Acid, or Gastric reflux (GR) is defined as the movement of gastric secretions from the stomach into the esophagus.
• Symptoms include drooling, vomiting, regurgitation, restlessness, abdominal pain, loss of appetite, obsessive lip smacking or licking the air, struggling to swallow, and changes to the bark
• GR is common in breeds predisposed to develop the condition, such as flat-faced dogs, and uncommon in other breeds
• Suspected GR is diagnosed by ruling out other possible conditions, assessing the tissues lining the esophagus and stomach, and an evaluation of gastric motility
• Treatment of GR focuses on reducing the flow and acidity of secretions into the esophagus
• GR may have an underlying cause which can be treated directly
• GR often requires lifelong management, unless any underlying conditions can be cured
The symptoms of acid reflux are caused by inflammation of the esophagus and throat due to the high acidity of stomach secretions. Repeated exposure to the low pH of gastric juices is damaging to tissues outside of the stomach. GR severity varies. Mild cases are often undiagnosed and are rarely a cause for concern. Moderate cases impact quality of life but normally respond well to treatment. Severe cases are rare but sometimes result in ulceration of the esophagus and life-threatening complications such as permanent narrowing of the esophagus. Dogs showing symptoms of gastric reflux, such as regurgitation, excessive salivation, or pain when swallowing require prompt veterinary care.
Severe GR sometimes presents as loss of appetite and weight loss. If the esophagus develops ulcers, vomit with blood can occur.
In some cases, gastric reflux causes inflammation of the voicebox (laryngitis). The inflammation triggers symptoms such as:
• Pain on swallowing • Coughing • Changes in the sound of the bark
GR is often associated with underlying conditions. ‘Flat-faced dogs’ (brachycephalic breeds) are predisposed to GR due to increased air pressure in the chest and throat when breathing. Some dogs have a hiatal hernia, a condition where part of the stomach is displaced forwards into the chest. Symptoms of gastric reflux are often observed after a period of fasting due to the build up of gastric secretions. In some cases, dogs regurgitate while under anesthesia, putting gastric acid in contact with the esophageal lining, leading to esophagitis with an isolated root cause.
GR presentation varies between dogs, but the underlying trigger is inflammation from the gastric secretions causing damage to the lining of the esophagus. Symptoms include:
• Excessive drooling • Recurrent lip smacking • Obsessively licking the air • Restlessness • Abdominal pain
Note: It is important to differentiate between vomiting and regurgitation. Vomiting is an active process with visible abdominal effort (heaving) whereas regurgitation is a passive process and dogs open their mouths and ‘bring up’ white, frothy liquid.
The main diagnostic tests to identify gastric reflux include:
• Physical examination • Blood tests • Diagnostic imaging, including endoscopy
Treatment of GR is divided between direct treatment of the symptoms of reflux and treatment of underlying conditions. Feeding strategies are used to improve digestibility and accelerate movement of food, and therefore gastric secretions, through the stomach. Feeding little and often, low fat diets, and maintaining the overall state of health often improve symptoms of GR. Medication is used to improve symptoms, including antacids, prokinetic medications, and gastroprotectant medications.
Other treatments depend on the specific underlying condition. In cases of hiatal hernia, surgery is required to resolve symptoms.
Episodes of GR occur intermittently in dogs and are triggered by events such as fasting, exercise, excitement, or heat. Episodes normally resolve spontaneously within a few minutes. Most cases of GR cannot be cured, but most will improve with appropriate management.
The likelihood of GR episodes are reduced by maintaining a healthy body condition, and feeding good quality, highly digestible, vet-approved food.
GR is most common in “flat-faced” (brachycephalic) dogs, such as pugs, english/french bulldogs, boston terriers, and boxers. In other breeds, moderate to severe GR is uncommon, but mild cases may be underdiagnosed.
• Feeding strategies • Medication • Surgery
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