Diagnosing FGESF

Diagnosing Feline Gastrointestinal Eosinophilic Sclerosing Fibroplasia can present challenges due to its nuanced presentation across clinical examinations, imaging studies, and even microscopic analysis. For these reasons, upon initial presentation, it is often confused with other serious gastrointestinal illnesses like Inflammatory Bowel Disease (IBD), lymphoma, and other forms of cancer. Achieving a conclusive diagnosis often necessitates the collection of biopsies and samples, typically through surgical or endoscopic means where feasible. Moreover, clinicians often order supplementary tests on these samples to mitigate the risk of misdiagnosis and to screen for concurrent infectious agents. 

                                      

Diagnostic Tests
Diagnosing this condition often involves a tissue biopsy, which provides a definitive diagnosis and helps rule out similar diseases, such as certain cancers. While samples are typically collected surgically, endoscopic methods (which are less invasive) may also be an option. A biopsy can be used to detect secondary complications, such as infections that might require antibiotics. However, this procedure can be relatively invasive (which may be deemed too risky at certain stages of illness) and may involve additional costs for specialized tests.

 

Less invasive sample collection

Veterinarians are becoming increasingly skilled at diagnosing this condition using less invasive methods, such as blood tests and fine needle aspirates. These less invasive methods can be particularly useful for sick animals, but they may not provide the same depth of information as a biopsy. Understanding the trade-offs between these diagnostic options is essential in making the best decision for your pet's health.

 

Presumptive Indicators

In cases where invasive procedures pose significant risks or are financially prohibitive, some veterinarians may opt to initiate treatment based on presumptive indicators alone. These indicators may include elevated blood globulin levels, elevated eosinophils, lesion localization, and cytology findings from fine needle aspirates. However, it's crucial to acknowledge that these tests are not pathognomonic, and without histopathological confirmation via biopsy and histopathological evaluation, such diagnoses remain speculative. This carries the potential for both prognostic uncertainty and the inadvertent exacerbation of complications through unjustified pharmacological interventions.

 

Physical Examination 

Physical examination findings will vary with lesion location. However, a mass is commonly palpated. It is often initially thought to be a cancer or even impacted feces. Critically, when the mass lesions are subjected to palpation, aspiration, biopsy or excision, they tend to have a gritty hard feel. This is a useful point of differentiation from other common intraabdominal masses, such as various cancers, although it is not a perfect test.  

 

Potential Signs

Given that the majority of reported lesions are localized to the gastrointestinal tract, it seems logical that the most common clinical signs reported are vomiting, diarrhea, weight loss, and loss of appetite. However, because of occasional involvement in other organs or body cavities, presenting signs can appear more obscure. Some cases reported having no prior clinical signs, with lesions being identified incidentally during routine evaluation. There is wide variation in duration of signs, from days to years. 

 

What to do if FGESF is suspected

If there is suspicion of FGESF, discuss the following variables with your veterinarian as they may help identify predisposing factors:

• Gastric worming prevention history. 

• Dietary history (i.e., access to bones) that may indicate if there has been a risk of intestinal trauma. 

• History of overgrooming or foreign body ingestion.

• History of vomiting or diarrhea or other comorbidities. 

• Travel history, (i.e. assess exposure to parasites).