Section: Overview
Reflux esophagitis is an inflammation of the esophagus that results from the backward flow of gastric or intestinal fluid into the esophagus. This fluid contains acids and other irritating substances that can cause severe inflammation and ulceration.
Causes
Poor patient positioning during anesthesia
Failure to have the patient fast prior to anesthesia
Frequent or chronic vomiting
Hiatal hernia is a protrusion of abdominal contents into the chest cavity through the esophageal hiatus, which is the naturally occurring opening through the diaphragm.
Young animals often have a lazy lower esophageal sphincter muscle that separates the esophagus from the stomach.
Cancer of the esophagus
Esophageal foreign body
Reflux esophagitis is seen in both dogs and cats. It occurs in males and females and all ages are affected, although younger animals with congenital hiatal hernia are at increased risk.
There is no breed predilection reported, but Chinese shar-pei dogs may be prone as it is associated with hiatal hernia.
What to Watch For
Regurgitation, the effortless evacuation of fluid, mucus and undigested food from the esophagus
Salivation
Anorexia, or poor, decreased appetite
Excessive/persistent gulping
Discomfort while swallowing
Weight loss
Coughing with associated/secondary pneumonia
Diagnosis
A thorough knowledge of history and clinical signs is very important and is most often helpful in the diagnosis. Diagnostic tests are necessary to confirm a diagnosis of reflux esophagitis. They include:
Complete blood count (CBC)
Biochemical profile
Urinalysis
Chest X-rays
Esophagram (barium/dye swallow)
Fluoroscopy, a type of radiographic evaluation that uses dye to assess the esophagus in motion
Endoscopy/esophagoscopy, a visual inspection of the esophagus with a specialized instrument
Treatment
Patients are generally managed as outpatients, but hospitalization/supportive care may be necessary in extreme/severe cases.
Low-fat, low-protein meals in small frequent feedings.
Nutritional support by feeding through a stomach tube or by intravenous feeding in severe cases.
Gastric (stomach) acid inhibitors such as Tagamet (cimetidine), Pepcid (famotidine), Zantac (ranitidine), Cytotec (misoprostol) and Prilosec (omeprazole) are of benefit in many cases.
Esophageal/gastric medications that protect or sooth are felt to coat an irritated esophageal lining. Carafate (sucralfate) is most commonly used.
Gastrointestinal motility (movement) modifiers
Antibiotic therapy in cases of severe inflammation and associated secondary infection.
Endoscopic removal of a foreign body
Surgical intervention may be indicated in certain cases, such as to repair a hiatal hernia.
Home Care
Administer prescribed medication/diet and treat esophageal reflux as directed by your veterinarian. Control vomiting, limit anesthesia and avoid other disorders that predispose to reflux esophagitis.
Avoid late night feedings, as late feedings tend to diminish gastroesophageal sphincter pressure during the animal's sleep, contributing to reflux.
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