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Tierarztl Prax Ausg K Kleintiere Heimtiere 2017; 45(06): 390-396
DOI: 10.15654/TPK-170089
Original Article
Schattauer GmbH

Correlation between the FCEAI and diagnostic para meters in chronic enteropathies in 147 cats (2006–2012)

Korrelation zwischen dem FCEAI und diagnostischen Parametern bei 147 Katzen mit chronischen Enteropathien (2006–2012)
Stefanie Mitze
1   Small Animal Clinic Haar, Haar, Germany
,
Katharina Moser
1   Small Animal Clinic Haar, Haar, Germany
,
Erik Teske
2   Department of Clinical Science of Companion Animals, University of Utrecht, The Netherlands
,
Wolf v. Bomhard
3   Speciality Practice for Veterinary Pathology, Munich, Germany
,
Christian Stockhaus
1   Small Animal Clinic Haar, Haar, Germany
› Author Affiliations
Further Information

Publication History

Received: 13 February 2017

Accepted after revision: 01 August 2017

Publication Date:
10 January 2018 (online)

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Summary

Objective: The Feline Chronic Enteropathy Activity Index (FCEAI) has been established as a quantitative index for disease activity in chronic enteropathies in cats. A definite diagnosis is aimed at histology with initial exclusion of extraintestinal causes by laboratory examinations, diagnostic imaging and endoscopy. The study aimed to examine diagnostic parameters and FCEAI in chronic gastroenteropathies. Materials and methods: A retrospective case review of 147 cats with chronic enteropathies was performed. In all patients, the FCEAI was established and endoscopy performed including biopsies and duodenal cytology. Histopathologic reports were reviewed for the diagnosis of lymphoma and architectural changes (epithelial integrity, villi/ gland atrophy, intestinal crypt atrophy, lymphangiectasia, epitheliotropism/infiltration of intraepithelial lymphocytes). A cytopathologic score (CS) and histopathologic score (HS) regarding lymphocytic intestinal infiltration were assigned. Statistical dependency analysis was used to determine correlations between the FCEAI, lymphoma, architectural changes, CS, HS, serum concentrations of cobalamin, folate and albumin. Results: The 147 cats consisted of predominately European Shorthair cats (n = 126), were mostly castrated (n = 127) and had a mean age of 9.8 (1–17) years. For the proven lymphoma group (12.2%; n = 18) and the non-lymphoma group a mean FCEAI of 7.3 (4–17) and 6.6 (2–13), respectively, was established. The FCEAI showed a low correlation with the CS (p = 0.010; R = 0.22) and intestinal villous atrophy (n = 121; p = 0.035; R = 0.19). Cats with a CS of 0 had a significant lower FCEAI score (p = 0.015) than cats with all other CSs. The histo- and cytopathologic scores were highly related (p < 0.001; R = 0.43). The gastric intraepithelial lymphocytic infiltration (n = 131) was significantly correlated to serum folate (p = 0.014; R = –0.56) and albumin (p = 0,048; R = –0.20). Conclusion: The FCEAI showed only a few correlations. Not only the grade of inflammation, but also the histologic architectural changes are of importance.

Zusammenfassung

Gegenstand: Der Feline Chronic Enteropathy Activity Index (FCEAI) wurde als quantitativer Index für die Entzündungsintensität bei chronischen Gastroenteropathien der Katze entwickelt. Eine Diagnose wird durch Ausschluss extraintestinaler Erkrankungen anhand von Labor- und bildgebenden Untersuchungen, Endoskopie und Gewebe diagnostik erzielt. Die Studie hatte zum Ziel, die Korrelation von dia gnostischen Parametern und FCEAI bei chronischen Gastroenteropathien zu evaluieren. Material und Methoden: Retrospektive Studie bei 147 Katzen mit chronischen Gastroenteropathien und endoskopisch gewonnenen Bioptaten für die zytologische/histologische Untersuchung. Histologische Befunde wurden auf Entzündungszellinten sität und Architekturveränderungen (Epithelintegrität, Villi-/Drüsenatrophie, Kryptenatrophie, Lymphangiektasie, Epitheltropismus/ intra epitheliale Lymphozyten) untersucht. Bezüglich der lymphoplasmazellulären Zellinfiltration wurden der zytopathologische (ZG) und histopathologische Grad (HG) berücksichtigt. Zur Ermittlung der Korrela tion zwischen FCEAI, Architekturveränderungen, ZG, HG und Serumkonzentration von Cobalamin, Folat und Albumin diente eine statistische Dependenzanalyse. Ergebnisse: Bei den 147 Patienten handelte es sich vorwiegend um Europäisch-Kurzhaar-Katzen (n = 126), meist kastriert (n = 127) mit einem mittleren Alter von 9,8 (1–17) Jahren. Der durchschnittliche FCEAI betrug 7,3 (4–17) für die Lym phomgruppe (12,2%; n = 18) und 6,6 (2–13) für die Nichtlymphomgruppe. Der FCEAI zeigte eine niedrige Korrelation mit dem ZG (p = 0,010; R = 0,22) und der Villiatrophie des Dünndarmepithels (n = 121; p = 0,035; R = 0,19). Katzen mit einem ZG von 0 hatten einen signifikant niedrigeren FCEAI (p = 0,015) als Tiere mit alle ande ren ZG. Zwischen HG und ZG bestand eine hohe Korrelation (p < 0,001; R = 0,43). Die intraepitheliale lymphozytäre Zellinfiltration des Magens (n = 131) war signifikant mit der Folat- (p = 0,014; R = –0,56) und Albuminkonzentration (p = 0,048; R = –0,20) korreliert. Schlussfolgerung: Der FCEAI korrelierte nur teilweise mit anderen Parametern. Neben dem Entzündungsgrad sollten Architekturveränderungen der Darmwand berücksichtigt werden.

