Narrowing of the Esophagus in Cats

Esophageal stricture is a narrowing of the esophagus that prevents the esophagus from opening when food or drink is passed through. It is primarily due to gastroesophageal acid reflux, a foreign object becoming lodged in the esophagus, or abnormal healing following surgery, but it can also be congenital due to a physical abnormality. It can also occur as a secondary condition after a recent surgery involving anesthesia, which is more common in older cats. Esophageal stricture can be acute or chronic, but is usually highly treatable if caught early enough. It can affect any cat at any age, but the condition is relatively uncommon.

The esophagus is a narrow tube that connects the mouth to the stomach and is the beginning of the digestive system. When the lining of the esophagus become inflamed the condition is called esophagitis, which makes eating and drinking very difficult and very painful. Left untreated, it can lead to a more severe condition called esophageal stricture that requires internal intervention.

Symptoms may not be evident when the condition is mild. If symptoms worsen, however, be on the lookout for:

• Vomiting or regurgitation about one to four weeks following an esophageal surgery
• Pain or crying out when swallowing
• Spontaneous gulping motions with the head and neck extended
• Gagging or retching
• Weight loss
• Drastic change in typical appetite
• Drooling
• Cold-like symptoms such as runny nose or coughing
• Lethargy
• Fever 
• Labored breathing
• Depression

There are two main causes of esophageal stricture: 

Trauma

Trauma from ingesting foreign objects such as a toy, bone, string, or button battery, a hairball or food lodged in the esophagus, or ingesting any caustic substance or certain acidic drugs can cause narrowing in a cat’s esophagus. 

Gastroesophageal Conditions

Conditions such as gastroesophageal acid reflux due to esophagitis, delayed gastric emptying, hiatal hernia, or tumors involving the gastroesophageal system can lead to esophageal stricture. 

Other Causes

Other causes, including those leading to the initial condition of esophagitis are:

• Mechanical trauma due to improper placement of a feeding tube or administration of general anesthesia from a prior esophageal surgery
• Congenital abnormalities
• Calicivirus infection
• Thermal injury from eating overheated (microwaved) food
• Radiation injury
• Megaesophagus (enlargement of the esophagus)
• Vascular ring abnormality
• Diverticula (dilated pockets along the esophageal wall)

The diagnosis is mainly based on your cat’s medical history and clinical signs. Be prepared to explain to your veterinarian when you first began seeing symptoms, your cat’s typical eating habits and any changes you have observed, any recent surgeries, and any medications your cat is currently taking. 

Your doctor may want to observe your cat eating in order to initially evaluate the situation and look for signs of either vomiting or regurgitation, which are both common signs of upper gastrointestinal disorders. Such symptoms can point to either esophageal disease or another underlying disease, especially if the regurgitation is chronic. 

Although it is uncommon, your cat may experience respiratory signs such as a runny nose and coughing due to regurgitation, which can cause nasal inflammation and aspiration. If your cat has a history of recurrent pneumonia and respiratory symptoms without an obvious cause, your doctor will want to check for esophageal disease.

After the physical examination is complete, your doctor will need to conduct routine testing including a full blood count to detect infection, a serum biochemistry profile, and a urinalysis. Your doctor will also check for signs of pneumonia, which is sometimes caused by food accidentally becoming lodged in the lungs in the course of struggling to swallow.

If your doctor suspects esophageal disease, pneumonia, or a foreign object, x-rays or ultrasound of the thoracic area may be helpful in identifying it. If the x-rays are inconclusive, your doctor may choose to perform an endoscopy. Endoscopy is a highly sensitive method of detecting esophageal disorders by providing your doctor with a clear view of the esophagus. In this procedure, an endoscope, a long, flexible tube equipped with a camera and a clipping tool to take tissue samples, is slid into the esophagus (and also possibly into the stomach and small intestine) while your cat is under mild sedation so that pictures of the esophagus and tissues samples for a biopsy can be taken. Your doctor will be watching for signs of erosions or ulcers, hemorrhaging, fibrous growths, dilation or stricture of the esophagus, an inflamed mucosa, and gas which may be a side effect of delayed motility and insufficient gastric emptying. If a foreign object is found lodged in the esophagus, your doctor will remove it during the procedure. 

