Use of Hydrolyzed Diets in Cats with Enteropathy

In the literature

Kathrani A, Church DB, Brodbelt DC, Pegram C, O'Neil DG. The use of hydrolysed diets for vomiting and/or diarrhoea in cats in primary veterinary practice. J Small Anim Pract. 2020; 61(12):723-731.

The Research …

Although vomiting and diarrhea are frequently seen in cats, the cause is often unknown. Laboratory and fecal testing, imaging, and biopsies are recommended for definitive diagnosis.¹ However, diet, antimicrobials, and/or glucocorticoids are used in many cases without a full diagnostic profile first being pursued. The outcomes in cats treated with ≥1 of these empiric therapies have not been previously reported.

This study sought to describe responses of cats with chronic vomiting and/or diarrhea of unknown etiology that were given a hydrolyzed diet with or without a concurrent antibiotic and/or glucocorticoid. Medical records of cats (n = 977) meeting the inclusion criteria were evaluated. Poor response was defined as needing antibiotics and/or glucocorticoids for vomiting and/or diarrhea at a subsequent visit after the diet was started or death associated with clinical signs within 6 months of follow-up.

Of the 977 cats, most (n = 697) were first prescribed a hydrolyzed diet only, and a small percentage of these (34%) had a poor response. Of cats initially prescribed both diet and antibiotics (n = 127), 56% had a poor response. Of cats initially prescribed both diet and glucocorticoids with or without antibiotics (n = 153), 65% had a poor response. Cats concurrently treated with either antibiotics or glucocorticoids plus diet and those given one or both (ie, antibiotics, glucocorticoids) before diet was tried had significantly increased odds of a poor response. Cats 6 years of age or older also had increased odds of having a poor response; however, other characteristics (eg, sex, neuter status, breed) were not significant.

Regardless of treatment, 42% of cats with suspected chronic inflammatory enteropathy had poor response. Due to the retrospective and uncontrolled nature of this study, it was not possible to determine efficacy of hydrolyzed diets in feline enteropathy. In addition, it is unknown if disease chronicity, severity, or exact pathophysiology (especially neoplasia^2,3) could explain the higher proportion of poor response in cats prescribed nondietary therapies.

… The Takeaways

Key pearls to put into practice:

• There are many potential underlying causes of vomiting and diarrhea in cats; comprehensive diagnostic testing is recommended to enable targeted therapy.

• Efficacy of antibiotic therapy in GI disease is unknown. These drugs should be used cautiously due to concerns regarding intestinal dysbiosis and antibiotic resistance.⁴

• Hydrolyzed diet as an initial sole therapy may be a rational approach for treatment of suspected inflammatory enteropathy in cats.