Pouch-Like Sacs on the Esophgeal Wall in Dogs

A pouch-like sac on the esophagus, called a diverticulum, will trap food and interfere with eating and digestion. This is quite rare, but it can occur in dogs as well as humans. A diverticulum may be either present at birth, or acquired from conditions that cause obstruction and inflammation of the esophagus or the surrounding area. Swallowing a foreign body is a common problem for dogs, as well as stricture, a tightened band of muscles in the esophagus, and any condition that causes chronic esophagitis. Problems within the esophagus typically cause pulsion diverticula, a pocket that develops in the epithelial layer of the esophagus and traps mucosa. Diverticula that extend through the entire esophageal wall are called traction diverticula. They are caused by inflammation in nearby organs, especially the chest cavity, which puts pressure on the esophagus and changes the shape of the esophageal wall. Most diverticula in dogs are cervical (in the neck area) or epiphrenic (located between the heart and the diaphragm). There may be one or several pouches, and congenital conditions are often combined with a bronchoesophegeal fistula, a hole connecting the esophagus with the bronchial tubes. Esophageal diverticula tend to be more common in small dogs. The most frequent symptoms are vomiting or regurgitation and difficulty eating. Over time, this can cause weight loss. Aspiration pneumonia can be a common complication. Very small diverticula may produce only mild, manageable symptoms, but large pockets will need to be reconstructed surgically.

Pouch-like sacs on the esophageal wall can trap food and cause dogs to vomit or regurgitate after eating. This is called esophageal diverticula. Large diverticula make it difficult for a dog to eat, and may cause aspiration and respiratory problems.

These are some of the symptoms you might see in a dog with esophageal diverticula.

• Retching
• Gagging
• Hypersalivation
• Vomiting or regurgitation
• Difficulty breathing especially while eating
• Unable to finish eating
• Weight loss

Types

Esophageal diverticula can be either acquired or congenital.

Acquired

• Pouches develop from an acquired condition that changes the shape of the esophagus
• Pulsion diverticula – an “out-pocket” in the epithelial layer of the esophageal wall, usually caused by inflammation or pressure changes in the gastrointestinal tract
• Traction diverticula – a pouch that extends through the entire esophageal wall, usually caused by inflammation in the chest cavity close to the esophagus

Congenital

• Inherited condition that is present at birth
• English Bulldogs may be predisposed for congenital cervical diverticula due to shortening and compression in the neck area

Inherited conditions are likely to be genetic, but veterinarians don’t know the exact gene or combination of genes that causes them. Some dogs may develop an acquired condition as the result of an inherited condition that is made worse by a triggering factor. These are some of the factors that could cause or contribute to esophageal diverticula.

• Esophagitis (chronic inflammation of the esophagus)
• Esophageal Stricture
• Foreign body
• Vascular ring abnormality – esophagus trapped in the trachea
• Megaesophagus – enlarged esophagus
• Hiatal hernia – protrusion of the stomach into the esophagus
• Inflammation in the bronchial tubes or trachea
• Ingestion of toxic chemicals
• Branchoesophageal fistula – abnormal connection between the bronchial tubes and the esophagus
• More common in smaller dogs
• More common in younger dogs
• Some studies have found that Cairn Terriers are more likely to inherit or acquire the condition

The veterinarian will give your dog a complete physical examination and may observe him eating if that is when symptoms typically occur. Your dog’s breed, age, and any prior digestive issues can all be relevant to diagnosis. Esophageal diverticula can usually be seen on an X-ray, especially if they are impacted with partially digested food. Contrast dyes are often added to increase visibility. An endoscopy may be ordered to see the diverticula in more detail and note the level of inflammation and scarring that is present. This can help to identify the cause of the problem, as well as any concurrent conditions like a foreign body, bronchoesophageal fistula, or megaesophagus. Endoscopy is an invasive procedure that involves inserting a small camera down your dog’s throat. This test will need a separate appointment and your dog will need to be anesthetized.

Small diverticula may be managed with a diet change and careful posture control during eating. Soft, bland foods that are easy to chew and digest can help to reduce symptoms. Keeping the front legs higher than the back legs while eating will make swallowing easier. Setting the food bowl on a ramp can help accomplish this, but you may need to watch your dog carefully while eating and make sure he maintains the vertical position for a several minutes after finishing, so that all the food has a chance to travel down the esophagus.

Larger diverticula that are causing breathing problems or pneumonia will need to be treated with surgery. The pouch will have to be removed, and the esophageal wall will have to be reconstructed so that food can pass down it easily. Surgery is usually successful, but it will depend on the placement of the diverticula as well as any related problems. Foreign bodies will be removed and other problems like bronchoesophageal fistula or megaesophagus will be treated during surgery. Dogs may need to reduce activity and follow a liquid diet for several weeks after surgery. If chronic inflammation was the primary cause for the diverticula, the veterinarian may recommend a permanent diet change or medication to reduce acid reflux.

The outlook for esophageal diverticula is guarded, but there is a reasonable chance your dog will recover or you will be able to manage the condition effectively. Successful surgery usually depends on the amount of reconstruction needed to make the esophagus function normally. If the pouch can be easily removed without much damage to the esophageal wall, surgery is more likely to be successful. This will depend on the veterinarian’s diagnosis.

If the diverticula are small and clinical symptoms are mild, diet change is often a successful way of managing the problem. Training may be needed to get your dog accustomed to eating in an unusual posture. Frequent smaller meals may be easier than eating a large amount at one time. Sticking strictly to the veterinarian’s instructions will be necessary in order to avoid complications like choking or pneumonia.