A biopsy may be taken to determine if the stricture is benign or malignant. A malignant diagnosis indicates additional esophageal issues.

By far, the most reliable method of diagnosing esophageal stricture is a barium contrast radiograph, or esophagoscopy, taken of the abdominal area. An esophagoscopy involves your cat ingesting liquid barium sulfate which illuminates the gastroesophageal tract on an x-ray and will reveal the location of the stricture as well as its length and any dilation. It allows your doctor to further determine whether the stricture is benign or malignant.

Treatment is focused not on returning your cat to a state of normalcy, but rather in helping your cat to function from day to day. Therefore, your doctor will be focused on keeping the esophagus open, reducing the inflammation, promoting healing, and restoring your cat’s nutrition levels.

The primary treatment for esophageal stricture is dilating the esophagus with a balloon catheter under general anesthesia. The catheter is a long tube similar to an endoscope that is slid into the esophagus until it reaches the location of the stricture. The tip of the catheter is then inflated like a balloon to a precise pressure, causing the esophagus to stretch. This is a non-surgical, outpatient procedure that may need to be repeated an average of four times at three to five-day intervals. Some cats may only need dilation repeated one or two times while other cats may need dilation two or three times per week up to 20 dilations if esophagitis is present. Up to 85 percent of cats respond well to this procedure as long as the doctor is allowed to perform it as often as necessary.

Serious complications of stricture dilation occur in less than 1% of patients but may include moderate to severe mucosal tearing, hemorrhage, and perforation, infection, diverticulum formation, aspiration and pain. 

The use of stents is becoming more popular among veterinarians for treating stricture. An intraluminal stent may help cats who have been unsuccessful after enduring a high number of dilations. A stent may help to keep the esophagus open enough to allow your cat to eat or drink while reducing the frequency of regurgitation. 

Hospitalization will be necessary to perform an endoscopy as well as if your cat is experiencing malnutrition or severe dehydration, especially if pneumonia is suspected. Oxygen therapy may be necessary if the inflammation is affecting your cat’s ability to breathe.

Surgery may be required to address any perforations or hemorrhaging within the esophagus or to remove any fibrous growths, although surgery to relieve stricture is not usually a chosen method of care. Because the esophagus is positioned almost entirely within the chest cavity, surgery is considered incredibly invasive and is avoided if it is at all possible.

Since esophagitis is the most common cause of esophageal stricture, treatment at home following dilation will focus on reducing inflammation. 

Your cat will need to take several liquid medications to gain control of the condition. Perhaps the most important medication is antacids. They will need to be given frequently each day along with food, which means that you will need to pay special attention to administer it to your cat exactly as your doctor instructs you so that your cat will receive the full benefit.

Other medications your doctor will prescribe are ones that will promote gastric emptying and coat the esophagus in order to protect it from residual acid. Antibiotics will also be given to prevent bacterial infection, especially if pneumonia was diagnosed. 

You may have to restrict food for a day or two to allow the medications to work and let your cat’s esophagus rest. After that, you will need to give your cat either a specific soft food or a pureed mixture that is highly nutritious, but low in fat and fiber in order to promote gastric emptying and motility. You will need to give it to your cat in frequent feedings throughout the day rather than the usual one or two full meals a day. Frequent but light meals will reduce the production of acid in the stomach and will help your cat’s esophagus to heal more successfully. 

Follow-up appointments will be required to ensure that your cat is responding adequately to the treatment. Additional endoscopies or dilations may be necessary to maintain openness of the esophagus, and to verify that esophagus is healing properly and no additional issues have occurred.

See your doctor right away if you notice any of the above symptoms. Early intervention is the key to helping your cat go on to live a happy, normal life.