Gastric Motility Disorder in Dogs

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Gastric motility disorders are abnormalities that result from conditions that disrupt normal emptying of the stomach resulting in distention and subsequent abnormal function of the stomach.

There are many causes of gastric motility disorders, including:

Metabolic Disorders

  • Hypokalemia (low potassium)
  • Renal (kidney) failure
  • Hypothyroidism (sluggish thyroid)

    Nervous Inhibition

  • Stress
  • Fear
  • Pain
  • Trauma

    Primary Stomach Diseases

  • Blockages
  • Gastritis (inflammation of the stomach)
  • Ulcers
  • Parvovirus
  • Previous gastric surgery

    Miscellaneous

  • Gastroesophageal reflux (backward flow) of gastric/intestinal juice
  • Dysautonomia (dysfunction of a part of the nervous system)
  • Primary idiopathic (Unknown cause)
  • Drugs

    Gastric motility disorders are seen in both dogs and cats. There are no sex, breed or age predilections; however it is uncommon to see primary disorders in younger animals.

    What to Watch For

  • Chronic vomiting after eating
  • Gastric distention
  • Nausea
  • Anorexia (poor appetite)
  • Belching
  • Pica (eating inappropriate things)
  • Weight loss

    Diagnosis

    A thorough knowledge of history and clinical signs is very important and is most helpful in making the diagnosis. Diagnostic tests are necessary to confirm a diagnosis of gastric motility disorders. They include:

  • Complete blood count (CBC)
  • Biochemical profile
  • Urinalysis
  • Fecal flotation
  • Abdominal radiographs (x-rays)
  • Abdominal ultrasound
  • A contrast (dye) upper gastrointestinal study
  • Endoscopy, specifically gastroscopy

    Treatment

    Treatment for gastric motility disorders is dependent upon the precise disease. In addition, symptomatic/supportive therapy may be indicated, regardless of the disease itself.

  • Most patients are treated as an outpatient
  • Hospitalization/supportive care in extreme/severe cases of disease
  • Dietary modification
  • Stomach acid blockers
  • Gastric coating agents
  • Prokinetic (promote movement) agents
  • Surgical intervention for certain disorders (blockages)

    Home Care and Prevention

    Administer prescribed medication and follow all feeding instructions. Contact your veterinarian if signs continue or worsen.

    There is no specific preventative care available.

  • Gastric motility disorders result from conditions that directly or indirectly disrupt normal emptying of the stomach that results in gastric distention and subsequent signs of illness. Although some gastric motility disorders are primary, the majority of cases occur secondary to other conditions or disorders.

    The magnitude of clinical signs depends on both the specific disease process and the severity of that disease. The clinical signs are often chronic, often present for weeks or months and most often include some degree of vomiting, usually of food. Because the history, physical exam findings and overall presentation of animals with gastric motility disorders may be variable and sometimes nonspecific, there are other illnesses and symptoms that might initially be considered when establishing a definitive diagnosis, especially those that cause chronic vomiting. These include:

  • Chronic, recurrent dietary indiscretion, especially overeating and ingesting foreign material.

  • Dietary intolerance can cause chronic vomiting, and mimic gastric motility disorders. They are often associated with protein, lactose, diets high in fat and certain food additives.

  • There are many infectious agents that can cause chronic vomiting. Bacterial, viral, fungal and parasitic diseases are common. Parvovirus is one of the more likely offenders.

  • Chronic drug administration and/or toxin exposure can cause chronic vomiting by directly irritating the lining of the gastrointestinal tract. Examples include non-steroidal anti-inflammatory drugs (aspirin), corticosteroids, antibiotics, insecticides, heavy metals, and lawn and garden products.

  • Obstruction/blockage of the gastrointestinal tract causes an outflow obstruction, and in turn, motility disorder. This is usually secondary to the presence of chronic foreign bodies, tumors, intussusceptions (telescoping of the bowel into itself), hypertrophic gastropathy (thickening and malfunction of the pyloric area of the stomach) or parasites.

  • Patients with metabolic diseases such as kidney, liver, diabetes mellitus and hypoadrenocorticism (Addison's disease), may present for signs similar to those with motility disorders.

  • Any patients with abdominal disorders present for vomiting. Chronic pancreatitis (inflammation of the pancreas), prostatic disorders, and low-grade peritonitis (inflammation of the abdominal cavity) should be considered.

  • Neurologic disorders, especially vestibular disease, can stimulate the area in the brain involving the vomiting reflex. Dysfunction of the autonomic nervous system (dysautonomia) has been recognized as a cause as well.

  • Inflammatory bowel disease is a microscopic accumulation of inflammatory cells of any/all parts of the gastrointestinal tract. No one cause has been identified. Vomiting is one of many signs that may be seen.

  • Lymphangiectasia is an intestinal disorder characterized by the dilation of lymph vessels throughout the gastrointestinal tract, causing chronic vomiting, diarrhea, protein loss and weight loss.

  • Gastrointestinal ulcers are associated with liver disease, kidney disease, stress, or pancreatic disease. Chronic vomiting, with or without blood is commonly seen.

  • A hiatal hernia is the sliding of abdominal contents into the chest cavity through the diaphragm.

  • Lymphosarcoma (a type of cancer) is most often a microscopic disease that infiltrates the gastrointestinal tract, and can cause many GI signs. It is seen in all ages and breeds.

