Treating FGESF

Evolving Treatment Strategies for Feline Gastrointestinal Eosinophilic Sclerosing Fibroplasia

The treatment landscape for Feline Gastrointestinal Eosinophilic Sclerosing Fibroplasia (FGESF) is rapidly evolving, with new insights emerging from retrospective studies and the collective experiences of veterinarians, clients, and patients. These developments are shaping a more effective approach to managing this challenging condition.

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Recent Findings

A key finding in recent studies is the significant benefit of combining surgery with corticosteroid therapy, most commonly, prednisolone. Cats treated with surgery alone often have shorter survival times compared to those receiving both surgery and corticosteroids. Interestingly, even in cases where surgery is not performed, the inclusion of prednisolone in the treatment regimen has been associated with improved survival times, underscoring the critical role of corticosteroids in managing FGESF.

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Importance of Corticosteroids

Long-term management of FGESF heavily relies on the ongoing use of corticosteroids to prevent the recurrence of masses. In cases where surgery was not followed by corticosteroid therapy, the recurrence of masses or development of new masses, was frequently observed. Long-term management of FGESF heavily relies on the ongoing use of corticosteroids. In one study, 85% of cats that discontinued prednisolone therapy, experienced a recurrence of clinical signs, with a median time of 114 days, before therapy had to be restarted. This emphasizes the necessity of maintaining corticosteroid treatment to achieve sustained control over the disease. The general treatment goal is to reach the lowest effective doses of therapy, reducing the risks of medication side effects while controlling the underlying disease. Secondary immunosuppressive agents and antibiotics have also been utilized in the treatment of FGESF, particularly when prednisolone is contraindicated, such as in pets with pre-existing heart disease or diabetes.

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Antibiotics & Supportive Medications

Antibiotics are often administered at the time of initial diagnosis due to evidence of bacterial infection, which is presumed to be secondary to the damage caused by FGESF. Bacterial infection is not indicated in every case of FGESF. Each cat’s experience is unique. Supplemental medications such as anti-nausea and appetite stimulants may also be prescribed as needed.

 

Dietary Modifications & Prophylaxis

Dietary modifications have also been explored as an adjunct treatment for FGESF, with improvements seen in some patients. However, it is important to note that most of these cats were also receiving pharmacological intervention, so other variables could have influenced the results. In addition to these treatments, maintaining routine prophylaxis, such as gastrointestinal deworming, is important in managing overall health.

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Summation

The integration of corticosteroid therapy, potentially in combination with dietary modifications and secondary immunosuppressive agents, appears to be a critical component in the effective management of cats with FGESF. As research continues to evolve, these treatment strategies are likely to become more refined, offering improved outcomes for affected cats. Ongoing communication with your veterinarian is critical so you understand the benefits and risks of certain therapeutic regimens. It is also important to understand that each patient will have therapy tailored to their specific form of the condition.

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What to Expect
FGESF is a chronic condition that requires years of therapy, sometimes indefinitely. It is a therapeutic challenge for veterinarians and caregivers to balance the response to medication with the potential side effects of therapy, all of which carry significant weight in any decision-making process. Your veterinarian will likely have you monitor closely for clinical signs that could suggest progression of the disease, e.g., weight loss, vomiting, diarrhea, or reduced appetite. Equally, you will be required to monitor for side effects due to therapy, e.g., drinking more, urinating more, which may suggest the development of diabetes (an uncommon complication associated with prednisolone use), and would be important to report. Additionally, follow-up ultrasound scans and blood tests may be recommended to ensure the lesion is responding to therapy. It's important to note that sometimes the lesion will never completely resolve with medical management, yet the clinical signs may be adequately managed.