Reflux esophagitis in three cats associated with metaplastic columnar esophageal epithelium

Gastroesophageal reflux is a relatively common condition in dogs and cats and may lead to secondary reflux esophagitis. A consequence of chronic gastroesophageal reflux that is well described in humans is Barrett's esophagus, which is the replacement of the normal squamous epithelium of the distal esophagus with metaplastic columnar epithelium. Three cats with clinical and endoscopic signs of chronic esophagitis had metaplastic columnar epithelium on biopsy of the distal esophageal mucosa. Suspected underlying causes were cardial incompetence and sliding hiatal hernia. Two cats had complete resolution of the clinical signs after treatment. One cat was euthanized.     

Esophagitis and esophageal strictures.

Esophagitis and esophageal strictures are important causes of esophageal disease in dogs and cats. Clinical suspicion is created when the clinician recognizes the clinical signs suggestive of esophageal disease and accounts for historical information and physical examination findings. Once suspected, the diagnosis of esophagitis and esophageal strictures is a fairly simple one in most cases. Although the benefit of diminishing secretion of gastric acid in patients with esophagitis is unquestioned, other questions regarding adjunctive medical treatments, such as sucralfate and glucocorticoids for dogs and cats with esophagitis, have not been answered through appropriate clinical studies. Esophageal strictures are readily treated with balloon dilation or esophageal bougienage, and clients can expect most patients to become functional, although dietary change may be necessary.     

Feline esophagitis secondary to gastroesophageal reflux disease: clinical signs and radiographic,endoscopic, and histopathological findings

Chronic esophagitis due to gastroesophageal reflux (GER) is rarely reported in the cat. This paper describes the clinical signs and diagnostic findings, including radiographic, endoscopic, and histopathological abnormalities, in three young, purebred, male cats with esophagitis presumed to be secondary to GER. Clinical signs included regurgitation, dysphagia, and weight loss. Contrast radiography revealed GER, esophageal dilatation, and decreased motility. Endoscopy showed hyperemia, increased vascularity, ulcers, erosion, and an abnormal lower esophageal sphincter. Histopathological lesions included squamous hyperplasia and dysplasia, erosions, ulcers, and an inflammatory infiltrate of lymphocytes, plasma cells, and neutrophils. Long-term follow-up demonstrated progression of the disease in two of the cats.     

Effects of the Y-U Pyloroplasty on Gastric Emptying and Duodenogastric Reflux in the Dog

A Y-U pyloroplasty was performed on five healthy adult dogs. Gastric emptying half times (t1/2 GE) of a canned food meal were measured by scintigraphy three times before surgery and three times from 6 to 8 weeks after surgery. Fluoroscopic studies of gastric and duodenal motility were made before surgery and 3, 7, and 35 days after surgery. Clinical observations were made daily throughout the study. Gross and histologic evaluations of the gastroesophageal and pyloric regions were performed at the termination of the study. The t1/2 GE was significantly decreased after surgery. By positive contrast fluoroscopy, the vigor of antral contractions was seen to be decreased in three of the five dogs. On days 7 and 35, fluoroscopic findings were comparable to preoperative studies. Duodenogastric reflux was recognized fluoroscopically in three dogs on four different occasions. This may reflect normal reflux patterns in the dog. No gastrointestinal problems were evident after surgery in four dogs. Reflux esophagitis developed in one dog after surgery, which resolved with therapy. Studies of the Y-U pyloroplasty after 2 months indicated that it decreased gastric emptying time of solid food. Results of postmortem examination showed no abnormal gross or histopathologic changes of esophageal, gastric, or proximal duodenal tissues.     