Keywords

FCEAI - IBD - lymphoma - cytology - histology

Schlüsselwörter

FCEAI - IBD - Lymphom - Zytologie - Histologie
 

  • References

  • 1 Allenspach K, Wieland B, Gröne A, Gaschen F. Chronic enteropathies in dogs: evaluation of risk factors for negative outcome. J Am Vet Med Assoc 2007; 21 (04) 700-708.
    PubMedGoogle Scholar
  • 2 Bailey S, Benigni L, Eastwood J, Garden OA, McMahon L, Smith K, Steiner JM, Suchodolski JS, Allenspach K. Comparisons between cats with normal and increased fPLI concentrations in cats diagnosed with inflammatory bowel disease. J Small Anim Pract 2010; 51 (09) 484-489.
    CrossrefPubMedGoogle Scholar
  • 3 Chang F, Mahadeva U, Deere H. Pathological and clinical significance of increased intraepithelial lymphocytes (IELs) in small bowel mucosa. APIMS 2005; 113 (06) 385-399.
    PubMedGoogle Scholar
  • 4 Cheroutre H, Lambolez F, Mucida D. The light and dark sides of intestinal intraepithelial lymphocytes. Nature Reviews Immunology 2011; 11 (07) 445-456.
    CrossrefPubMedGoogle Scholar
  • 5 Day MJ, Bilzer T, Mansell J, Wilcock B, Hall EJ, Jergens A, Minami T. et al. Histopathologic standards for the diagnosis of gastrointestinal inflammation in endoscopic biopsy samples from the dog and cat: a report from the world small animal veterinary association gastrointestinal standardization group. J Comp Pathol 2008; 138 (2–3): S1-S43.
    CrossrefPubMedGoogle Scholar
  • 6 Daniaux LA, Laurenson MP, Marks SL, Moore PF, Taylor SL, Chen RX, Zwingenberg AL. Ultrasonographic thickening of the muscularis propria in feline small intestinal small cell T-cell lymphoma and inflammatory bowel disease. J Feline Med Surg 2014; 16 (02) 89-98.
    CrossrefPubMedGoogle Scholar
  • 7 Davenport DJ, Leib MS, Roth L. Progression of lymphocytic-plasmacytic enteritis to gastrointestinal lymphosarcoma in three cats. Proc Vet Cancer Soc 7th Annu Conf. 1987 Suppl.
    PubMedGoogle Scholar
  • 8 Dickson BC, Streuker CJ, Chetty R. Coeliac disease: an update for pathologists. J Clin Pathol 2006; 59 (10) 1008-1016.
    CrossrefPubMedGoogle Scholar
  • 9 Evans SE, Bonczynski J, Broussard JD, Han E, Baer KE. Comparison of endoscopic and full thickness biopsy specimens for diagnosis of inflammatory bowel disease and alimentary tract lymphoma in cats. J Am Vet Med Assoc 2006; 229 (09) 1447-1450.
    CrossrefPubMedGoogle Scholar
  • 10 Fragkou FC, Adamama-Moraitou KK, Poutahidis T, Prassinos NN, Kritsepi-Konstantinou M, Xenoulis PG, Steiner JM, Lidbury JA, Sucholdolski JS, Rallis TS. Prevalence and clinicopathological features of triaditis in a prospective case series of symptomatic and asymptomatic cats. J Vet Intern Med 2016; 30 (04) 1031-1045.
    CrossrefPubMedGoogle Scholar
  • 11 Freiche V, Fraucher MR, German AJ. Can clinical signs, clinicopathological findings and abdominal ultrasonography predict the site of histopathological abnormalities of the alimentary tract in cats?. J Feline Med Surg 2016; 18 (02) 118-128.
    CrossrefPubMedGoogle Scholar
  • 12 Gaschen L. Ultrasonography of small intestinal inflammatory and neoplastic diseases in dogs and cats. Vet Clin Small Anim 2011; 41 (02) 329-344.
    CrossrefPubMedGoogle Scholar
  • 13 Gaschen L, Kircher P, Stüssi A, Allenspach K, Gaschen F, Doherr M, Gröne A. Comparison of ultrasonographic findings with clinical activity index (CIBDAI) and diagnosis in dogs with chronic enteropathies. Vet Radiol Ultrasound 2008; 49 (01) 56-64.
