INFLAMMATORY BOWEL DISEASE (IBD) IN FERRETS
Inflammatory Bowel Disease (IBD) in ferrets is a chronic inflammation of the stomach and intestine, which is very common and can lead to fatal complications. The medical term for the disease is lymphoplasmacytic gastroenteritis. Until recently IBD has been overlooked in ferrets, due in part to its subtle nature (many cases have no outward signs). Also many cases of IBD have been misdiagnosed as coronavirus (ECE) or Helicobacter infections, delaying recognition of IBD in ferrets.
What causes inflammatory bowel disease? Something has stimulated the immune system to attack the stomach and bowel linings, causing longterm damage to the digestive tract. The liver often becomes secondarily inflammed as well (hepatitis). The cause is unknown; food allergy is probably the most common theory. Excess carbohydrate content in the diet (such as many dry kibble diets may contain) may lead to chronic bowel disease in some individuals. Other possible causes include viral or parasitic. Microscopically the disease resembles IBD of cats, dogs and humans; the causes of IBD in all these species is a subject of debate.
What does IBD look like? In the milder forms, there are no signs.
Surprisingly, severe cases may have no signs either, until the disease is very advanced. Early signs are inconsistent stools: some firm, some mucoid or greenish or tarry. This may be mild and chronic, or the pet may suddenly have episodes of severe greenish to brown diarrhea and act quite ill; sudden signs often are due to bacterial overgrowth in the bowel (bacteria take advantage of diseased bowels and overgrow, causing diarrhea and nausea). Antibiotics often seem to cure the sudden episodes, but signs may reoccur later, as the underlying IBD is still active. Some pets are chronically thin and lack a normal muscular build, but seem active. Some show signs of nausea such as tooth grinding or pawing at the mouth.
What does IBD do? The stomach and bowel are damaged, sometimes badly enough to cause weight loss and poor digestion. The liver often becomes inflamed along with the intestines; most hepatitis in ferrets is due to IBD. Stomach ulcers and bleeding may occur; infections in the gut or liver may be seen. Inflammation may slow stomach contractions and delay emptying; we may see more hairballs retained in stomachs of ferrets with IBD. Gastritis may lead to acid reflux, which can damage the esophagus, leading to megaesophagus and the inability to swallow food. Most importantly, IBD causes many of the lymphomas we see in our ferret patients. The lymph nodes surrounding the diseased stomach and bowel become inflamed and enlarged; given time, many cases develop cancer in these nodes, which is lymphoma… this is often fatal.
How common is IBD? It is the most common severe disease of ferrets in our practice. About 50% of my patients presented for adrenal disease or insulinomas also have IBD, and it is often contributing to some of the signs the patient is exhibiting (such as weight loss and hypoglycemia).
How do we diagnose IBD? Clinical signs, if present, are useful. Half of our cases have no signs of IBD, and are caught unexpectedly during blood testing. Elevated serum lipase (over 500 U/L at a commercial lab, or over 1000 U/L on VetTest machines) indicates gastritis in ferrets (amylase should be normal in these cases). Elevated globulin (over 3.0 g/dl) indicates an inflammatory response. Elevated Alt (not Ast) over 200 U/L indicates hepatitis. Exact confirmation of IBD (including severity, and whether Helicobacter is present) must be with stomach and bowel biopsy. This should be done surgically, NOT with an endoscope; scoping does not allow good intestinal or lymph node biopsy in ferrets, which is crucial. The surgery is quick and easy. Pathology must be read by a very experienced exotics pathologist; one of the best in the U.S. is Dr. Mike Garner at Northwest ZooPath in the Seattle area. If surgery can’t be done then patients may be treated presumptively.
How do we treat IBD? If Helicobacter infection is seen on stomach biopsy, we treat to eliminate the bacteria (this takes 14 days). If no biopsy is done, we treat for this bacteria presumptively. After this, long term antiinflammatory drugs are the best treatment. Imuran (azathioprine) produces the best control with fewest side effects; prednisone may be used but has side effects over many months, and some animals do poorly on it, especially if hepatitis is present. Hypoallergenic diets such as Hills Z/D feline may help if food allergy is a cause of the IBD. Low starch diets such as Pretty Pets Natural Gold ferret food, or Purina DM diet feline, or Innova EVO for ferrets, may help if carbohydrate overload is part of the problem. But antiinflammatory drug treatment usually is lifelong; diet changes and elimination of Helicobacter (when present) usually fail to totally cure the inflammation. Monitor the symptoms (if present) and the lipase and globulin levels to determine if treatment is effective; adjust the medications if needed.
Remember, this disease is often not outwardly impressive; ferrets often seem normal for a long time. But many will die of lymphoma or other complications if not treated. Nearly all cases which are treated properly can survive long term, even when the lymph nodes are very close to developing lymphoma. As long as cancer isn’t already present, we can prevent it by using medications. IBD does not have to kill!
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