Esophagitis in Cats and Dogs

Severe oesophagitis and oesophageal stricture secondary to anaphylaxis in a dog

This report describes the development of oesophagitis and oesophageal stricture in a dog secondary to anaphylaxis. A 9-month-old male entire Brussels Griffon presented in anaphylactic shock after exposure to Hymenoptera species (Sp). The dog had a history of an anaphylactic reaction after exposure to Hymenoptera, successfully managed with antihistamines and dexamethasone. On this presentation, the dog was vomiting, lethargic, hypotensive and hyperlactatemic, with a mild elevation in serum alanine transaminase (ALT) concentration and gall bladder wall oedema. An adrenaline constant rate infusion was required for 48 h; however, persistent vomiting and regurgitation occurred despite prokinetic and antiemetic therapy. The dog developed hypersalivation and discomfort around the neck on day 6 of hospitalisation. Oesophagitis was suspected and confirmed by endoscopic examination. The dog remained in hospital for a total of 10 days with a percutaneous endoscopic gastrostomy tube (PEG) placed. He was discharged and managed as an outpatient for 1 month while deescalating therapy and could not eat orally during this time. Repeat endoscopy and an oesophagogram performed 5 weeks post-discharge revealed a 2 mm oesophageal stricture 9.8 mm in length proximal to the lower oesophageal sphincter. The dog required four endoscopic guided ballooning procedures before the oesophageal diameter was deemed acceptable. After the first procedure, the dog could eat orally and gastrointestinal signs resolved. His PEG tube was removed after the fifth endoscope, 93 days from initial presentation, and further ballooning was not required. Gastrointestinal signs are commonly seen with anaphylaxis; however, these are usually self-limiting. This was the first description in the veterinary literature of severe oesophagitis and stricture formation secondary to anaphylaxis.

Prevalence of respiratory signs in dogs with chronic gastroenteropathy in a referral population in the United Kingdom: 42 cases (2020)

OBJECTIVES

To determine the prevalence of respiratory signs in a referral population of dogs with chronic gastroenteropathy in the United Kingdom, and to describe the epidemiology and clinical presentation of the affected dogs.

MATERIALS AND METHODS

Retrospective review of canine patients diagnosed with chronic gastroenteropathy in a referral centre in the United Kingdom. Data included signalment, gastrointestinal and respiratory signs, blood analysis results and, where present, diagnostic imaging techniques, endoscopy, videofluoroscopic swallow study, bronchoalveolar lavage results and treatment response. To be included, a follow-up of a minimum of 3 months was required. Cases were excluded if there was no minimum diagnostic dataset, the aetiology of the respiratory signs was other than gastrointestinal disease or a non-gastrointestinal systemic disease was the cause of the gastrointestinal signs.

RESULTS

One hundred and forty-eight dogs were included and 42 (28.4%) had concurrent respiratory signs. Gagging (69%) and vomiting (52.4%) were the most common gastrointestinal signs, while coughing (50%), tachypnoea (33.3%) and reverse sneezing (30.9%) were the most common respiratory signs. Abdominal ultrasound was performed in 31 (73.8%) while CT scan was the most common modality for thoracic (62.5%) and head (21.9%) imaging. Endoscopic procedures included gastrointestinal (54.8%), bronchoscopy (19%) and rhinoscopy (23.8%). Dietary modification was the most common treatment (66.67%). Eleven dogs (26.2%) had a relapse of the respiratory signs during the follow-up period, of which, nine (81.8%) had a concurrent relapse of the gastrointestinal signs.

CLINICAL SIGNIFICANCE

Concurrent respiratory signs in dogs with chronic gastroenteropathy are frequent. A clinical improvement of these respiratory signs might be achieved during the therapeutic management of gastrointestinal disorders.

Rational use of gastroprotectants in cats: An evidence-based approach

PRACTICAL RELEVANCE

Acid-related disorders including esophagitis and gastroduodenal ulceration are uncommon in the cat. However, when they occur, they can have devastating consequences and require targeted intervention, including the use of gastroprotectants. Careful consideration of the causes of esophagitis and gastroduodenal ulceration can help the clinician to determine which gastroprotectant to use, and when to begin and end gastroprotective therapy.

CLINICAL CHALLENGES

Gastroprotectants remain one of the most misused classes of drugs in veterinary and human medicine. There are very few studies evaluating the efficacy of gastroprotective agents in cats. Furthermore, goals for the degree of gastric acid suppression are extrapolated from studies performed in dogs and humans.

AIMS

This review provides a foundation for the logical approach to the choice of gastroprotectant as indicated by the disease process, and is aimed at all veterinarians who prescribe gastroprotectants for use in cats.

EVIDENCE BASE

The guidance provided in this review is supported by current literature, including consensus opinion from the American College of Veterinary Internal Medicine. Gaps in evidence for use of gastroprotectants in cats are filled by extrapolations from studies performed in dogs and humans.

A Comparative Assessment of the Diagnosis of Swallowing Impairment and Gastroesophageal Reflux in Canines and Humans

Swallowing impairment is a highly prevalent and clinically significant problem affecting people and dogs. There are myriad causes of swallowing impairment of which gastroesophageal reflux is the most common in both species. Similarities in anatomy and physiology between humans and canines results in analogous swallowing disorders including cricopharyngeus muscle achalasia, esophageal achalasia, hiatal herniation, and gastroesophageal reflux with secondary esophagitis and esophageal dysmotility. Accordingly, the diagnostic approach to human and canine patients with swallowing impairment is similar. Diagnostic procedures such as swallowing fluoroscopy, high-resolution manometry, pH/impedance monitoring, and endolumenal functional luminal imaging probe can be performed in both species; however, nasofacial conformation, increased esophageal length, and the difficulty of completing several of these procedures in awake dogs are inherent challenges that need to be considered. Human patients can convey their symptoms and respond to verbal cues, whereas veterinarians must rely on clinical histories narrated by pet owners followed by comprehensive physical examination and observation of the animal eating different food consistencies and drinking water. Dogs may also be unwilling to drink or eat in the hospital setting and may be resistant to physical restraint during diagnostic procedures. Despite the species differences and diagnostic challenges, dogs are a natural animal model for many oropharyngeal and esophageal disorders affecting people, which presents a tremendous opportunity for shared learnings. This manuscript reviews the comparative aspects of esophageal anatomy and physiology between humans and canines, summarizes the diagnostic assessment of swallowing impairment in both species, and discusses future considerations for collaborative medicine and translational research.