Congenital Esophageal Hiatal Hernia in the Chinese Shar-Pei Dog

Esophageal hiatal hernia was diagnosed in 11 young Chinese Shar-Pei dogs between October 1985 and July 1991. The dogs ranged in age from 2 to 11 months and included 3 females and 8 males. The most common clinical signs were regurgitation, vomiting, and hypersalivation. Physical examination was normal in 6 dogs; abnormal physical examination findings in the other 5 dogs included fever, dehydration, hypersalivation, and pulmonary wheezes and crackles. Laboratory evaluation was significant only for neutrophilia in 5 dogs. A diagnosis of hiatal hernia was made on the basis of survey thoracic radio-graphic and/or barium esophagram findings of displacement of the esophagogastric junction and stomach into the thoracic cavity; the diagnosis was confirmed by surgery in 9 dogs and at necropsy in 2 dogs. Megaesophagus (n = 7), gastroesophageal reflux (n = 4), and esophageal hypomotility (n = 1) were additional findings in some dogs. Aspiration pneumonia was diagnosed in 7 of the dogs. Medical therapies formulated for the therapy of presumed reflux esophagitis generally failed to resolve the clinical signs associated with the hiatal hernia. Hiatal herniae were surgically repaired in 9 of the Shar-Peis by various combinations of diaphragmatic crural apposition, fixation of the esophagus to the diaphragmatic crus (esophagopexy), and left fundic tube gastropexy. Eight of the animals survived surgery, six of which have been asymptomatic since surgery (19 to 36 months). The megaesophagus, esophageal hypomotility, and bronchopneumonia resolved in all of these dogs. (Journal of Veterinary Internal Medicine 1993; 7:210–215. Copyright © 1993 by the American College of Veterinary Internal Medicine.)     

Evaluation of metoclopramide and ranitidine on the prevention of gastroesophageal reflux episodes in anesthetized dogs

This research aimed to evaluate the effect of metoclopramide and ranitidine in the prevention of gastroesophageal reflux episodes during anesthetic procedures. Ninety healthy female dogs were submitted to elective ovariosalpingohisterectomy, randomly divided into three groups of 30 animals. The control group received only the anesthetic protocol. The metoclopramide group received an intravenous bolus of 1mg/kg, and continuous infusion (1 mg/kg/h intravenously) immediately after anesthetic induction. The ranitidine group received an intravenous bolus of 2 mg/kg, 6 h before anesthesia. Anesthesia (acepromazine, propofol and isofluorane) was standardized and the esophageal pH variations were recorded. Esophagoscopy was carried out after surgery. No difference (p<0.05) was verified in the reflux episodes between the groups. Seven animals presented reflux. Metoclopramide in bolus and continuous infusion, as well as ranitidine, 6 h before anesthesia, did not influence the reduction of the incidence of gastroesophageal reflux.     

Idiopathic gastroesophageal reflux disease in an adult horse

Chronic gastroesophageal reflux disease was diagnosed in a 22-year-old female Tennessee Walking Horse that had signs of bruxism and ptyalism. Esophageal ulceration was detected via endoscopy. Compared with the damage to the proximal portions of the esophagus, the severity of the ulceration increased toward the gastroesophageal junction. Esophageal ulceration attributable to chronic gastric acid reflux is usually secondary to pyloric outflow obstruction in horses. In the horse of this report, there was no evidence of either a chronic pyloric or duodenal obstruction that could have resulted in esophageal ulceration. Esophageal ulceration in this horse was attributed to gastroesophageal reflux disease, a common condition in humans in which the underlying abnormality is functional incompetence of the gastroesophageal junction. Treatment is directed at decreasing gastric acidity and protecting the ulcerated mucosa. In the horse of this report, treatment was unsuccessful and the horse was euthanatized; a physical cause of gastroesophageal reflux disease was not identified during an extensive postmortem examination.     

GASTROINTESTINAL NUCLEAR MEDICINE

Nuclear medicine has achieved an important role in the diagnosis of gastrointestinal (GI) disease in humans. Esophageal and gastric motility problems, gastroesophageal reflux, abnormal gastric secretory function, GI bleeding, and inflammatory diseases of the GI tract can all be evaluated using nuclear scintigraphy. The use of these techniques in human medicine, their advantages and disadvantages relative to other available diagnostic tests, and their potential application to veterinary medicine are discussed. Examples of esophageal and gastric motility studies performed on normal and abnormal dogs are included.     

Chronic Gingivostomatitis with Esophagitis in Cats

Background

Chronic gingivostomatitis in cats (FCG) is a debilitating disease with potentially deleterious effects on overall health.

