Esophagitis (Inflammation of the Esophagus) in Cats

Overview of Feline Esophagitis

Esophagitis is an inflammation of the esophagus. There are a variety of causes and there is no reported age, breed or sex predilection.

Causes

• Frequent vomiting
• Ingestion of chemical or caustic irritants
• Hiatal hernia
• Neoplasia (cancer) of the esophagus
• Esophageal foreign body
• Reflux or backward flow of gastric or intestinal juice secondary to many causes, including general anesthesia

What to Watch For

• Salivation
• Anorexia (poor or decreased appetite)
• Excessive or persistent gulping
• Discomfort while swallowing
• Coughing
• Regurgitation, the effortless evacuation of fluid, mucus and undigested food from the esophagus

Diagnosis of Esophagitis in Cats

A thorough knowledge of history and clinical signs is very important and is often helpful in the diagnosis. Diagnostic tests are necessary to confirm a diagnosis of esophagitis. They include:

• Complete blood count (CBC)
• Biochemical profile
• Urinalysis
• Chest X-rays
• Esophagram (barium swallow)
• Fluoroscopy (an evaluation that can assess the esophagus in motion)
• Esophagoscopy (visual inspection of the esophagus)

Treatment of Esophagitis in Cats

Treatment for esophagitis should be directed at the underlying disease or associated conditions. In the event no underlying cause is identified, symptomatic and sometimes supportive measures are recommended. They include:

• Gastric acid inhibitors or blocking agents
• Esophageal and gastric coating agents
• Gastrointestinal motility modifiers
• Dietary modification
• Antibiotic therapy, in cases of secondary pneumonia
• Endoscopic removal of a foreign body
• Surgical intervention
• Hospitalization and supportive care in severe cases
• Nutritional support by placing and feeding through a stomach tube or intravenous nutrition, in severe cases

Home Care and Prevention

Home care for esophagitis includes administering all prescribed medications and feeding only approved diets.

Since many esophageal diseases can result in difficulty swallowing or regurgitation, inhaling food particles or saliva is possible. This can result in secondary aspiration pneumonia. Careful observation of your cat is necessary. Contact your veterinarian at once if you notice any breathing difficulty, lethargy or coughing.

Several causes of esophagitis are not preventable. Prompt examination and treatment will help speed recovery. Prevent animals from ingesting caustic substances and foreign bodies and avoid late night feedings. Late feedings tend to diminish gastroesophageal sphincter pressure during the cat’s sleep, contributing to reflux.

In-depth Information on Esophagitis in Cats

The magnitude of clinical signs depends on the severity and depth of esophageal inflammation. The signs may be subtle and may be present for weeks or months, or they may be extremely severe and come about quickly.

Because the history, physical examination findings and overall presentation of cats with esophagitis are variable, there are other illnesses or symptoms that might initially be considered when establishing a definitive diagnosis. These include:

• Hiatal hernia is an abnormality of the diaphragm that allows part of the stomach to be displaced into the thoracic (chest) cavity.
• Neoplasia (cancer) of the esophagus can be associated with inflammation and cause similar signs.
• Esophageal foreign bodies are objects within the esophagus that will not move out without assistance. Most often they include things like bones or toys, but can include food or any other object.
• Esophageal stricture is an abnormal narrowing of the esophagus. This often occurs secondary to severe esophageal inflammation.
• Megaesophagus is a decreased or absent esophageal movement that usually results in dilatation (stretching and widening) of the esophagus.
• An esophageal diverticulum is a pouch-like dilatation of the esophageal wall.
• Vascular ring anomaly is strangulation or compression of the esophagus within several structures, causing a partial megaesophagus.
• Melena is digested blood that is passed in the feces. It can occur secondary to swallowing blood for any number of reasons, including severe esophageal inflammation, inflammation or ulceration within the mouth or gastrointestinal tract, or any coagulation (clotting) disorder.
• Pain from any other disease process, including tooth, mouth or neck pain may cause the same symptoms as esophagitis.

Diagnosis in-depth

Certain tests must be performed to make a definitive diagnosis of esophagitis and to exclude other disease processes that may cause similar symptoms. A thorough work-up begins with a broad, general baseline of diagnostics, to ensure that one does not overlook other illnesses or factors. In many cases, specific, more advanced tests are performed as well. A complete evaluation should be performed in these animals since an accurate diagnosis is important for treatment and prognosis. Tests may include:

• A complete history and a thorough physical examination
• A complete blood count (CBC) is most often within normal limits; however, with severe inflammation or secondary pneumonia, one might expect to see elevations in the white blood cell count.
• A biochemical profile to rule out other systemic disorders (liver, kidney disease) that may predispose to reflux and, in turn, esophagitis.
• A urinalysis
• Chest X-rays, although most often within normal limits, are needed to evaluate the size and shape of the esophagus, determine if there is a foreign body present, and to evaluate for the possibility of secondary aspiration pneumonia.
• An esophagram (barium swallow) may be necessary if the above tests are inconclusive. It is a very useful test in evaluating the esophageal mucosal (lining) surface, assessing for strictures (narrowing) or dilations. This is usually a very safe test and, in some cases, can be performed in the primary care veterinarian’s hospital.
• Dynamic contrast fluoroscopy, a type of radiographic evaluation, helps assess esophageal function and detects hypomotility (decreased movement), if present. This test is generally performed at a specialty hospital, and is considered a very helpful tool in the diagnosis of certain esophageal diseases. If a diagnosis is made prior to this step, it is not necessary to perform.
• Esophagoscopy evaluates the inside of the esophagus and is usually the most reliable means of diagnosing esophagitis. The mucosa (lining) may appear red, ulcerated, or may even be bleeding. If in doubt, biopsies should be obtained, as they can confirm the diagnosis when viewed under the microscope. One must be cautious, as general anesthesia is necessary, and this can worsen reflux of gastric acid in some cases. It is important to make sure that the individual is otherwise healthy, so as not to create additional risk to the patient. Most often, a specialist is needed to perform this diagnostic procedure, as is special delicate instrumentation.

Treatment in-depth

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.

Follow-up Care for Cats with Esophagitis

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.