Reflux Esophagitis in Cats

Reflux esophagitis is an inflammation of the esophagus (the muscular tube that connects the throat to the stomach) resulting 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.

Reflux in cats can come on suddenly, or it can be a chronic condition. When the condition is chronic, esophageal strictures may occur when scar tissue narrows the esophagus.

If your cat is showing symptoms of reflux esophagitis, you should see a veterinarian as soon as possible. This condition may progress to aspiration pneumonia, a potentially serious condition that results when food is inhaled into the lungs.

Causes of Reflux Esophagitis

There are many different causes of reflux esophagitis in cats, including:

• Poor patient positioning during anesthesia
• Failure to have the patient fast prior to anesthesia
• Frequent or chronic vomiting
• Retaining ingested medications in the esophagus
• Hiatal hernia, which is a protrusion of abdominal contents into the chest cavity through the esophageal hiatus (a naturally occurring opening in the diaphragm)
• Hairballs that are only partially vomited becoming stuck in the esophagus and eroding the mucous lining
• Lazy lower esophageal sphincter muscle that separates the esophagus from the stomach
• Swallowing of plants, chemicals, or cleaning products leading to irritation
• Cancer of the esophagus
• Radiation therapy
• Infections
• Esophageal foreign body (like bones or string) injuring the lining of the esophagus
• Eating food that is too hot

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.

Common Symptoms

• Regurgitation, which is the effortless evacuation of fluid, mucus, and undigested food from the esophagus (this is different than vomiting – there is no retching or abdominal contraction)
• Gagging
• Salivation
• Anorexia or poor, decreased appetite
• Excessive/persistent gulping
• Discomfort while swallowing
• Repeated swallowing motions
• Reluctance to eat
• Weight loss
• Drooling
• Coughing with associated/secondary pneumonia

Diagnosis of Reflux Esophagitis in Cats

When visiting the veterinarian, a thorough knowledge of the animal’s history and clinical signs are necessary for diagnosis, as are diagnostic tests.

These 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 of Reflux Esophagitis in Cats

The severity of the condition and the underlying cause will determine the treatment and prognosis. If your cat’s esophagitis is caused by reflux, your veterinarian will treat the cause and symptoms of reflux.

Treatment Measures

• Patients are generally managed as outpatients, but hospitalization/supportive care may be necessary in extreme or severe cases. Fluids are administered to patients suffering from dehydration and oxygen will be supplemented until your cat’s breathing improves.
• Feed your cat low-fat, low-protein, soft meals in small, frequent feedings.
• Nutritional support may be given by feeding through a stomach tube or by intravenous feeding in severe cases.
• Gastric (stomach) acid inhibitors such as Tagamet (cimetidine), Pepcid (famotidine), 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.
• The prognosis is good if the condition is recognized and treated promptly, however, if the condition has progressed to the point where the esophagus has formed a stricture, the prognosis is usually poor.

If endoscopy is not successful in removing items that are lodged in the esophagus, or if the items have caused a perforation of the esophagus, surgery will be necessary, but unfortunately the prognosis in this case is not very good.

Home Care for Reflux Esophagitis

Pet parents should always administer prescribed medication and diet, and treat esophageal reflux as directed by their veterinarian. A soft, palatable, and nutritious food should be given to your cat. Always work to control vomiting, limit anesthesia, and avoid other disorders that predispose to reflux esophagitis.

Avoid late night feedings, as they tend to diminish gastroesophageal sphincter pressure during the animal’s sleep, contributing to reflux.

Your veterinarian will perform follow-ups and endoscopies to see if the esophagus is healing properly.