Bilious Vomiting Syndrome in Dogs

Bile aids in the digestion process by breaking down lipids (fats).  Bile cells continually produce bile which travels down to the duodenum, the first part of the small intestine, or it can enter the gallbladder, where it is stored.  It is a yellowish green bitter substance, which contains water, bile acids, cholesterol, fatty acids and electrolytes. Bile acids are also called bile salts.

When the dog’s stomach is empty there is nothing to absorb the stomach acids and bile. This causes nausea and bilious vomiting.  This condition is a bit challenging to treat because an empty stomach causes nausea and vomiting, which causes the dog not to want to eat. Not eating means an empty stomach, which causes nausea and vomiting.  It becomes an ongoing cycle.

Bilious vomiting syndrome may be more common in dogs with giardiasis (parasite), food allergies or inflammatory bowel disease (IBD).

The continual vomiting can cause a dog to dehydrate.  Puppies especially can become dehydrated very quickly.  If your dog is showing symptoms of bilious vomiting, he should be seen by a veterinarian.

Bilious vomiting syndrome (BVS) in dogs is vomiting due to bile build-up irritating the stomach lining. Bilious vomiting in dogs usually occurs in the morning or late at night, when the dog’s stomach is empty.

Symptoms may include:

• Frothy yellow vomit
• Vomiting usually occurring in the morning or late at night
• Depression
• Lethargy
• Drooling
• Licking his lips
• Lack of appetite
• Concentrated urine, pale gums, sunken eyes and loss of skin elasticity are signs of dehydration

• Accumulated bile in the small intestine can leak into the stomach
• Bile is a very high alkaline substance, which is irritating to the stomach lining
• The empty stomach cannot absorb the bile; the dog then gets nauseated and bilious vomiting occurs
• Bilious vomiting is more common in dogs with the parasite Giardia
• Bilious vomiting syndrome is common in dogs with inflammatory bowel disease

The attending veterinarian will want to go over your canine’s medical history. Advise the doctor in detail what symptoms you have observed, expanding on information such as when the vomiting usually occurs. 

• Is it a daily event?
• Does the bilious vomiting happen once and then cease, or continue for some time?

The veterinarian may want to know what the dog’s current diet is and how often is he fed. 

The veterinarian will then perform a physical examination on the patient. This may include taking your dog’s temperature, weight, pulse and blood pressure.  The doctor may palpate the patient’s stomach and listen to his heart and lungs. He may also check the dog’s skin elasticity, gums, and eye reflex response.

The veterinarian may suggest abdominal x-rays, an ultrasound, a fecal exam and a urinalysis.  A complete blood count and a serum chemistry panel may be taken. A complete blood count can help determine the dog’s overall health.  The serum chemistry panel can evaluate organ function. Bile vomiting can be caused by several conditions; the veterinarian will want to rule-out other health conditions or diseases (e.g. stomach obstruction, pancreatitis, and parasites).

If your dog is dehydrated, the veterinarian will start an IV to administer replacement fluids.  The fluid therapy may be given over 24 to 48 hours depending on how severe the dehydration is.  This means the patient will need to remain hospitalized and will receive intensive care.

Dogs diagnosed with bilious vomiting will be prescribed an H2 blocker such as Tagamet, Pepcid or Zantac. H2 blockers reduce the amount of stomach acids being produced. The doctor may prescribe prokinetic agents to improve gastric motility, which may help with acid reflux. Sucralfate may be recommended short term to help coat the irritated/inflamed stomach and esophagus.

The patient will need smaller meals, to be fed more frequently.  A healthy snack before bed may also help your dog not to vomit in the morning. Canines diagnosed with inflammatory bowel disease will need to be on a high-quality diet free of any of their allergens. Hydrolysed hypoallergenic diets may be recommended. A detailed medical treatment plan will be prepared by the veterinarian team.

Dogs diagnosed with Giardia will be treated with anti-parasitic medication such as fenbendazole and/or metronidazole. Your dog will need to be bathed with a medicated shampoo to eliminate any parasitic cysts (eggs) from his fur.  Your pet’s bowls, bedding, and toys should be washed in very hot water.  It is important to also clean and disinfect the flooring, carpets and upholstery. Hard surfaces should be disinfected with a diluted bleach solution. Pet’s should be re-tested after two weeks.

Recovery of bilious vomiting syndrome, once treated for the specific cause, has a good prognosis.  It is important to follow the treatment plan prepared by your veterinarian for your pet’s specific situation.  Follow up visits will be required to monitor his progress.