Gastritis in Cats
Dr. Bari Spielman
A tentative diagnosis of acute gastritis is usually made on the basis of history and clinical findings, and no specific diagnostic work up is warranted. If the patient is not responding to symptomatic therapy, and/or the signs are severe, diagnostic tests should be performed. In cases of chronic gastritis, a full diagnostic work up is almost always recommended. A complete blood count (CBC) will evaluate for the presence of infection, inflammation, and anemia, associated with some diseases that cause gastritis.
A biochemical profile evaluates the kidney, liver, electrolytes, total protein, and blood sugar status. All of these parameters are important to establish in the patient with gastritis.
A urinalysis helps evaluate the kidneys and hydration status of the patient.
Multiple fecal examinations are important to rule out gastrointestinal parasites as a cause of gastritis.
A thyroid (T4) blood test should be performed on any vomiting cat that is 6 years of age or older, as chronic vomiting, diarrhea, and weight loss are common signs seen in hyperthyroid cats.
Abdominal radiographs (X-rays) evaluate the abdominal organs (kidneys, liver) and may help visualize the presence of a foreign body or tumor.
Your veterinarian may recommend additional tests to ensure optimal medical care. These are selected on a case-by-case basis.
An ACTH stimulation test may be recommended to rule out hypoadrenocorticism (Addison's disease). It is a combination of 2 blood tests that measures adrenal function. It is safe, and can usually be performed at your local veterinary hospital.
Bile acids are paired blood tests obtained before and after a meal that evaluates liver function. The test is very safe and can be performed at your local veterinary hospital.
A blood lead level may be indicated in the cat with gastritis, where there has been known or possible lead exposure.
A gastrin level should be run on any cat with multiple or recurrent ulcers or signs of gastritis. Elevated levels are usually seen in cats with gastrinoma (a tumor that secretes gastrin, causing ulceration.)
An upper gastrointestinal (GI) barium (dye) series may be considered in those cases where baseline diagnostics do not confirm a diagnosis, and gastritis persists. It may help diagnose foreign objects or tumors that are not apparent on radiographs, or confirm a diagnosis of GI ulceration. A safe dye is given to the cat by mouth, and is then watched as it travels through the GI tract. It is a non-invasive test that can often be performed by your regular veterinarian, although in some cases may necessitate transfer to a specialty hospital.
An abdominal ultrasound evaluates the abdominal organs and helps assess for the presence of tumors. Organs, lymph nodes, and masses can be sampled with a needle or biopsy instrument with the guidance of ultrasound. This procedure is relatively safe, however may necessitate a mild sedative. It is often recommended that a specialist perform the procedure.
Gastroduodenoscopy (upper GI endoscopy) may be of benefit in the cat with gastritis. It may facilitate the removal of foreign bodies, help evaluate for ulcer disease, and sample tissue for the presence of inflammation or cancer. Hospitalization is brief, and healing is generally quick and uneventful. It does, however, necessitate general anesthesia, and therefore is associated with minor risks. It is often necessary to refer the cat to a specialist, and is performed when other diagnostics are either inconclusive or support the diagnosis of a gastric foreign body.
Lastly, an exploratory laparotomy should be performed as a diagnostic tool in any individual that has had an extensive diagnostic, and sometimes treatment, course with little or no response. It is an invasive procedure but is necessary in a handful of cases for a definitive diagnosis.
In cases of acute gastritis, symptomatic therapy is often the mainstay of treatment, as most of these cases generally respond quickly and thoroughly. These treatments may reduce severity of symptoms or provide relief for your cat. However, nonspecific therapy is not a substitute for definitive treatment of the underlying disease responsible for your cat's condition, which is the situation in some cases of acute gastritis and most cases of chronic gastritis.
Withholding food and water for several hours allows the GI tract to "rest", and is the single most important means of symptomatic therapy for the cat with gastritis. Complete dietary restriction allows the lining of the GI tract to heal. Gradual reintroduction of small amounts of bland food should be instituted after the fast, and the original diet may be slowly reintroduced after 2-3 days if there have been no signs of gastritis. If at any point gastritis recurs, discontinue everything given by mouth and contact your veterinarian.
Oral medication of any kind should be avoided if at all possible. Any contact with the stomach lining will potentially perpetuate inflammation.
Fluid and electrolyte therapy may be necessary in some cats with acute gastritis, and is directed toward correcting dehydration, acid-base, and electrolyte abnormalities. Occasionally, subcutaneous (under the skin) administration may be acceptable, and may be able to be performed at home. In severe cases, intravenous administration may be indicated and necessitates hospitalization.
Antiemetics (drugs that stop vomiting) should be used with caution. Examples include Reglan® (metoclopramide) or Thorazine® (chlorpromazine). It is best to identify and treat the underlying cause of gastritis, however in selected cases their use may be recommended.
Antacids (drugs that decrease acid production by the stomach) such as Tagamet® (cimetidine), Pepcid® (famotidine) or Zantac® (ranitidine), may be of benefit in some cases.
Gastrointestinal protectants and adsorbents (medications that protect or sooth) are felt to coat an "irritated" gastrointestinal lining and bind "noxious" (harmful) agents. Examples include Carafate® (sucralfate) and Pepto-Bismol® (bismuth subsalicylate).
Antibiotics and parasiticides (medication that kills parasites) are indicated in cases of bacterial or parasite related gastritis.
Anti-inflammatory agents, such as corticosteroids, may be indicated in cases of documented inflammatory bowel disease.
Endoscopy or surgery may be indicated to remove foreign objects or tumors causing gastritis.