Hypothesis/Objectives

Little is known about the pathophysiology and overall impact of FCG. The aims of our study were to investigate whether gingivostomatitis occurs concurrently with esophagitis, if FCG treatment contributes to esophagitis and if esophagitis exacerbates signs of FCG.

Animals

Fifty‐eight cats with clinical signs of FCG and 12 healthy control cats exhibiting no signs of oral disease, all client‐owned.

Methods

Prospective study. Physical, oral and endoscopic examinations were performed on all cats. Measurements of salivary and esophageal lumen pH were obtained from both groups. Biopsies were acquired from sites of esophageal inflammation in cats with FCG and from normal‐appearing esophageal mucosa in control cats.

Results

The majority of cats with clinical signs of FCG exhibited some degree of esophagitis especially in the proximal (44/58) and distal (53/58) parts (P < 0.001) with or without columnar metaplasia, compared to controls. All cats lacked signs related to gastrointestinal disease. Salivary and esophageal lumen pH were not statistically different compared to controls.

Conclusions and Clinical Importance

Feline chronic gingivostomatitis seems to occur concurrently with esophagitis. Esophagitis also should be managed in cats with chronic gingivostomatitis because it may aggravate the existing condition.     

Megaesophagus and aspiration pneumonia secondary to gastric ulceration in a foal

A 3-month-old foal with a history of persistent fever and leukocytosis was found to have pneumonia, ulceration of the squamous portion of the stomach, and dilatation of the distal portion of the esophagus. The foal was euthanatized and necropsied. The distal portion of the esophagus was severely dilated, and there was severe ulceration and mural thickening of the stomach at the cardia. Because of the severe gastric ulceration and mural thickening, the gastroesophageal junction was fixed in an open position, permitting gastroesophageal reflux. The megaesophagus and pneumonia were considered to have resulted from chronic gastroesophageal reflux.     

Severe esophageal injuries occurring after general anesthesia in two cats: case report and literature review

Two healthy cats underwent elective surgical procedures under general anesthesia. One developed severe esophagitis leading to esophageal rupture, mediastinitis, and pyothorax. The other cat developed esophageal stricture, diverticulum formation, and suspected iatrogenic perforation. Both cats had signs of dysphagia and regurgitation beginning a few days after anesthesia. The first cat also had severe dyspnea due to septic pleural effusion and pneumomediastinum. In the second cat, endoscopy revealed diffuse esophagitis, an esophageal stricture, and a large esophageal diverticulum. Rupture of the esophageal wall occurred while inflating the esophagus for inspection. Due to the poor prognosis, both cats were euthanized. Necropsy revealed severe esophageal changes. Postanesthetic esophagitis has been previously described in dogs and cats; however, severe life-threatening esophageal injuries rarely occur as a sequel to general anesthesia. To the authors' knowledge, esophageal rupture secondary to perianesthetic reflux has never been reported in cats.     

Esophageal hiatal hernia and megaesophagus complicating tetanus in two dogs

Two dogs with tetanus developed transient megaesophagus and hiatal hernia associated with gastroesophageal reflux and regurgitation. The megaesophagus and hiatal hernia were diagnosed radiographically and resolved with resolution of the tetanus. These 2 cases, plus previously reported cases, indicate that tetanus can cause megaesophagus and esophageal dysfunction. Therefore, thoracic radiography should be included as part of the diagnostic evaluation of dogs suspected of having tetanus.     

Barrier pressure at the gastroesophageal junction in anesthetized dogs.

