Feline inflammatory bowel disease (IBD) is treated sequentially with dietary modification, immunosuppression, and — in refractory cases — adjunctive agents, with response monitored using a combination of clinical scoring and emerging fecal biomarkers.

Dietary therapy is the appropriate first intervention. Food-responsive enteropathy (FRE) is a recognized subtype of chronic enteropathy (CE) in cats, and dietary intervention can achieve clinical remission in a subset of patients without immunosuppression.Journal of Vete…+1 The veterinary literature does not specify a single preferred hydrolyzed or novel-protein diet formulation from these sources, but a dietary trial preceding immunosuppressive therapy is standard practice.Journal of Vete…+1 For some cats — particularly those with chronic colitis — long-term management with diet alone is achievable.MSD Vet Manuals

Prednisolone is the cornerstone of immunosuppressive therapy for cats with IBD that fail dietary management. A standard prednisolone protocol used in clinical trials is 0.64 mg/kg PO q12h.Journal of the… At 6 months, prednisolone-treated cats achieved a mean Feline Chronic Enteropathy Activity Index (FCEAI) score of 3.7 (range 0.5–9), compared with a pretreatment mean of 3.6.Journal of Feli… Chlorambucil is added for cats with small cell gastrointestinal lymphoma (SCGL), the most common gastrointestinal neoplasm in cats and a condition that must be distinguished from IBD prior to finalizing the treatment plan.Journal of Vete…+1 Cyclosporine is an additional immunosuppressive option used in feline CE.Journal of Feli…

Adipose-derived mesenchymal stem cell (ADSC) therapy is an emerging alternative to prednisolone. Two intravenous injections of feline ADSCs produced a mean FCEAI score of 0.75 (range 0–1.5) at 6 months, compared with 3.7 (range 0.5–9) in the prednisolone group, with one treatment failure in each group at the 2-month recheck.Journal of Feli… Standardization of ADSC preparation and administration protocols remains an unresolved challenge limiting broader clinical application.The Veterinary…

Neutrophilic IBD warrants a directed antimicrobial approach targeting Campylobacter coli. C. coli is present in the intestinal mucosa of 6 of 7 cats with neutrophilic IBD versus 1 of 8 cats with lymphoplasmacytic IBD, with significantly higher mucosal bacterial counts in the neutrophilic group.Journal of Vete… Identifying this subset allows targeted therapy and reduces zoonotic risk.Journal of Vete…

Response to treatment is monitored clinically using the FCEAI and, increasingly, with fecal biomarkers. Fecal ceruloplasmin concentrations decrease significantly after treatment in cats with CE (pretreatment median 6.36 μg/g versus post-treatment median 1.16 μg/g), supporting its use as an objective treatment-monitoring biomarker.Journal of Vete… Fecal alpha-1-acid glycoprotein (AGP) concentrations are significantly lower in cats with IBD and FRE (median 0.6 μg/g) compared with cats with SCGL (median 10.75 μg/g), offering diagnostic utility in distinguishing these conditions before treatment.Journal of Vete… Fecal calprotectin shows promise as a surrogate biomarker for disease severity and treatment monitoring in cats with CE, though serum calprotectin has not yet been systematically evaluated in this context.Journal of Vete…

Intestinal fibrosis identified on biopsy carries prognostic significance and may influence treatment targets. The presence of intestinal fibrosis is associated with clinical remission and death caused by CE in cats, and colonic sampling adds diagnostic value beyond what has historically been appreciated.Journal of Vete… Antifibrotic biological therapies used in human IBD have not yet been evaluated in cats.Journal of Vete…

Would you like to go deeper on how to differentiate IBD from small cell lymphoma before choosing between prednisolone monotherapy and a prednisolone-chlorambucil combination?