WHAT IS CANINE MEGAESOPHAGUS
Canine Megaesophagus (ME) is difficult to detect and diagnose, and the medical options are few. The muscles of the esophagus fail and it cannot propel food or water into the stomach. (It’s like a balloon that has been inflated several times and then hangs limp.) The result is that ingested food sits in the esophagus within the chest cavity and never makes it to the stomach.
The most serious complication is that digestive fluid/food will at some point pool in the esophagus which generally results in aspiration of digestive fluid/food, leading to pneumonia (Aspiration Pneumonia - AP).
Megaesophagus can occur at any age as a puppy or as an older dog. If it afflicts a puppy, the cause is usually genetic, or can be due to a surgically repairable condition called PRAA (Persistant Right Aortic Arch - PRAA). If not secondary to another disorder in adult animals, it is called "idiopathic" (cause unknown). Megaesophagus can be secondary to other diseases such as Myasthenia Gravis, Thyroid, Addisons and other Neurological disorders.
Regurgitation can be of water, mucous or food. “Regurging” looks like bringing up food and water without any warning…an erp or blech versus "vomiting" which is associated with retching and heaving while working to get the food out. Some or all of the below may be noticed;
● Loss of appetite or refusal to eat
● Sudden weight loss
● Swallowing difficulty, exaggerated and/or frequent swallowing
● Trying to clear the throat frequently with a "hacking" sound
● Sour and/or foul smelling breath.
● Many canines may be mis-diagnosed with a gastro-intestinal problem.
● Aspiration pneumonia (AP) can be a frequent complication and is our worst enemy
Management: (from Dr Kathy Morris, moderator for Yahoo ME Support Group, 20+ years experience in all capacities with these dogs)
1. Feed VERTICALLY and remain so for 20-30 minutes -"Elevated" food and water is not
enough. MOST Megaesophagus dogs need to be fed and given water, and held VERTICALLY, so that food and water can fall into the stomach. Too many newbies try to get by with NOT doing so, only to finally relent when THEIR way doesn't work.
2. Metoclopromide pills or injection, or oral cisapride (requires compounding) to promote emptying of the stomach so that food/water can fall into the stomach without resistance (helps most dogs; makes a few dogs worse; ineffective in some dogs).
3. Many of these dogs have ESOPHAGITIS, which requires treatment with oral liquid carafate (one hour before food/meds or two hours after; it binds to "stuff" so if given with most food or with other meds, both may be inactive). Additionally, esophagitis is pretty painful, so could be making them restless and miserable.
4. Antibiotic Responsive Gastroenterocolits (ARG/IBD/SIBO) seems to be common in these dogs and be responsible for increased regurgitation. Treatment with a combination of amoxicillin, metronidazole and carafate, +/- cerenia, for nausea, for 2-4 weeks may result in decreased regurgitation.
5. Nausea can be helped with injectable or oral Cerenia.
6. Keeping these dogs well hydrated, especially if they are bringing up a lot of fluid (causes dehydration). Learning how to administer subcutaneous (under the skin) fluids is a good idea.
7. Many dogs benefit from using an acid-neutralizer (Zantac, Pepcid AC, Prilosec, etc. - NOT Tums or Tagamet) to reduce the acid that refluxes up into the esophagus from the stomach.
8. Having your dog either sleep on an incline with the front elevated and/or wear a Pro-collar (see the files, again) to elevate the head while laying down or sleeping, will also minimize "micro-aspiration" of refluxed material from the stomach.
