Gastric, or acid, reflux is when stomach contents leak backwards into the esophagus. This leaking of stomach acid causes inflammation of the esophagus (esophagitis).
• Gastric reflux doesn’t always produce obvious symptoms in cats
• Affected cats my lick their lips, be restless, or have difficulty swallowing
• They may also regurgitate, passively bringing up stomach contents without the abdominal heaving associated with vomiting
• Esophagitis is both a common cause and result of gastric reflux
• Reflux may also be caused by anesthesia, medications, and tumors of the stomach or esophagus
• A physical exam and thorough diagnostic workup are necessary for pursuing the underlying cause
• Treatment options include medications to decrease stomach acidity, protect the esophagus, promote gastric motility, and nutritional therapy
• The prognosis of gastric reflux varies widely
There are several potential causes for gastric reflux in cats, which can be broadly divided into three categories:
Motility disturbances: failure of food/liquid to pass normally through the esophagus into the stomach
Obstruction: an object, mass, or extra tissue in the esophagus or stomach that is not physically allowing food/liquid to pass
Inflammation: irritation of the esophagus that makes the sphincter between the esophagus and stomach weak
Cats experience gastric reflux most commonly during anesthesia. This is usually mild and temporary, but can lead to chronic problems if severe. Left untreated, cases of feline acid reflux can lead to decreased appetite and weight loss. It is important to seek veterinary attention when a cat is experiencing symptoms of gastric reflux. Gastric reflux is associated with a variety of underlying conditions, so diagnostic testing is critical. Severe consequences of gastric reflux are uncommon.
Acid reflux is associated with various root causes, including:
• General anesthesia • Side effect of medication • Esophageal stricture or scarring • Injuries
• Tumors in the esophagus or stomach
Treatment and prognosis vary and depend on the underlying cause.
Gastric reflux is often asymptomatic in cats. When present, symptoms may include:
• Regurgitation • Difficulty swallowing • Lip licking • Restlessness • Hypersalivation
• Grinding teeth (bruxism)
Note: there is an important distinction between regurgitation and vomiting. Vomiting is an active process and is preceded by retching and signs of nausea. Regurgitation is a passive process where food or fluid exits the mouth by gravity alone.
Investigation and diagnosis of acid reflux may include:
• Physical exam • Blood work • Urinalysis • Radiographs (x-rays) • Ultrasound • Esophagoscopy
Once the underlying cause for gastric reflux is diagnosed, a combination of treatments are prescribed and often include:
• Acid secretion inhibitors: medications that decrease the acidity of the stomach by decreasing or preventing acid production
• Mucosal protectants: medications that coat the lining of the esophagus to prevent further esophageal damage
• Gastric motility enhancers: these help to strengthen the muscle tone of the esophageal sphincter and promote forward movement of content through the gastrointestinal tract
Other treatments that are commonly recommended include:
• Changing to a low-fat diet • Feeding small, frequent meals
Depending on the underlying cause of the gastric reflux, surgery may be required.
Gastric reflux is poorly understood in cats and believed to be underdiagnosed. It is usually mild and asymptomatic. The prognosis varies. Acid reflux resulting from stomach or esophageal cancer, for example, has a poor prognosis. Gastric reflux occurring as a side effect of a medication is expected to fully resolve when the medication is discontinued.
This condition is not contagious to other pets or people.
Attention to preventing gastric reflux during anesthesia may play a role in decreasing the incidence of this illness. While gastric reflux during general anesthesia is usually mild and temporary, in some cases it is severe enough to permanently damage the esophagus. This in turn leads to inflammation of the esophagus (esophagitis), which perpetuates gastric reflux. Adherence to general veterinary guidance around nutrition and feeding as well as regular check ups also help to prevent reflux and increase the likelihood of early detection of more serious underlying conditions.
This condition is presumed to be common in cats, although underdiagnosed since it rarely causes significant clinical signs.
• Acid secretion inhibitors • Mucosal protectants • Gastric motility enhancers
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