fatty liver. He's had every conceivable blood test and two ultrasounds with a needle biopsy on his liver. Still no definitive diagnoses. He takes a small daily dose of a steroid and has had only two mild short flares in 2 1/2 years. A lot of people look down on the permanent use of a steroid and I know there are possible side effects and it will shorten his life but it is working for him.

jcat · Aug 10, 2013

I really expected our vets to prescribe steroids, too, so it was a pleasant surprise to find out that they're no longer being used here for IBD unless nothing else helps. :cross: that the Entero-Chronic gets FDA approval some day. It did take weeks for it to make a big difference for Mogli, though other people's pets have shown an improvement within days.

franksmom · Aug 10, 2013

jcat said:
One of the main problems does seem to be the lack of a definite diagnosis, because biopsies simply aren't always feasible, so vets will say "IBS" or "IBD". Another huge problem is that even if you do have biopsies done, you still don't know the cause(s) of IBD or IBS, so treatment is a bit by trial and error. What works for one cat won't work for another. It's so incredibly baffling, and there were times when cleaning the litter box reduced me to tears, or I had the feeling that absolutely nothing would help.

Our cat has an odyssey behind him, and it's doubtful that it's ever going to be completely over, although he's doing extremely well at the moment. We opted for extensive testing and got some answers (IBD), but the question is whether that ultimately makes a difference, except that I worry he'll eventually develop cancer (which unfortunately can be missed despite biopsies, since it's virtually impossible to cover the whole gastrointestinal tract). What caused it? Was there one trigger, or was it a combination of things? He can't tolerate poultry, grain or fatty meats. He had coccidia as a kitten and enterohemorraghic E coli when we brought him home from the shelter. Did one of them cause it, or are the food intolerance and infiltration signs that there's something wrong with his immune system? Could his habit of chewing plastic and paper have played a role in the development of IBD, or does he chew because he wasn't getting enough nourishment for months on end?

What has really helped him is a (German) presciption low-fat, grain-free unique protein canned diet (we're now up to four different meats [rabbit, kangaroo, reindeer & horse; the brands are Vet-Concept and Cat Sana]) with a tablespoon of rabbit and potato dry as a between-meal snack twice a day (the nutritionist says he could also get a TB of cooked potatoes or turnips instead) to slow down his digestion. He got a Spanish nutraceutical every day till two weeks ago (preferred over corticosteroids in Europe, but Entero-Chronic is only available in the EU). Some cats do very well on raw, but that's absolutely the wrong thing for him because of the fat content and history of E coli. Other cats do well on big brand-name gastrointestinal diets, but most contain poultry and/or grains, which he can't eat. That's what I mean by trial and error.

I guess the reason I started this thread is because I get so frustrated when I see threads about IBD or IBS and know that there's no one answer that will help, because every case is different, and what will help one cat might make another one worse.

Agree with you that every case is different and it is good to keep in mind when giving advice. I wish there were more definitive answers for treatments.

This is a super helpful thread thanks for starting it!!

vball91 · Aug 10, 2013

I think this will be a good thread to refer people to as well. My understanding is that IBD is much more common in cats. My belief is that because so many cats are fed species-inappropriate foods, a diet change is the first thing that should be done. I really do wonder how many fewer diseases would manifest in cats if they were all fed a species-appropriate diet. Like other autoimmune diseases that aren't understood, I wonder how much is due to some genetic predisposition that is then triggered by "something," whether that something is chronic inflammation from inappropriate ingredients, a virus or bacterial infection.

denice · Aug 10, 2013

There is a proliferation of different auto-immune diseases among humans as well. When I went through a medical coding and billing course one of the instructors said she believed that doctors labeled everything they didn't understand as auto-immune. Some people believe that they are caused by pollutants and processed foods but who knows. A hundred years ago people were thought of as frail, sickly and they died young. Was it some kind of auto-immune reaction? I don't know and there is really no way of knowing. When I was going through my saga with Patches I was asking one vet about diet changes and she said the best diet for a cat was a mouse. True but not very practical. Many people feed things like beef and venison to control IBD. May be healthy but I wouldn't want to meet the domestic cat capable of killing a cow or deer. Sometimes we just have to accept that we just don't know, do the trial and error and go with what works.

franksmom · Aug 10, 2013

I think the cause may be different in all cats but I do agree a species inappropriate diet plays a role.