If your dog has Aspiration Pneumonia (AP):
● Most veterinary pulmonologists suggest both Baytril A N D either amoxicillin or clavamox for 4-6 weeks for AP
- Clavamox could cause nausea, so could try Cerenia
- Use the LEAST amount, or the less aggressive antibiotic, at an appropriate dose, and for a long enough time, because these dogs may need antibiotics in the future and we want to "save" the more high powered for later if necessary
● Nebulizer with saline or Albuterol
- Check out the nebulization link at www.morrisvet.com and look at “nebulizer link” for more information
- Can purchase nebulizers on Ebay
- If no nebulizer, can trun shower on and keep in bathroom for the steam
- Percussion therapy (go to YouTube.com and type in dog percussion therapy for a demo video)
● May use wet towels or ice packs if can’t get to DVM immediately; can also place frozen
vegetables under arm pits and on head for comfort and relief
● If it recurs within a few weeks after stopping the antibiotics may need to have a tracheal wash or bronchoalveolar lavage to isolate the causative agent and the best antibiotic
● Give fluids sub-q if/as needed
● Use lactaited Ringers" for electrolytes if/as needed
● May use Cerinia injections for a few days as well, and liquid carafate for a few days
● Try to feed baby food first and work up to normal
● ALWAYS feed in the manner ME dog is accustomed (vertical or elevated) unless IV only
● Get informed, get your vet's advice on options, but in the end you know your dog best as to what they will or will not accept
● If esophagitis is suspected, pain meds, as well as oral carafate (sucralfate) is indicated
● Consider keeping a journal of what works and doesn't work, and/or a day by day report that you and your dvm can refer to.
Other Megaesophagus Suggestions:
1. Do not assume gloom and doom. With dedication of owner and DVM many dogs can live relatively normal lives. ME dogs DO NOT die from ME…they die from other causes, so euthanizing them should not be first option.
2. Test for Addison's, Myasthenia Gravis, hypothyroidism and lead toxicity (if lead exposure). Perform a thyroid panel, not just a T4, as sick euthyroid may erroneously suggest hypothyroidism.
3. 3 view x-rays of chest to rule out pneumonia - if present treat at LEAST 4 weeks.
4. Do not depend on auscultation, alone, for diagnosis. Clinical signs of pneumonia may preceed radiographic signs by 1-3 days. If suspect AP, TREAT. Consider albuterolnebulizer treatments as adjuntive therapy. If pet has had AP, consider dispensing a"starter" supply of antibiotics for use as needed. Owner can purchase additional doses after starting.
5. A nebulizer can be purchased from some pharmacies, medical supplyhouses, or ebay. Good brands of nebulizer are PulmoMate, PulmoNaide, Omron.
Sample (but, not the ONLY) protocol for ME dogs and is a place to start:
Each ME dog MUST have their own individual protocol determined basis their full diagnosis and needs. NO TWO ME DOGS ARE ALIKE so it unfortunately does take some experimentation to find what works. Then, the owner MUST be prepared to make changes pending any signs the current plan is not working.
1. Administer a dose of promotility medication (metoclopromide, cisapride, orother) 15-30 minutes prior to eating.
2. Feed 4-5 times daily w/ the dog's body perpendicular to the floor so food "falls" through the esophagus into the stomach. (consider using a chair or other method of feeding the dog in a VERTICAL position during and after).This takes advantage of gravity, allowing the esophagus contents to "fall" into the stomach.
3. Administer acid neutralizer with the meal (Pepcid AC, Prilosec, etc.) at night; 2-3times daily if Zantac or Pepcid with one of the feedings.
4. Administer Carafate (A "bandage" for ulcers or erosions in the esophagus orstomach) 2 hours prior to bedtime; or, if required more often, liquid Carafate can begiven 1 hour BEFORE, or 2 hours AFTER any other medication, or food. (Carafate willbind to anything else, except water, therefore, to allow the Carafate to "bandage"esophagus erosions, it needs NOT to be attached to food, or anything else).
5. Administer antacid right before bed to minimize acid in stomach, so if reflux from the esophagus occurs from the stomach while the dog is laying down, it is not as acidic. Acid inhibitors are SUPPOSED to be given on an empty stomach, but, most owners report help even if given WITH food.
6. Attempt to have dog sleep with front end elevated, for example in a crate with the frontend elevated. Using a Pro collar to keep the head elevated may also minimize night-time regurgitation.