OBJECTIVE: To evaluate the effect of body position on barrier pressure at the gastroesophageal junction in anesthetized Greyhounds and to assess alterations in barrier pressure following gastropexy. ANIMALS: 8 adult Greyhounds. PROCEDURE: Barrier pressure at the gastroesophageal junction was measured by fast (1 cm/s) and slow (1 cm/10 s) withdrawal of a subminiature strain gauge transducer through the gastroesophageal junction in 8 anesthetized dogs. The effect of body position was measured. Each dog then was placed in right-lateral recumbency, and gastropexy was performed in the left flank. Additional measurements were obtained 1, 5, 10, 20, and 30 minutes after gastropexy. RESULTS: Barrier pressure for dogs positioned in sternal recumbency (mean +/- SEM, 1.1 +/- 0.53 mm Hg) was significantly less than for dogs positioned in right lateral or left lateral recumbency. Following gastropexy, there was a steady increase in barrier pressure. Thirty minutes after gastropexy, barrier pressure was significantly higher (13.36 +/- 3.46 mm Hg), compared with the value before surgery. CONCLUSIONS AND CLINICAL RELEVANCE: Barrier pressure in anesthetized dogs is highly variable and influenced by body position. This is most likely the result of anatomic interrelationships between the diaphragm, stomach, and terminal portion of the esophagus. Gastropexy also increases barrier pressure in the immediate postoperative period, which may be clinically relevant in terms of understanding how resolution of gastroesophageal reflux disease associated with hiatal hernia may be affected by gastropexy combined with hernia reduction.     

Ambulatory esophageal pHmetry in healthy dogs with and without the influence of general anesthesia

This research aimed to determine the value of esophageal pH in awake and anesthetized dogs, to evaluate the esophageal pH value in awake dogs, in different body positions, as well as to study the occurrence of gastroesophageal reflux episodes in these positions. Thus, 40 healthy male and female adult dogs with mean body weight of 15.5 ± 4.6 kg were used. Esophageal pHmetry was conducted by inserting a catheter through the oropharynx in 30 dogs (stage 1) anesthetized with acepromazine, propofol and isoflurane, submitted to elective ovariosalpingohysterectomy. In addition, 8-h esophageal pHmetry was carried out transnasally in 10 awake dogs (stage 2), allowed to move and change body positions (lateral and sternal decubitus, and standing position), which were recorded. The mean esophageal pH value was lower (p < 0.01) in the anesthetized dogs (7.3 ± 0.82) than in the awake dogs (8.2 ± 0.3). Only four anesthetized dogs (13.33%) suffered reflux episodes. Reflux was not observed in the awake dogs and no esophageal pH differences were found between the body positions studied. Compared to the alert state, general anesthesia in dogs submitted to the previously mentioned anesthesia protocol causes esophageal pH reduction and predisposes to the occurrence of gastroesophageal reflux episodes. Transnasal pHmetry of 8 h in healthy awake dogs reveals that the esophageal pH value is alkaline and does not vary according to body position. In these animals, decubitus position is not a determining factor for reflux episodes to occur.     

Normal Swallowing in the Dog: A Cineradiographic Study

Normal dog swallowing dynamics were analyzed and correlated with specific structures. There were oropharyngeal, esophageal, and gastroesophageal phases. The oropharyngeal phase was characterized by food prehension and bolus formation (oral stage), reflex pharyngeal peristalsis (pharyngeal stage), and reflex cricopharyngeal sphincter relaxation (cricopharyngeal stage). The esophageal phase was characterized by primary peristalsis initiated by the oropharyngeal phase and secondary peristalsis which occurred in response to mechanical stimuli from a bolus in the esophagus. There was a post-peristalsis refractory period during which new peristalsis would not occur. Repeated rapid swallowing would, therefore, result in accumulation of ingesta in the esophagus. The gastroesophageal phase occurred when a bolus passed through the gastroesophageal junction, an area which serves as a lower esophageal sphincter. Gastroesophageal reflux was observed as a normal, infrequent event followed by rapid esophageal clearance. Low doses of tranquilizers had no significant influence on swallowing function. The differences observed between sternal and lateral recumbent postures related only to the rate of food consumption which, in turn, influenced esophageal motor response and inhibited gastroesophageal closure. These differences did not adversely affect the autonomous phases of swallowing.     

Star gazing in a dog: Atypical manifestation of upper gastrointestinal disease

A Yorkshire terrier dog was presented for episodes of “star gazing” behavior expressed as upward raising of the head and neck extension with subsequent staring at the ceiling or sky. Erosive gastritis with reflux esophagitis was diagnosed. Treatment of these conditions was associated with resolution of the behavior, suggesting a causal link.     

