Reflux Esophagitis in Dogs

Esophageal disease is a lot more common in dogs than most of us think.  One of the primary symptoms of esophageal disease is the reflux or regurgitation of digestive fluids like stomach acid, pepsin, and bile, and this symptom is frequently misconstrued as vomiting, which is a common symptom of gastrointestinal disease. Understanding the difference between regurgitation and vomiting can help to eliminate misdiagnosis of the disease.  The regurgitation of gastric fluids back into the throat through the esophagus brings those acidic fluids into contact with the mucous lining of the esophagus where inflammation and discomfort occurs, causing esophagitis.

Reflux esophagitis is simply defined as inflammation of the esophagus caused by reflux (or regurgitation) of gastric contents from the stomach back into the throat through the esophagus. This is also referred to as GERD (gastroesophageal reflux disease).

The symptoms you will likely notice in your pet that might suggest reflux esophagitis:

• Regurgitation - learning to differentiate between regurgitation and vomiting will aid in identifying esophageal issues versus gastrointestinal issues; this may occur soon after eating but also could present several hours or even days after eating
• Excessive salivation
• Gulping 
• Difficulty swallowing
• Loss of appetite
• Cough
• Weight loss

If any of these symptoms present and seem to be persistent, calling your veterinary professional is highly recommended.

Types

There is only one type of reflux esophagitis though there are multiple causes for the inflammation of the esophagus.  That lone type results from regurgitation (reflux) of digestive fluids back into the esophagus from the stomach that causes inflammation.  There are, however, several types of esophageal disorders that are worth mentioning:

• Disorders of swallowing - involves the muscle that opens and closes to allow food and liquids to go from the mouth to the esophagus
• Expansion of esophagus (also called megaesophagus) - caused by a congenital defect whose primary symptom is regurgitation
• Esophageal strictures - narrowing of esophagus
• Esophageal diverticula - pouch-like expansions of the esophageal wall

The causes of reflux esophagitis in dogs can easily be confused with those of gastrointestinal diseases and disorders.  These are the causes of reflux esophagitis:

• Hiatal hernia
• Manipulation of the esophageal tissues for undergoing anesthesia
• Chronic vomiting 
• The presence of foreign body caught in the esophagus
• Food sensitivities
• Cancer of the esophagus

It is important to note the difference between vomiting and regurgitation.  It simply comes down to the fact that regurgitation is more voluntary while vomiting is not.  Regurgitation has no advance warning whereas vomiting is usually preceded by nausea and stomach upset.   Vomiting also involves prodromal signs (salivation, licking of the lips, pacing) and is typically followed by visible and vigorous abdominal contractions whereas regurgitating has none of those signs.

One should expect some imaging testing to be done to assess the possibility of a foreign body being caught in the esophagus as a cause of the inflammation that results in the symptoms and discomfort.  Those imaging options would likely be x-ray or esophagram (uses dye in an x-ray setting), or the veterinarian may need to do an esophagoscopy (examination of esophagus using an endoscope) to view the esophagus.  Once the root cause is determined, a treatment plan will be developed accordingly.

Treatment of mild cases of inflammation will most likely require no medical intervention.  For those cases in which the inflammation is more serious, drugs to decrease the acid from the stomach may be prescribed, or, medications could be used that will affect the muscle tone in the lower portion of the esophagus.  Your veterinarian will likely recommend a diet change that includes feeding your dog soft food which is low in fat and fiber.  He will likely recommend feeding smaller amounts more often.  For more severe cases of inflammation, a feeding tube which is placed through the body wall into the stomach to allow food to bypass the esophagus may be utilized to allow the esophagus to rest. Antibiotics can also be prescribed in an attempt to prevent bacterial infection.

Once the inflammation has been quieted, your veterinary caregiver may recommend continuing medications to reduce stomach acid as well as those medications which may have been prescribed to control muscle tone of the lower esophagus.  Expect that feeding habits would likely have to be adjusted as well to keep the inflammation under control.