Antiulcer Therapy in Cats

Ulcers of the stomach and gut are painful and have the potential to ulcerate with life-threatening complications. Signs of gastric ulceration include a poor appetite, vomiting (sometimes with blood), lethargy, and lacking of grooming. These signs are nonspecific but if the cat has a history of recent NSAID (non-steroidal anti-inflammatory) or steroid treatment,  then medication should be stopped immediately and veterinary assistance sought. 

Antiulcer medications act in various ways including forming a bandage layer over the stomach to protect the wall or to reduce the amount of erosive stomach acid produced. This gives the stomach wall a chance to regenerate and repair. 

How the treatment is administered depends on the severity of the ulceration. 

In mild cases, an oral suspension containing sucralfate syringed into the cat on an empty stomach is sufficient. This is given two or three times a day, and binds to the exposed gastric mucosa, protecting it and facilitating repair. 

In more serious cases, a combination of antiulcer medications is given. This could include sucralfate orally, and other drugs via intravenous or subcutaneous injection. Typically this might include omeprazole (a proton pump inhibitor which decreases the secretion of hydrochloric acid) or Famotidine (an H2 inhibitor which decreases stomach acid excretion). Once the initial crisis is over, treatment by injection may be changed to oral therapy. 

Treatment is often given for two to three weeks if the initial cause is identified (such as giving NSAID on an empty stomach) and removed. When neoplasia or renal disease is responsible, antiulcer medication may be given in the long term. 

Modern antiulcer medications are sophisticated and effective. The best results are obtained when the initiating cause is identified and rectified. This, along with supporting the stomach lining so it gets a chance to repair, can lead to a full resolution provided the problem was diagnosed in the earlier stages. 

A deep gastric ulcer which perforates is life-threatening. This is either due to hemorrhage from the stomach wall or leakage of gut contents into the abdomen and subsequent peritonitis. In these severe cases then surgery is necessary to resect the damaged tissue and flush contaminants out of the abdomen. 

In those cases resulting from primary disease such as neoplasia or renal disease, antiulcer therapy can help control nausea and improve appetite. However, it will not alter the course of the original disease from progressing. 

In mild cases of gastric ulceration, the patient often starts to feel better after two to three days. In some cases a change of diet is advisable, because the cat may have developed an aversion to foods they were offered whilst ill. 

Once the cat is eating of their own accord, then a slow gradual improvement can be expected. If the cat suddenly deteriorates, such as they collapse or vomit whole fresh blood, then perforation of the ulcer is a possibility and more aggressive surgical treatment becomes necessary. 

Some antiulcer medications such as famotidine or cimetidine are available as over the counter medications at relatively low cost. Newer, more sophisticated medications are more expensive. Omeprazole is available in tablet form for a few dollars, but if intravenous administration is required the cost becomes that of placing an intravenous catheter and giving a slow infusion ($20 to $60) 

Sucralfate suspension costs around $20 or more for 30ml, which would typically last a cat around six days. The cost of long-term use can therefore mount up.

Antiulcer medications are well-tolerated and linked to few side effects. However, owners should avoid using human over the counter antacid medications without first checking with their vet. For example, some human indigestion remedies are high in magnesium. This can be difficult for cats to process, especially those with impaired renal function, which could lead to magnesium toxicity. 

Sucralfate is considered extremely safe for cats, however, it forms such an effective barrier that it stops absorption of other drugs. Thus, if the cat is receiving several medications orally, it is best to give the other medications first, several hours before the sucralfate. 

There is a theoretical risk that cats given antiulcer medications in the long term which reduce stomach acid levels, could predispose the stomach wall to fungal infections. This is because the normal protection is removed, leaving it more vulnerable. This however is a rare occurrence, so concerned owners should discuss long-term usage with their vet. 

And finally, a problem called acid rebound can occur when long term antiulcer medication is stopped suddenly. Therefore a gradual reduction of dose may be appropriate. 

To prevent gastric ulcer formation it is essential to follow directions when giving NSAIDs or steroids. These are to stick within the recommended dose and to give the medication with or after food. 

Other conditions such as renal disease respond well to therapy, especially with early diagnosis, which could vastly delay the cat entering the toxic stage. Therapy involves feeding a renal diet, using phosphate binders, dosing with an ACE inhibitor, and monitoring blood pressure.