Benign esophageal stricture in the dog and cat: A retrospective study of 20 cases

Twenty animals with benign esophageal strictures are presented. Most of the esophageal strictures were thought to be related to gastroesophageal reflux during ovariohysterectomy and were located at the distal portion of the thoracic esophagus (caudal to the base of the heart). For the dilation procedure, the endoscope tip or a balloon catheter was used and the outcome was generally considered to be good. The endoscope tip was an adequate instrument for dilation in some cases.     

Incidence and characterization of esophagitis following esophageal foreign body removal in dogs: 60 cases (1999–2003)

Objective: To characterize the presence of esophagitis in dogs after esophagoscopy for diagnosis and treatment of esophageal foreign body and to relate the degree of esophageal injury to clinical signs and outcome. Design: Retrospective study. Animals, intervention, and measurements: Medical records of 60 dogs with esophageal foreign bodies diagnosed between January 1999 and December 2003 were reviewed. Information obtained from the medical records included age, breed, and sex; type and duration of clinical signs; physical examination, radiographic, and esophagoscopy findings; type and location of foreign body; surgical intervention; morbidity, and outcome. Animals were divided into 2 cohorts based upon the degree of esophageal injury detected during esophagoscopy: mild esophagitis or moderate‐to‐severe esophagitis. Data were then compared between the groups. Results: Dogs with moderate‐to‐severe esophagitis had a longer duration of clinical signs, were more likely to present for lethargy and regurgitation/vomiting, and had a longer time to recovery. This cohort had significantly greater morbidity including esophageal stricture, perforation, necrosis, and diverticulum formation, as well as aspiration pneumonia, pneumothorax, severe tracheal compression, and death. Dogs with mild esophagitis were more likely to present to the hospital for gagging. Conclusions: This study demonstrated a wide range of injury associated with esophageal foreign bodies. The degree of esophagitis appears to relate to the duration and severity of some of the clinical signs.     

Wireless Ambulatory Esophageal pH Monitoring in Dogs with Clinical Signs Interpreted as Gastroesophageal Reflux

Background

Although gastroesophageal reflux (GER) often is assumed to be causative for upper gastrointestinal and respiratory signs in dogs, no attempts have been made to verify this assumption.

Objectives

To monitor esophageal pH with the Bravo pH system in healthy dogs and client‐owned dogs displaying signs commonly attributed to GER.

Animals

Seven healthy and 22 client‐owned dogs.

Methods

After routine esophagogastroduodenoscopy, radiotelemetric pH capsules were placed in distal esophagus for continuous pH recording. Reflux was defined as single pH measurement <4. At discharge, owners were instructed to press individually predefined clinical sign‐buttons on the receiver whenever indicated. Results between groups were compared using Mann–Whitney U‐test.

Results

The median (range) number of refluxes in client‐owned and healthy dogs, respectively, was 17 (1–205) and 10 (1–65), the number of refluxes >5 minutes in duration was 1 (0–14), and 1 (0–4), duration of longest reflux (min) was 10 (0–65) and 8 (0–27), and fractional time pH <4 (%) was 0.76% (0.01–6.28), and 0.3% (0–3.1). No differences were found between groups. The median of 7 (1–35) clinical sign‐button pushes were recorded in 21 dogs. Median of 12.5% (2.8% [1/35]–50% [2/4]) reflux‐positive clinical sign‐button pushes was found in 10 dogs with reflux‐positive pushes. Five (22.7%) dogs had increased esophageal acid exposure, and mild esophagitis was noted in 1 dog.

Conclusion and Clinical Importance

Despite evidence of increased GER in some dogs, the clinical sign‐reflux association remained poor. Future investigation should focus on dogs with esophagitis.     

Esophagoscopy.

Esophageal pathology is one of the areas that had the major benefits from the advent of endoscopy. Esophagoscopy is a highly reliable diagnostic method for evaluating esophageal disorders that affect the mucosa or alter the lumen of the organ, such as foreign bodies, esophagitis, reflux disease, strictures, ulcers, fistula, and neoplasia. With endoscopy, the treatment of esophageal disorders has greatly improved as well, with the retrieval of foreign bodies and the dilation of esophageal strictures under direct visualization the main therapeutic indications.