Esophageal Stricture in Dogs

Esophageal narrowing is a relatively uncommon condition in dogs, caused in the majority of cases by the ingestion of foreign materials (rawhide, toys, ropes), accidental poisoning, or as a side effect from receiving anesthesia for an unrelated surgery. Dogs suffering from a narrowing of the esophagus have great difficulty swallowing food, and often regurgitate meals and treats.

Narrowing of the esophagus can have many varied symptoms, including:

• Regurgitation of food; water is generally better tolerated
• Difficulty swallowing
• Signs of distress, such as crying, whining or moaning while eating
• Anorexia (refusal to eat)
• Coughing
• Weight loss
• Excessive drooling
• Persistent gulping

Advanced esophageal stricture may lead to aspiration pneumonia, a condition in which food or liquid is inhaled into the lungs. If this occurs, the dog may also present with:

• Extreme weight loss and malnutrition
• Wheezing or labored breathing
• Weakness or lethargy
• Fever
• Coughing

Types

Acquired esophageal stricture is a rare inherited condition that generally presents itself during the first months of life.

Benign esophageal stricture (BES) is most commonly caused by gastroesophageal reflux disease (GERD). Secondary causes may include trauma, such as that experienced after swallowing a foreign object or caustic substance, or following recent surgery during with anesthesia was used.

• Gastroesophageal reflux disease (GERD)
• Inflammation of the esophagus (esophagitis) following trauma or surgery
• Presence of foreign object in the esophagus
• Repeated episodes of vomiting
• Benign or malignant tumors

The veterinarian will first physically examine your dog to check for swelling and tender areas in the neck and throat region. During this time, your veterinarian will also gain medical history from you about your dog, including information as to whether your dog has come in contact with caustic agents, had recent surgery, or is currently taking any medications.

In order to differentiate between causes, your veterinarian may perform any or all of the following procedures:

• Complete blood count (CBC) to check for inflammation, infection and illness
• Urinalysis to rule out other conditions
• Chest X-ray to identify foreign objects or growths
• Esophagram, a type of barium X-ray that highlights any narrowing or foreign objects
• Fluoroscopy, a test that allows doctors to view the esophagus in motion
• Endoscopy, which gives vets a close-up view of the esophagus via a camera attached to a long tube that is inserted down the esophagus.

In cases of simple stricture, blood tests, and urinalysis results are generally normal. Dogs whose narrowing is due to cancer or aspiration pneumonia may have irregular results that your doctor will discuss with you.

Treatment is largely dependent on the cause of the problem.

• GERD - Dogs that have been diagnosed with GERD will be treated with proton pump inhibitors, a prescription medicine that reduces gastric acid, or over-the-counter acid blockers. You may also be instructed to feed your dog a soft diet for a time, and at specific times, being careful never to feed your dog close to bedtime.
• Ingestion of foreign objects - Strictures caused by partial obstruction of the esophagus are treated by first removing the object causing the blockage. This is done during a non-surgical procedure called an endoscopy. The removal of the foreign object as quickly as possible is imperative to relieve inflammation and prevent further damage, including tissue death.
• Surgical complications - Dogs that develop narrowing of the esophagus following anesthesia during surgery are candidates for a balloon catheter, a procedure in which tubes are inserted into the esophagus and then expanded, like a balloon, to mechanically dilate the narrowed tissue.
• Injury - Balloon catheters are used to treat dogs with mild to moderate strictures caused by injury. More advanced cases of trauma may call for surgical intervention.
• Growths - Lesions, tumors and masses are biopsied during endoscopic procedures to rule out malignancy.

Dogs will likely be hospitalized initially to be assessed, given intravenous fluids, if necessary, and to be monitored post-procedure. If your dog has developed aspiration pneumonia, intravenous medications, and oxygen, plus extended hospital stays, may be necessary.

Recovery from narrowing of the esophagus is largely dependent on the cause of the problem. Dogs are often given antacids or proton pump inhibitors following surgery to reduce stomach acid and prevent it from traveling up the esophagus and further injuring healing tissue.

Post procedure, all dogs are placed on a soft diet free of hard kibble and monitored by both owners and veterinarians. Follow-up appointments are necessary so that your veterinarian can assess healing and prevent possible complications. Walks and strenuous play are to be avoided for one week to 10 days following treatment. Most dogs with mild to moderate strictures will be fully healed within a three-week period.

The treatment for narrowing of the esophagus can vary greatly, depending on the exact cause and the city in which you live. Narrowing due to GERD is often treated with a change in diet and prescription or over-the-counter acid blockers, all which can run from $10-$100. Dogs that have an injury to their esophagus and require an endoscopic procedure can expect a bill that ranges from $2,300-$3,850, including post procedure prescriptions for pain and inflammation. Growths and other lesions noted during imaging will need a biopsy, and those cost between $150 to $350. If cancer is the cause of the stricture, your veterinarian will then discuss additional treatment options with you.