Esophageal Disease in Dogs

Overview of Canine Esophageal Disease

The esophagus is the tubular, muscular organ that extends from the pharynx to the stomach and functions to transmit ingested material to the stomach. Esophageal disease is any disease that effects the esophagus.

Causes of Esophageal Disease in Dogs

Megaesophagus is decreased or absent esophageal movement that often results in dilatation, or stretching beyond normal size. It may be congenital (existing from birth) or acquired later in life.
Vascular ring anomaly is strangulation (compression) of the esophagus within several structures, causing a partial megaesophagus.
Esophagitis is an inflammation of the esophagus.
Esophageal foreign bodies are any objects 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 communication between the esophagus and another structure (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 seen more commonly in younger animals, and some are seen more commonly in certain breeds (foreign bodies more commonly in small or toy breeds).

What to Watch For

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

Diagnosis of Esophageal Disease in Dogs

Determining the cause of the esophageal disease can help determine proper treatment. A thorough knowledge of history and clinical signs is very important and is most helpful in making the diagnosis. Diagnostic tests are necessary to confirm a diagnosis of esophageal disease. They include:

Complete blood count (CBC)
Biochemical profile
Urinalysis
Thoracic (chest) radiographs (x-rays)
Esophagram (barium swallow)
Fluoroscopy, which is an evaluation that assesses the esophagus in motion
Esophagoscopy allows visual inspection of the esophagus
Diagnostics specific to megaesophagus, such as acetylcholine receptor antibody titers, blood lead level, endocrine testing and antinuclear antibody titers

Treatment of Esophageal Disease in Dogs

Treatment for esophageal disease should be directed at the specific disease. Appropriate therapy is dependent upon the precise disease. In addition, symptomatic or supportive therapy may be indicated for esophageal disease, regardless of the disease itself.

Medical management, including gastric (stomach) acid blockers, esophageal or gastric coating agents and prokinetic agents that promote movement.
Dietary modification
Surgical intervention for certain esophageal diseases
Hospitalization and supportive care in severe cases of disease

Home Care and Prevention for Esophageal Disease in Dogs

Administer prescribed medication and practice directed feeding recommendations. Be aware of secondary aspiration pneumonia. This can occur if food particles are inhaled into the airways.

Most esophageal diseases are not preventable. For the few that are, preventing ingestion of caustic substances and foreign bodies is recommended.

In-depth information on Canine Esophageal Disease

The magnitude of clinical signs depends on both the specific disease and the severity of that disease. The clinical signs may be subtle yet present for weeks or months, or may be extremely severe, and come about quickly. Because the history, physical exam findings and overall presentation of dogs with esophageal disease are variable, there are other illnesses or symptoms that might be considered initially when establishing a definitive diagnosis. It is most important to note that regurgitation (the effortless evacuation of fluid, mucus and undigested food from the esophagus) is one of the most common clinical signs associated with esophageal disease, and must be differentiated from vomiting. The differentiation is important, as it helps to distinguish esophageal disease from gastric (stomach) or intestinal disease.

The following is a list of esophageal diseases:

Megaesophagus
Intrathoracic, Masses or growths in the chest may put pressure on the esophagus, causing a blockage – either partial or full – causing signs consistent with esophageal disease.
Vascular ring anomaly is an entrapment of the esophagus within several abnormal structures, causing a partial megaesophagus.
Neuromuscular diseases (nerve and muscle), including myasthenia gravis, polymyositis, systemic lupus erythematosis, polyradiculoneuritis, botulism, tetanus and dysautonomia.
Central nervous disorders, including infectious, inflammatory, neoplastic and traumatic
Miscellaneous disorders, including endocrine diseases (hypothyroidism, hypoadrenocorticism), certain toxicities (lead, thallium, acetycholinesterase) and thymoma (a tumor arising from an organ in the chest).
Esophagitis is the inflammation of the esophagus.
Esophageal foreign body is an 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 communication between the esophagus and another structure.
Hiatal hernia is an abnormality of the diaphragm allowing part of the stomach to be displaced into the chest cavity

Diagnosis In-Depth of Esophageal Disease in Dogs

Certain diagnostic tests must be performed to make a definitive diagnosis of 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 are 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 or 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 or growth, 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 mucosa (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 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. It is recommended that a specialist or an individual with some experience with endoscopy performs this 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 or muscle biopsies may be recommended in those cases with megaesophagus.

Treatment In-depth for Dogs with Esophageal Disease

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 antagonist (cimetidine (Tagamet®), ranitidine (Zantac®), famotidine (Pepcid®)) proton pump inhibitors such as omeprazole (Prilosec®). Sucralfate (Carafate®) liquid helps smooth 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 promote gastric emptying.
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 that 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; however, if performed in the hands of an experienced individual, many of these patients can do quite well. There are cases where, despite treatment, recurrent strictures occur 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 Dogs with Esophageal Disease

Optimal treatment for your dog 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 is often all that is necessary. In cases of severe esophageal disease, like severe esophagitis or stricture formation, follow-up endoscopy is recommended two to four 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. 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 or lengthy healing periods. In extreme cases, despite appropriate therapy, complete resolution or even control may be unattainable.