Also known as peptic ulcers, gastric ulcers are lesions (open sores) that develop in the deeper layers of the stomach lining or duodenum (the first part of the small intestine leading out of the stomach) due to exposure to the stomach acid (hydrochloric acid) and digestive enzymes which are required for the digestion of food.
Usually, the stomach and duodenum are protected from stomach acids and digestive enzymes by the gastric mucosa, a thick mucus layer, if this mucus barrier is broken, the stomach acids and enzymes penetrate the deeper layers causing damage to the underlying tissue. Untreated, the ulcer can eventually burn through the entire wall of the stomach allowing digestive juices to enter the peritoneum.
Several hormones are responsible for the triggering the production of stomach acid including acetylcholine, gastrin, and histamine. Ulcers develop when there is an increase in the production of stomach acid or when there is a breach in the protective mucus barrier. Below are common causes of gastrointestinal ulcers in cats:
- Increased production of stomach acid which overwhelms the protective mucus barrier. Certain diseases can lead to the increased production of stomach acid including tumours such as gastrinomas and mast cell tumours.
- NSAIDS such as aspirin
- Ingestion of poisons such as antifreeze, certain plants or other caustic substances
- Stress associated with surgery and recovery
- Inflammatory bowel disease
- Gastrointestinal parasites
- Gastrointestinal obstruction due to tumours or foreign objects
- Helicobacter pylori is a bacteria which has been found to cause ulcers in humans. Cats can be infected with H. pylori however there is yet to be conclusive data to link this bacteria with ulcers. One recent study did suggest a link between H. pylori and gastric lymphoma in cats.
- Liver disease
- Addison's disease
Ulcers can occur in cats of any age and there appears to be no breed or gender predilection.
What are the symptoms of gastrointestinal ulcers?
Not all cats with gastrointestinal ulcers will display symptoms. When they are present, they are typically the following:
- Vomiting (sometimes with blood in the vomit or the appearance of coffee grounds)
- Unexplained weight loss
- Loss of appetite
- Abdominal pain
- Dark tarry stools (melena)
- Pale gums due to anemia (low red blood cells)
- Rapid heart rate
- Increased salivation
- If the ulcer perforates, extreme pain, abdominal distension due to pneumoperitoneum (gas within the abdominal cavity), depression and collapse may occur due to septic peritonitis. A perforated ulcer is life-threatening and must be treated immediately.
Other symptoms relating to the underlying cause may also be present such as increased thirst and urination in cats with kidney disease.
How are gastrointestinal ulcers diagnosed?
Your veterinarian will perform a complete physical examination of your cat and obtain a medical history from you including symptoms you have observed, how long they have been present, any medications your cat is on and possible exposure to toxins. He will need to perform some tests which may include:
- Complete blood count, biochemical profile, and urinalysis to evaluate the overall health of your cat and evaluate kidney and liver function. If your cat has an underlying condition, abnormalities may show up on these results which can help your veterinarian to narrow down a possible cause. Anemia is a common finding with cats who have ulcers.
- Abdominal ultrasound and/or x-ray to look for any blockages, foreign objects or tumours. If a tumour is found, your veterinarian may also perform X-rays of the chest to look for signs of metastasis to the lungs.
- A fecal sample will be analysed for the presence of blood, bacteria, and parasites.
- Endoscopy, a plastic tube with a camera will be inserted through your cat's mouth and into the intestinal tract and stomach while under anesthesia. During this procedure, biopsies may be taken for further examination.
- Upper gastrointestinal barium series. This test is performed to visualise the upper GI tract and stomach. Barium is a white powder which is not transparent to x-rays. Once it is swallowed, it coats the GI structures, an x-ray is then taken to evaluate for tumours and ulcers.
How are gastrointestinal ulcers treated?
Treatment is aimed at addressing the underlying condition, where possible, as well as protecting the cat's GI tract and stomach from further damage. Stomach ulcers should resolve once the underlying condition has been treated, however not all underlying causes can be completely eliminated.
Treatment may include the following:
- Medicines to reduce stomach acid such as cimetidine, ranitidine or famotidine which prevent further damage and also allows your cat's GI tract or stomach to heal.
- Sucralfate is a medication which forms a gel-like consistency in the acidic stomach, covering the ulcers and preventing further damage to the already eroded tissue.
- Your cat may be put on a bland diet such as chicken or rice while he is recovering.
- In some cases, surgery may be required to cut out the ulcerated areas or tumours.
- Duel antibiotics may be prescribed if your cat is infected with H. pylori.
- In cases where severe bleeding has occurred, your veterinarian may need to give your cat a blood transfusion as well as fluid therapy.
- If the ulcer has perforated, gastric resection is necessary.
If the underlying cause can be treated the prognosis is good, however, gastric cancers, kidney or liver disease and cats who have developed sepsis sadly have a grave prognosis.