Feline Esophageal Disease
The esophagus is a tubular, muscular organ that functions to transmit material from the throat to the stomach. Esophageal disease is any disease that effects the esophagus.
Causes
Megaesophagus is the decreased/absent esophageal movement that often results in dilatation. It may be congenital (existing from birth) or acquired later in life.
Vascular ring anomaly is strangulation or compression of several abnormal structures within the throat, causing a partial megaesophagus.
Esophagitis is an inflammation of the esophagus.
Esophageal foreign bodies are any object present or remaining within the esophagus.
Esophageal stricture is an abnormal narrowing of the esophagus.
Esophageal diverticula are pouch-like dilatations of the esophageal wall.
Esophageal neoplasia is cancer of the esophagus.
Esophageal fistula is an abnormal tube-like passage between the esophagus and another structure, usually a bronchus.
Hiatal hernia is an abnormality of the diaphragm allowing part of the stomach to be displaced into the chest cavity.
Although in most esophageal diseases there are no sex, breed or age predilections, some esophageal diseases are congenital and seen more commonly in younger animals.
What to Watch For
Salivation
Anorexia (poor appetite)
Excessive or persistent gulping
Discomfort upon swallowing
Coughing
Regurgitation, or the effortless evacuation of fluid, mucus, and undigested food from the esophagus
Diagnosis of Esophageal Disease in Cats
Certain diagnostic tests must be performed to definitively diagnose esophageal disease and exclude other disease processes that may cause similar symptoms. A complete history is especially important in these cases, as regurgitation, a common clinical sign seen with esophageal disease, is often referred to as vomiting by the pet owner. A thorough work-up begins with a broad general baseline of diagnostic tests and, in many cases, more specialized or advanced testing is indicated as well. It is important to note that an accurate diagnosis is necessary for an accurate treatment regime.
A complete blood count (CBC) is most often within normal limits; however, with severe inflammation/infection or anemia associated with chronic (long-term) illness, one may expect to see an elevation in the white blood cell count, or decrease in the red blood cell count, respectively.
A biochemical profile is needed to rule out other systemic disorders that may predispose to certain esophageal diseases.
A urinalysis is part of any complete baseline work-up.
Chest X-rays are needed to evaluate the size and shape of the esophagus, assess for the presence of a foreign object, evaluate the heart size, and assess the lungs for the possibility of secondary pneumonia.
An esophagram, or barium swallow, is helpful in evaluating the esophageal lining, detecting the presence of a stricture (narrowing) or dilation. This test can be performed in most hospitals, and is a fairly low risk procedure for the patient.
Dynamic contrast fluoroscopy, a type of radiographic evaluation, helps assess the function of the esophagus, evaluating movement of solids and liquids through the esophagus. Because of the type of instrumentation involved, it is often necessary to have the patient be seen at a referral facility. While this procedure is not necessary in all cases, it can be invaluable in others.
Esophagoscopy is a procedure that allows visual inspection of the esophagus. In some cases, it may be the most useful tool in diagnosing certain esophageal diseases, in particular foreign bodies, strictures, and esophagitis. One must be cautious, as this procedure necessitates general anesthesia. In addition, it is recommended that most cases be referred to a specialist or an individual with some experience with the endoscopy procedure.
Antinuclear antibody titers may be run to confirm immune-mediated diseases associated with esophageal disease.
An ACTH stimulation test, acetylcholine receptor antibody titers, lead level, serum creatine kinase, thyroid function tests, electromyography, and/or muscle biopsies, may be recommended in those cases with megaesophagus.
Treatment of Esophageal Disease in Cats
The primary goals in treating esophageal disease are to identify and treat the primary disease, provide adequate nutrition, and treat any associated complications. Although most animals with esophageal disease are treated as outpatients, certain individuals with extremely severe cases do warrant hospitalization for intensive therapy and support. Therapy for various esophageal diseases includes:
Gastric (stomach) acid inhibitors (blocking agents) and sucralfate are recommended in most cases of esophageal disease, especially if esophagitis is a component. Gastric acid inhibitors block acid secretion, therefore diminishing the volume of acid that can leak backward into the esophagus. Examples include a group called H2 receptor antagonists such as cimetidine (Tagamet®), ranitidine (Zantac®), famotidine (Pepcid®) and proton pump inhibitors such as omeprazole (Prilosec®). Sucralfate (Carafate®) liquid helps smooth and coat an inflamed stomach and esophagus.
Motility modifying drugs, such as metoclopramide (Reglan®), promote movement within the gastrointestinal tract and stimulate movement within the esophagus.
Dietary modification should include small frequent feedings of an easily digestible product. The specific disease should be addressed with the appropriate feeding regime. In particular, megaesophagus or, at least cases where esophageal motility is decreased, need very special attention. Generally, elevated feedings tend to be tolerated thoroughly, and it is best to try different consistency foods, ranging from liquid or gruel, to solids.
Endoscopic placement of a gastric feeding tube may be indicated in those patients who need nutritional support and cannot tolerate oral feeding. Intravenous feeding is another option; however, it necessitates the patient remain in the hospital.
Balloon dilatation or bougienage are techniques used to open up an esophageal stricture. There are risks of esophageal perforation (rupture); however, if performed in the hands of an experienced individual, many of these patients can do quite well.
There are cases in which recurrent strictures occur despite treatment and ultimately do not do well.
Surgery may be indicated for several conditions associated with the esophagus, including vascular ring anomaly, hiatal hernia, diverticula and foreign objects that cannot be removed via endoscopy.
Follow-up Care for Esophageal Disease in Cats
Optimal treatment for your cat requires a combination of home and professional veterinary care. There is no set regime when following animals with esophageal disease; rather, a plan that is formulated specifically for that individual may be implemented.
It is important to administer all prescribed medications, and follow feeding recommendations closely. In individuals with mild to moderate disease, follow up with periodic veterinary exams often all that is necessary. In cases of severe esophageal disease (for example, severe esophagitis or stricture formation), follow-up endoscopy is recommended 2 to 4 weeks after the initial diagnosis.
It is important to be aware of signs that would suggest a secondary pneumonia. These include coughing, difficult or pronounced breathing, general malaise or any unusual behavior for your pet. A chest X-ray would be indicated in these cases.
In severe or prolonged cases of esophagitis, strictures are not uncommonly seen. Alert your veterinarian if there is an increase in regurgitation, or extreme discomfort upon ingesting food. The prognosis for these animals depends on the particular disease and its severity. Generally, mild to moderate cases respond nicely to treatment. Although severe cases often respond well, they may be associated with complications and/or lengthy healing periods. In extreme cases, despite appropriate therapy, complete resolution or even control may be unattainable.