    CrossrefPubMedGoogle Scholar
  • 14 Janeczko S, Atwater D, Bogel E, Greiter-Wilke A, Gerold A, Baumgart M, Bender H, McDonoough PL, McDonough SP, Goldstein RE, Simpson KW. The relationship of mucosal bacteria to duodenal histopathology, cytokine mRNA, and clinical disease activity in cats with inflammatory bowel disease. Vet Microbiol 2008; 128 (1–2): 178-193.
    CrossrefPubMedGoogle Scholar
  • 15 Jergens AE, Crandell JM, Evans R, Ackermann M. et al. A clinical index for disease activity in cats with chronic enteropathy. J Vet Intern Med 2010; 24 (05) 1027-1033.
    CrossrefPubMedGoogle Scholar
  • 16 Jergens AE. Feline idiopathic inflammatory bowel disease: What we know and what remains to be unraveled. J Feline Med Surg 2012; 14 (07) 445-458.
    CrossrefPubMedGoogle Scholar
  • 17 Jergens AE, Andreasen CB, Miles KB. Gastrointestinal endoscopic exfoliative cytology: techniques and clinical application. Compend Contin Educ Pract Vet 2000; 22 (10) 941-951.
    PubMedGoogle Scholar
  • 18 Jugan MC, August JR. Serum cobalamin concentrations and small intestinal ultrasound changes in 75 cats with clinical signs of gastrointestinal disease: a retrospective study. J Feline Med Surg 2017; 19 (01) 48-56.
    CrossrefPubMedGoogle Scholar
  • 19 Kiupel M, Smedley RC, Pfent C, Xie Y, Xue Y, Wise AG. et al. Diagnostic algorithm to differentiate lymphoma from inflammation in feline small intestinal biopsy samples. Vet Pathol 2011; 48 (01) 212-222.
    CrossrefPubMedGoogle Scholar
  • 20 Kleinschmidt S, Harder J, Nolte I. Chronic inflammatory and non-inflammatory diseases of the gastrointestinal tract in cats: Diagnostic advantages of full thickness intestinal and extraintestinal biopsies. J Feline Med Surg 2010; 12 (02) 97-103.
    CrossrefPubMedGoogle Scholar
  • 21 Kumar S, Hakim A, Alexakis C, Chhaya V, Tzias D, Pilcher J, Vlahos J, Pollok R. Small intestinal contrast ultrasonography for the detection of small bowel complications in Crohn’s disease: correlation with intraoperative findings and magnetic resonance enterography. J Gastroenterol Hepatol 2015; 30 (01) 86-91.
    CrossrefPubMedGoogle Scholar
  • 22 Lalor S, Schwartz AM, Titmarsh H, Reed N, Tasker S, Boland L, Berry J, Gunn-Moore D, Mellanby RJ. Cats with inflammatory bowel disease and intestinal small cell lymphoma have low serum concentrations of 25-Hydroxyvitamin D. J Vet Intern Med 2014; 28 (02) 351-355.
    CrossrefPubMedGoogle Scholar
  • 23 Malamut G, Matysiak-Budnik T, Grosdider E, Jais JP, Morales E, Damotte D, Caillat-Zucman S, Brousse N, Cerf-Benussan N, Jian R, Cellier C. Adult celiac disease with severe or partial villous atrophy: a comparative study. Gastroenterol Clin Biol 2008; 32 (03) 236-242.
    CrossrefPubMedGoogle Scholar
  • 24 Mangelsdorf S, Teske E, v. Bomhard W, Stockhaus C. Cytology of endoscopically obtained biopsies for the diagnosis of chronic intestinal diseases in cats. Tierärztl Prax 2015; 43 (K): 15-22.
    PubMedGoogle Scholar
  • 25 Maunder CL, Day JM, Hibbert A, Steiner JM, Suchodolski JS, Hall EJ. Serum cobalamin concentrations in cats with gastrointestinal signs: correlation with histopathological findings and duration of clinical signs. J Feline Med Surg 2012; 14 (10) 686-693.
    CrossrefPubMedGoogle Scholar
  • 26 Moore PF, Rodriguez-Bertos A, Kass PH. Feline gastrointestinal lymphoma: Mucosal architecture, immunophenotype and molecular clonality. Vet Pathol 2012; 49 (04) 658-668.
    CrossrefPubMedGoogle Scholar
