Inflammation of the Esophagus in Dogs

Esophagitis is described when the esophagus (a tunneled canal that is lined with mucous membrane and linking the throat to the stomach) becomes inflamed within its inner and outer layers.  Inflammation of the esophagus may result from conditions such as acid reflux, obstruction due to a foreign object, or neoplasia. The most common indicator of esophagitis in dogs is struggles with food consumption and fluid intake. Your pet may regurgitate his food or show signs of discomfort when swallowing. Mild inflammation often has no obvious symptoms. Medication is most often the course of treatment, though in some cases, surgery is needed.

Inflammation of the esophagus can be a secondary complication resulting from a wide variety of gastrointestinal disorders. Inflammation, such as with esophagitis, typically occurs when there is an illness involving the gastrointestinal tract.

• Pain 
• Drooling
• Vomiting
• Loss of appetite
• Difficulty swallowing
• Coughing
• Weight loss
• Poor posture and movement
• Excessive reflux or regurgitation

Types

There are many types of disorders of the esophagus that can cause inflammation.  

• Esophageal foreign bodies
• Acid reflux
• Gastroesophageal reflux
• Inflammatory bowel disease
• Congenital lower esophagus sphincter abnormality
• Strictures
• Megaesophagus (dilation of the esophagus)
• Esophageal diverticula (expansion of the esophageal wall)
• Infections (aspiration pneumonia)
• Parasitic infections (protozoa, ringworm, tapeworm, whipworms, flukes)
• Viral infections (rotavirus, parvovirus, coronavirus)
• Bacterial infections: (salmonella, e.coli)
• Various medications (antibiotics, nonsteroidal inflammatory agents)
• Tumors
• Cricopharyngeal achalasia (swallowing disorder)
• Stomach ulcers (infected with H.Pylori)

• The swallowing and ingestion of foreign bodies, such as bones or toys, often cause esophagitis in canines
• Esophageal strictures can be associated with the act of consuming foreign bodies and can cause inflammation
• Any disease that causes acute or chronic emesis (vomiting) can result in gastroesophageal reflux disease where reflux consistently flows from the stomach to the esophagus
• One of the reasons for reflux could be the abnormal functioning of the lower esophageal sphincter 
• When the sphincter is closed, food and acids are not allowed to flow backwards into the esophagus;  if your dog has recently undergone anesthesia, this can cause the sphincter to relax and remain that way too long, allowing the flow of acids to enter the esophagus
• Dogs with narrow nostrils and shorter noses (known as Brachycephalic breeds) such as Pugs, English and French Bulldogs, Chinese Shar-Peis, and Chow Chows are known to have a congenital condition that results in the abnormal functioning of the diaphragm (hiatal hernia)
• This hernia occurs when the muscle lining of the hiatus (initial part of the diaphragm) weakens, allowing the stomach contents to protrude through the diaphragm and into the chest region
• Neoplastic tumors, toxicity (like poisoning due to ingestion of cleaning products or rodenticide), parasites, and bacterial or viral infections also contribute to inflammation

If you or your veterinarian suspect that blockage is due to a lodged foreign object, he may conduct thoracic and neck x-rays.  An esophagogram, which is the use of barium contrast (barium sulfate or iodinated contrast) is a diagnostic tool that can actively visualize the inside of your dog’s body as he consumes food. This provides further information that includes the size, content, and overall condition of the gastrointestinal tract.

The use of an endoscope may be suggested as it has a camera attached that can take photographs and take tissue samples for testing.   An additional tool is the esophagoscopy, taking a step further as it uses the endoscope to inspect the condition of the esophageal mucosa.

Contrast radiology, biopsy, and esophagoscopy can also be done to check for strictures, reflux, and neoplastic growth.  A complete blood count and biochemical profile are standard tests to be done that examine the specific amount of red and white blood cells, in addition to platelets, to determine whether they are neoplastic cells.

There are many ways to treat inflammation of the esophagus, starting with dietary management.  Based on the severity of the blockage, stricture, or reflux, food and water intake should be restricted to allow the esophagus to heal (symptoms could worsen and the overall health of your pet could deteriorate).  A low fat and low protein diet rich in carbohydrates should be given in small increments along with foods that do not have allergens, including soy, rice and gluten. If your pet is a candidate for surgery, the use of IV fluids (especially electrolytes and potassium) or a feeding tube that is directly inserted into the stomach, bypassing the esophagus completely may be necessary to allow it to heal.   

Using medications such as gastric acid inhibitors (antacids) that decrease the amount of gastric stomach acid produced may be prescribed. Esophageal or gastric coating agents can be used to protect and soothe the lining of the esophagus due to consistent exposure to stomach acids.  Gastrointestinal motility drugs can aid with swallowing.  Antibiotics can be used to eliminate and kill harmful bacteria, in addition to pain medication to reduce any discomfort. Nonsteroidal inflammatory agents should be used with discretion, as they are well known to cause ulcers.  

Strictures (narrowing) of the esophagus can occur due to severe esophagitis. Balloon catheter therapy is done with an endoscope to widen the stricture, and may be done a couple of times more to ensure that the results are permanent. Rigid endoscopy removal may also be helpful to remove foreign bodies such as toys or bones as the use of the forceps enables maneuverable ability to grasp objects. However, surgery may be necessary based on the level of damage and the cause. A transthoracic esophagostomy may be required for larger foreign bodies. Tumors may be treated with aggressive chemotherapy drugs or radiation.

The use of medication is extremely helpful in countering the symptoms of esophagitis. Your veterinarian may advise you to refrain from solid foods and water for up to 3—5 days. The outlook and prognosis of mild to moderate esophagitis is good. Dogs with strictures have a more guarded prognosis as esophageal perforation (a hole in the esophagus leading to the stomach) may occur with balloon catheter therapy and can be lethal. However, if your dog is diagnosed with neoplastic tumor growth, the prognosis is considered to be very poor with a life expectancy of 1-2 months (no treatment) and up to 12-14 months (with treatment).