One of the most important considerations when managing these patients is to accurately differentiate regurgitation from vomiting. Regurgitation is one of the most commonly misinterpreted signs in veterinary medicine. Obtaining a thorough history is of paramount importance when differentiating the two.
Not only are different organs involved, but also different diagnostic techniques and therapeutics are warranted. Regurgitation can be associated with a multitude of different disease processes, therefore, establishing the underlying cause is essential. Your pet may be very mildly affected, with infrequent and/or subtle signs, or very severely affected, with signs that warrant hospitalization for support and a more aggressive work-up.
- A complete blood count (CBC) is most often within normal limits, however with severe inflammation/infection or anemia, 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 (liver, kidney disease) that may predispose to certain diseases associated with regurgitation.
- A urinalysis is part of any complete baseline work-up.
- Endocrine testing (ACTH stimulation test and thyroid assays) should be performed to rule out regurgitation associated with hypoadrenocorticism or hypothyroidism.
- Antinuclear antibody (ANA) titers are performed to help rule out immune-mediated diseases (such as systemic lupus erythematosis) associated with regurgitation.
- Thoracic (chest) radiographs (X-rays) are needed to evaluate the size/shape of the esophagus, assess for the presence of a foreign body, growth or megaesophagus and assess the lungs for the possibility of secondary pneumonia.
- An acetylcholine receptor antibody test is a simple blood test performed on individuals with regurgitation secondary to megaesophagus to rule out myasthenia gravis. Although most often there are additional systemic signs associated with myasthenia, megaesophagus and regurgitation may be the only manifestations in certain cases.
- Blood lead and/or organophosphate levels are run on patients who we suspect toxicities as underlying causes of regurgitation.
- Electromyography (EMG) and muscle biopsies are recommended when a myopathy (muscle disorder) is suspected. These necessitate anesthesia, and are, therefore, associated with more risk than many of the other diagnostics described. An EMG is most often performed in a specialty hospital as specialized equipment and expertise are necessary.
- An esophagram (barium contrast radiograph) may be indicated to rule out structural changes, such as a foreign body, growth, stricture.
- Fluoroscopy helps assess the function of the esophagus. It evaluates the movement of solids and liquids through the esophagus. It is often necessary to have the procedure performed in a specialty facility as it requires expertise and special instrumentation.
- Esophagoscopy (direct visual inspection of the inside of the esophagus) is a very helpful tool in diagnosing certain diseases that can cause regurgitation. Examples include esophagitis, foreign body and growths. This procedure necessitates anesthesia and is associated with more risk than some of the previously mentioned diagnostics. Most often a specialist is involved as experience and special instrumentation is needed.
The following nonspecific (symptomatic) treatments may be applicable to some, but not all pets with regurgitation. These treatments may reduce severity of symptoms or provide relief for your pet. However, nonspecific therapy is not a substitute for definitive treatment of the underlying disease responsible for your pet’s condition.
- 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, individuals with megaesophagus need very special attention. Generally, elevated feedings tend to be tolerated best. It is recommended to try different consistency foods, ranging from liquid/gruel to solids/kibble.
- Motility modifying drugs (drugs that promote movement through the gastrointestinal tract), such as metoclopramide (Reglan®), can be used to stimulate movement within the esophagus and promote gastric emptying.
- Gastric (stomach) acid inhibitors (blocking agents) are recommended to block acid secretion, therefore diminish the volume of acid that is refluxed (leaked backward) into the esophagus. Since esophagitis is often a component (cause or effect) of regurgitation, their use is generally recommended for symptomatic relief. Examples include a group called H2 receptor antagonists (cimetidine Tagamet®, ranitidineZantac®, famotidine Pepcid®) or another group of drugs (proton pump inhibitors) that include omeprazole (Prilosec®).
- Sucralfate(Carafate®) suspension (liquid) helps sooth and coat an inflamed esophagus, which is often associated with regurgitation.
- Hospitalization may be indicated symptomatically/supportively for those patients who are extremely ill. Fluid and electrolyte replacement and/or nutritional supplementation may be indicated for certain individuals. Placing a gastrotomy (stomach) tube endoscopically or surgically may be helpful in bypassing a diseased esophagus to deliver adequate nutrition to the regurgitating patient. Alternatively, instituting parenteral (intravenous) nutrition for a period of time, while trying to identify and treat the underlying cause, might be the safer choice for the compromised patient that might be at risk having to undergo an anesthetic procedure.
- Antibiotic therapy may be recommended in cases where secondary pneumonia is suspected, specifically if a regurgitating patient begins to cough, has difficulty or a change in breathing or becomes febrile.
Unlike vomiting, regurgitation is not accompanied by nausea and does not involve forceful abdominal contractions. It is a symptom of esophageal disease and not a disorder in itself.