  • 27 Nakashima K, Hiyoshi S, Ohno K, Uchida K, Goto-Koshino Y. et al. Prognostic factors in dogs with protein-losing enteropathy. Vet J 2015; 205 (01) 28-32.
    CrossrefPubMedGoogle Scholar
  • 28 Norsworthy GD, Scot Estep J, Hollinger C, Steiner JM, Lavallee JO, Gassler LN, Restine LM, Kiupel M. Prevalence and underlying causes of histologic abnormalities in cats suspected to have chronic small bowel disease: 300 cases (2008–2013). J Am Vet Med Assoc 2015; 247 (06) 629-635.
    CrossrefPubMedGoogle Scholar
  • 29 Scott KD, Zoran DL, Mansell J, Norby B, Willard MD. Utility of endoscopic biopsies of the duodenum and ileum for diagnosis of inflammatory bowel disease and small cell lymphoma in cats. J Vet Intern Med 2011; 25 (06) 1253-1257.
    CrossrefPubMedGoogle Scholar
  • 30 Simpson KW, Fyfe J, Cornetta A, Sachs A. et al. Subnormal concentrations of cobalamin (Vitamin B12) in cats with gastrointestinal disease. J Vet Intern Med 2001; 15 (01) 26-32.
    CrossrefPubMedGoogle Scholar
  • 31 Trepanier L. Idiopathic inflammatory bowel disease in cats: Rational treatment selection. J Feline Med Surg 2009; 11 (01) 32-38.
    CrossrefPubMedGoogle Scholar
  • 32 Waly NE, Stokes CR, Gruffydd-Jones TJ, Day MJ. Immune cell populations in the duodenal mucosa of cats with inflammatory bowel disease. J Vet Intern Med 2004; 18 (06) 816-825.
    CrossrefPubMedGoogle Scholar
  • 33 Washabau RJ, Day MJ, Willard MD, Hall EJ, Jergens AE, Mansell J. et al. Endoscopic, biopsy, and histopathologic guidelines for the evaluation of gas trointestinal inflammation in companion animals. J Vet Intern Med 2010; 24 (01) 10-26.
    CrossrefPubMedGoogle Scholar
  • 34 Weiss DJ, Gagne JM, Armstrong PJ. Relationship between inflammatory hepatic disease and inflammatory bowel disease, pancreatitis, and nephritis in cats. J Am Vet Med Assoc 1996; 209 (06) 1114-1116.
    PubMedGoogle Scholar
  • 35 Williams JM, Panciera DL, Larson MM, Werre SR. Ultrasonographic findings of the pancreas in cats with elevated serum pancreatic lipase immunoreactivity. J Vet Intern Med 2013; 27 (04) 913-918.
    CrossrefPubMedGoogle Scholar
  • 36 Willard MD, Mansell J, Fosgate GT, Gualtieri M, Olivero D, Lecoindre P, Twedt DC, Collett MG, Day MJ, Hall EJ, Jergens AE, Simpson JW, Else RW, Washabau RJ. Effect of sample quality on the sensitivity of endoscopic biopsy for detecting gastric and duodenal lesions in dogs and cats. J Vet Intern Med 2008; 22 (05) 1084-1089.
    CrossrefPubMedGoogle Scholar
  • 37 Winter MD, Londono L, Berry CR, Hernandez JA. Ultrasonographic evaluation of relative gastrointestinal layer thickness in cats without clinical evidence of gastrointestinal tract disease. J Feline Med Surg 2014; 16 (02) 118-124.
    CrossrefPubMedGoogle Scholar
  • 38 Worhunsky P, Toulza O, Rishniw M, Berghoff N, Ruaux CG, Steiner JM, Simpson KW. The relationship of serum cobalamin to methylmalonic acid concentrations and clinical variables in cats. J Vet Intern Med 2013; 27 (05) 1056-1063.
    CrossrefPubMedGoogle Scholar
  • 39 Zwingenberg AL, Marks SL, Baker TW, Moore PF. Ultrasonographic evaluation of the muscularis propria in cats with diffuse small intestinal lymphoma or inflammatory bowel disease. J Vet Intern Med 2010; 24 (02) 289-292.
    CrossrefPubMedGoogle Scholar
  • 40 Zakeri N, Pollock RC. Diagnostic imaging and radiation exposure in inflammatory bowel disease. World J Gastroenterol 2016; 22 (07) 2165-2178.
    CrossrefPubMedGoogle Scholar