What are the treatment options for inflammatory bowel disease in cats and how is response monitored?

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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.58 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.513 For some cats — particularly those with chronic colitis — long-term management with diet alone is achievable.10 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.12 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 3.6.14 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.24 Cyclosporine is an additional immunosuppressive option used in feline CE.4 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.14 Standardization of ADSC preparation and administration protocols remains an unresolved challenge limiting broader clinical application.7 Neutrophilic IBD warrants a directe