The primary goals in treating esophagitis are to identify and treat the primary cause, decrease or prevent further exposure of the esophagus to gastric acid, provide adequate nutrition, and treat any complications. Although most animals with esophagitis are treated as outpatients, certain individuals with extremely severe cases do warrant hospitalization for intensive therapy and support. Therapy for esophagitis includes: Gastric acid inhibitors are recommended to block acid secretion, and therefore diminish the volume of acid that can be refluxed (leaked backwards) into the esophagus. Examples include a group called H2 receptor antagonists (cimetidine (Tagamet®), ranitidine (Zantac®), famotidine (Pepcid®)), or proton pump inhibitors such as omeprazole (Prilosec®).
Sucralfate (Carafate®) suspension (liquid) helps soothe and coat an inflamed stomach and esophagus.
Motility modifying drugs are drugs that promote movement within the gastrointestinal tract, such as metoclopramide (Reglan®), and can be used to stimulate movement within the esophagus and help to tighten the lower esophageal sphincter, the band of tissue that separates the stomach from the esophagus. In turn, this decreases the amount of reflux into the esophagus.
Dietary modification should include small, frequent feedings of an easily digestible product. In addition, it is preferable not to feed these animals late at night, as they will be more apt to reflux with a full stomach while sleeping.
Antibiotic therapy may be recommended in some cases where there is extreme inflammation and especially in cases where secondary pneumonia has been documented.
Nutritional support may be indicated in those cases where feeding the individual orally will worsen and perpetuate esophageal inflammation. Placing a stomach tube using an endoscope or surgery may be necessary to bypass the esophagus and deliver nutritional support. Intravenous nutrition may be of benefit if the individual is not a good candidate for anesthesia. Both are temporary means of delivering support until the esophagitis has resolved.
Endoscopic removal of a foreign body may be indicated in cases where a foreign body is present.
Surgery may be indicated in certain situations to include removal of an esophageal foreign body where endoscopy was unsuccessful.
Optimal treatment for your cat requires a combination of home and professional veterinary care. Follow-up can be critical, especially if your cat does not rapidly improve. Administer all prescribed medications as directed. Alert your veterinarian if you are experiencing problems in treating your cat.
In individuals with mild to moderate cases of esophagitis, following their condition clinically may be all that is necessary. Continuing all recommended therapy and reporting progress to your veterinarian is often all that is necessary, and reporting even the smallest setback is of paramount importance.
In cases of severe esophagitis, follow-up endoscopy is generally recommended 2 to 4 weeks after the initial diagnosis. It is important to assess the healing of these patients, and to assess the esophagus for any changes consistent with the presence of an early stricture. In addition, it helps to determine if the patients who are being fed by gastrotomy tube can be switched to oral feedings.
It is important to be aware of signs that would suggest a secondary pneumonia has occurred. These include coughing, difficult or pronounced breathing, general malaise (lethargy), or simply not acting normal. Thoracic (chest) radiograph would be indicated in these cases.
In severe cases, esophageal stricture is not uncommonly seen. Things to be especially aware of include frequent or persistent regurgitation, or extreme discomfort upon ingesting food.
The prognosis for these animals depends on the underlying cause and the degree of severity and inflammation. Generally, mild to moderate cases respond nicely to treatment. Severe cases may respond well, but may be associated with complications or lengthy healing periods. In extreme cases, despite appropriate therapy and recommendations, complete resolution and even control may be unattainable.