  • Diagnosis In-depth

    Certain diagnostic tests must be performed to diagnose a gastric motility disorder, and to exclude other disease processes that may cause similar symptoms. A thorough work-up begins with a broad general baseline of tests, and in many cases, more specialized or advanced testing may be indicated as well. It is important to note that an accurate diagnosis is necessary for an appropriate treatment regime.

  • Obtaining a complete medical history and performing a thorough physical examination are necessary in order to create an appropriate diagnostic plan for the patient with a gastric motility disorder.

  • A complete blood count (CBC) will evaluate for the presence of infection, inflammation, and anemia, associated with some diseases that cause gastric motility disorders.

  • A biochemical profile evaluates kidney, liver, electrolytes, total protein, and blood sugar status. All of these parameters are important to establish on these patients. A low potassium level is not uncommonly seen as a cause of motility disorders.

  • A urinalysis helps evaluate the kidneys and hydration status of the patient.

  • A fecal flotation must be performed to rule out parasites as an associated cause.

  • Abdominal X-rays evaluate the abdominal organs, presence of fluid, and the presence of a foreign body or tumor.

    Your veterinarian may recommend additional tests to insure optimal medical care. These are selected on a case-by-case basis.

  • An ACTH stimulation test may be recommended to rule out hypoadrenocorticism (Addison's disease). It is a safe, simple, timed blood test that measures adrenal function and can usually be performed at your veterinary hospital.

  • Bile acids are a simple timed blood test that evaluates liver function. The test is very safe and can be performed at your veterinary hospital.

  • A blood lead level may be indicated in these patients where there has been known or possible lead exposure.

  • Chest X-rays are an important part of the work up for the chronically vomiting patient, as tumors and other types of cancer can metastasize (spread) to the lungs.

  • Abdominal ultrasound evaluates the abdominal organs and helps assess for the presence of tumors. Organs, lymph nodes, and masses can be sampled with a needle or biopsy instrument with the guidance of ultrasound. This procedure is relatively safe, but may necessitate a mild sedative. It is often recommended that a specialist perform the procedure.

  • An upper gastrointestinal (GI) barium (dye) series may be considered in those patients with chronic vomiting associated with gastric motility disorders. It may help diagnose foreign objects or tumors that are not apparent on X-rays, or confirm a diagnosis of GI ulceration. A safe dye is given to the patient by mouth, and is then watched as it travels through the GI tract. It is a non-invasive test that can often be performed by your regular veterinarian, although in some cases may necessitate transfer to a specialty hospital.

  • Gastroscopy may be of benefit in the vomiting patient. Although it is usually within normal limits in patients with idiopathic or primary gastric motility disorders, it may facilitate the removal of foreign bodies, help evaluate for ulcer disease, and sample tissue for the presence of inflammation or cancer. Hospitalization is brief, and healing is generally quick and uneventful. It does, however, necessitate general anesthesia, and therefore is associated with minor risks. It is often necessary to refer the patient to a specialist, and is performed when other diagnostics are either inconclusive or support the diagnosis of a gastric foreign body.

  • Lastly, an exploratory laparotomy should be performed as a diagnostic tool in any individual that has had an extensive diagnostic and treatment course, with little to no response. It is an invasive test, but it is necessary in a handful of cases for a definitive diagnosis and possible therapy or cure.

    Therapy In-depth

    In patients with gastric motility disorders, little is as important as finding the underlying cause to insure appropriate therapy. Most patients are treated as outpatients, although in critically ill animals with severe vomiting and dehydration, hospitalization and intensive therapy is necessary. Therapy for gastric motility disorders include:

  • Dietary manipulation is important in the management of primary gastric motility disorders. Dietary modification should include small frequent feedings of an easily digestible product. Diets should be formulated that are liquid or semi-liquid consistency and low in fat and fiber content. The specific disease should be addressed with the appropriate feeding regime.

  • On severe cases intravenous fluid and electrolyte therapy may be necessary to correct dehydration, acid-base, and electrolyte abnormalities.

  • Antiemetic drugs to stop vomiting should be used with caution. It is best to identify and treat the underlying cause of vomiting; however, in selected cases they may be recommended.
                            
  • Antacids to decrease acid production by the stomach, such as Tagamet (cimetidine), Pepcid (famotidine) or Zantac (ranitidine), may be of benefit in some cases, especially where ulceration is associated.

  • Gastrointestinal protectants and adsorbents to protect or sooth are felt to coat an "irritated" intestinal lining and bind "noxious" (harmful) agents. Sucralfate (Carafate) liquid helps smooth and coat an inflamed or ulcerated stomach.

  • Promotility drugs to increase movement such as metoclopramide (Reglan) may be of benefit in some cases.

  • Surgery is indicated for those patients with gastric outflow blockages, including tumors and foreign bodies.

  • Optimal treatment for your pet requires a combination of home and professional veterinary care. There is no set regime when following animals with gastric motility disorders, rather a plan that is formulated specifically for that individual. It is important to administer all prescribed medications and follow feeding recommendations closely.

    The length of treatment depends on the ability to resolve the underlying disorder or on the response to therapy. Depending on the underlying disorder, some gastric motility disorders are very treatable and even curable; however, others may have a good prognosis, such as in the case of an invasive or metastatic tumor.

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