GI ulceration can occur when there is a disruption of the normal protective mechanism provided by the gastroduodenal mucosal barrier. This can occur in association with a variety of disorders including:
A recent study evaluated the effect of orally administered drugs - including famotidine and different formulations of omeprazole - on the intragastric pH in cats. The findings are revealed in my discussion on the topic - view it on demand in the Evidence Based Updates.
(Approved for CE credit in New York and by the NJVMA, pending approval for CE credit by AAVSB RACE).
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We contacted corresponding author, Katie Tolbert, DVM, PhD, DACVIM regarding this EBU and we have invited her to join our Roundtable discussion on this topic.
Dr. Tolbert has also indicated the following comments / clarifications regarding this EBU:
"We actually placed the pH capsules on day 4 not day 1 as indicated in the EBU. We were interested in comparing the effect of acid suppressants when dosed chronically which is the reason for waiting until all drugs were at steady state. Also, she may be interested to read Dr. Quimby's paper on gastrin and CKD in cats (J Vet Intern Med. 2014 May-Jun;28(3):827-37). Interestingly, they found no evidence for erosive or ulcerative gastritis in cats with CKD (despite high serum gastrin). In fact, the cats had evidence of gastric gland atrophy so the use of acid suppressants in cats with CKD has become somewhat muddy!"
Thanks for those comments. I guess that I just misread the timing of the placement of the pH capsule in relation to treatment because it does clearly state that it was placed on day 4 of treatment. I also hadn't read Dr Quimby's paper but rather was relying on decades of level D "evidence." That demonstrates an excellent point that expert opinion and physiologic principles may be disproven with actual research studies in the species of interest. It will be interesting to see if the International Renal Interest Society will remove the recommendation to treat cats with stage 3 and 4 chronic kidney disease displaying vomiting/decreased appetite/nausea with a proton pump inhibitor.
I actually agree with you that cats with CKD need acid suppressants based on clinical experience of an improvement in appetite, GI symptoms, etc. However, I do think that more research needs to be performed to determine what level of acid suppression they need. My guess is that they do not need twice daily omeprazole therapy since they don't appear to have erosive or ulcerative disease. This is the reason for not mentioning CKD in the introduction. In fact, I have some concern that this degree of acid suppression may be harmful to them. I would reserve twice daily omeprazole for cats with suspected or documented ulcerative disease. We do have a study (grant proposal pending) to start to piece out some of the questions regarding gastric acid and use of acid suppressants in cats with CKD. We are very excited about this study as it will be a bi-hospital study involving UTK CVM and a private practice in Tennessee.