I know it sounds weird but in Frank's case I think it was caused by his lack of ability to digest fur. I never thought problem with hairballs until recently but he always had issues eating until he was shaved. I would never have been able to get him to eat a more species appropriate diet until I shaved him because he barely ate anything. I tried since he was a kitten to get him to do more than just lick the gravy from wet food- I spent years hand feeding him wet food! He never even ate that much dry but at least he got enough calories to survive. At one point I though he had cerebral palsy because his weirdness while he ate. In retrospect I think he was always nauseous because he would always perch in rigid postures and have problems chewing his food which he no longer does. I did take him to the vet a few times about his weird eating stance and the only thing they said was he may have cerebral palsy but I shouldn't worry because he was still a healthy weight. I also think he may have vomited more regularly than I thought he did because we always thought it was my sisters cat who puked every where but again in retrospect it could have been Frank doing it. I know a lot of ragdolls have IBD issues and I wonder if their long fur has anything to do with it. I also have read chronic hairball issues are very prevalent in IBD cats.

goholistic · Aug 10, 2013

Franksmom, it's interesting that you suspect the inability to digest fur as a possible culprit. I thought about this same issue with Sebastian, but there's no telling for sure. He always seemed to get a tummy ache and would skip a meal before hacking up a huge hairball (or hairball "cigar" is what I call them). So it wouldn't surprise me that this essentially foreign object would cause the GI tract to go into overdrive.

As a matter of fact, I just took him in to the vet this morning unexpectedly because he vomited a red-tinged watery liquid (blood?) shortly after vomiting a small hairball. I thought, "Oh no...here we go again." They gave him fluids and Cerenia and I have to check back in on Monday when his regular doc is in the office. But something is aggravating him, whether it be hair or the food he's eating, who knows.

I may need to delve into the realm of a true hardcore novel protein diet for him (possibly raw), and I am not looking forward to the trial and error that awaits. I've been on high alert since his bout of pancreatitis a few weeks ago (a possible by-product of IBD or lymphoma).

jcat, the German prescription diet you are using is certainly unique. I am not aware of such options in the US.

And yes, I totally agree that every cat is different and no one solution fits all.

jcat · Aug 10, 2013

GoHolistic said:
jcat, the German prescription diet you are using is certainly unique. I am not aware of such options in the US.

It appears to be a relatively small company founded about a decade ago that operates in Germany, Switzerland and Poland. I'd never heard of the brand till Jamie developed a UTI, and the vet prescribed their canned urinary food (which he wouldn't eat because it was paté). The shelter had had Mogli on Royal Canin Intestinal, and it didn't help at all. Small wonder, because it's poultry and grain-based. Our vets swear by Vet-Concept and both feed the non-prescription varieties to their own pets. It does have some pretty unusual meat on offer. :lol3:

We used to have a lot of U.S. imports here, but after the 2007 melamine scandal/pet food recalls few remained. A lot of small European companies with high-quality pet food cropped up to fill the void, so there's a pretty good selection of grain-free, for example.

It would be really interesting to know whether long-haired cats are more prone to IBD than short-haired ones. Mogli has really short hair and no undercoat, and so far I haven't seen a single hairball, although he hates being brushed or combed.

denice · Aug 10, 2013

Patches is a short haired cat with no undercoat. My other cat has longer fur with a thick undercoat. When I was trying to figure things out with Patches I was taking her for lion cuts to cut down on the hair that Patches was swallowing. It didn't help him so I quit getting her lion cuts. I thought she was cute with her cut but of course she was not amused by it. What made things difficult with Patches was there was no rhyme or reason to the flares. I do think that the condition is aggravated by swallowing hair. Patches has had two short mild flares since he went on the steroid and they were both in the spring. Next year in early spring I think I will start him on Miralax and continue it through the shedding season and see if he can get through it without a flare.

goholistic · Aug 10, 2013

jcat said:
It appears to be a relatively small company founded about a decade ago that operates in Germany, Switzerland and Poland. I'd never heard of the brand till Jamie developed a UTI, and the vet prescribed their canned urinary food (which he wouldn't eat because it was paté). The shelter had had Mogli on Royal Canin Intestinal, and it didn't help at all. Small wonder, because it's poultry and grain-based. Our vets swear by Vet-Concept and both feed the non-prescription varieties to their own pets. It does have some pretty unusual meat on offer.

We used to have a lot of U.S. imports here, but after the 2007 melamine scandal/pet food recalls few remained. A lot of small European companies with high-quality pet food cropped up to fill the void, so there's a pretty good selection of grain-free, for example.

Okay, so by accident I came across a company today called Rayne Clinical Nutrition (http://www.raynenutrition.com/) that has locations in Missouri USA and Australia. Have you ever heard of them? They have an interesting selection of special wet diets for felines, especially their Kangaroo & Squash and Rabbit & Squash formulas under "Maintenance Diets." They even have their own Rabbit & Sweet Potato dry food. The only setback is that they are only available by veterinary prescription.

I'm struggling a bit with diets for my two cats with intestinal issues. Should I start a new thread about this? I've already done the countless hours of research, and I generally know what would be best for them, but right now I'm stuck and feeling a bit down about it.

denice · Aug 11, 2013

Wouldn't your vet be willing to wright a prescription? I assume you are talking about canned food rather than raw. I think most vets wouldn't oppose trying something that isn't a raw diet. They might think it's a little kooky but they wouldn't oppose it. The only concern he may have is the pancreatitis. The vet that I take my cats to now was the first one to send Patch's blood to Texas for the definitive test for it. His test came back negative and she said that opened up more possibilities with his diet.

The difference between IBD and IBS

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