IBD Help - I'd appreciate some advice and perspective
Looking for advice from anyone who's dealt with feline IBD or small-cell lymphoma.
My 9-year-old male cat was diagnosed with presumed IBD in 2021 (he was about 4). At the time, he was vomiting daily. They didn't do intestinal biopsies, but they did lymphnode aspirates and felt IBD was the most likely diagnosis. We switched to feeding six small meals a day with an automatic feeder, and that completely controlled his symptoms for years.
Everything changed after two back-to-back rounds of antibiotics in Aug./Sept. 2025. He developed diarrhea that initially came and went (a few days of diarrhea followed by a month or two of normal stool), but over the next 5-6 months it gradually became more frequent.
We've since tried multiple diet changes, probiotics, bloodwork, stool testing, and ultrasounds. Both ultrasounds showed chronic enteropathy with mildly enlarged intestinal lymphnodes, but nothing else significant. By the time we got in with an internist this July, the diarrhea had become an everyday issue, and it still is.
He's currently on Royal Canin Urinary SO + Hydrolyzed Protein and AnimalBiome S. boulardii + FOS. We're still waiting on a PCR diarrhea panel that was submitted this week, and his fecal transplant capsules arrive today. I'm also trying to get a second opinion at another specialty hospital and should hopefully have an appointment in a couple of weeks.
Here's where I'm struggling. My internist is recommending we start prednisolone without doing biopsies. His reasoning was that endoscopic biopsies often don't provide definitive answers, and while full-thickness surgical biopsies are better, they can still be inconclusive.
I have no problem starting steroids if that's what's best for him. My hesitation is that if he's going to be on steroids for years, I'd really like to know what we're treating. Is this truly IBD? Is it small-cell lymphoma (which would then require the addition of a chemo drug)? If it is IBD, could biopsies help identify the subtype and guide treatment? Its my understanding that steroids will skew the results of biopsies, so I really need to decide which direction to go in and move forward.
For those who have been through this:
- Did you pursue biopsies before starting steroids, or did you start treatment first?
- If you did biopsies, were they endoscopic or full-thickness, and were they worth it?
- Looking back, would you make the same decision?
I'm exhausted watching him have diarrhea every day and just want to make the best decision for him. Thank you