Comparison of outcomes in dogs undergoing hiatal hernia repair with and without use of a gastropexy: 41 cases (2012-2022)

OBJECTIVES

To determine the difference in complication rate, gastrointestinal grade and requirement for ongoing medical and/or surgical management following hiatal hernia repair in dogs with and without gastropexy.

MATERIALS AND METHODS

Clinical records were reviewed retrospectively for dogs that had undergone surgical hiatal hernia repair at two veterinary referral centres between April 2012 and March 2022. Pre-operative grading of gastrointestinal signs and brachycephalic obstructive airway syndrome was performed. All dogs had an oesophagopexy and phrenoplasty. Referring primary veterinary practices and clients were contacted to obtain follow-up information. Fisher's exact tests and Mann Whitney tests were used to assess pre- and intra-operative similarities between groups. Wilcoxon signed rank tests were used to determine the changes in gastrointestinal grade at short- (<6 months) and long-term (>6 months) follow-up.

RESULTS

Forty-one dogs which underwent oesophagopexy and phrenoplasty were included. Fifteen dogs had no gastropexy performed and 26 dogs had left-sided gastropexy performed. Dogs that underwent gastropexy (n=8, 29%, 95% CI: 13 to 51%) were significantly more likely to require further surgery related to the initial surgery or persistence of gastrointestinal signs compared to dogs that had no gastropexy (n=0, 0%, 95% CI: 0 to 18%) . This difference was not significant when dogs which had further surgery to address brachycephalic obstructive airway syndrome were excluded. Gastrointestinal grade significantly improved for both groups at both short- and long-term follow-up. There was no significant difference in overall complication rate, gastrointestinal grade or requirement for further medical treatment between groups.

CLINICAL SIGNIFICANCE

A left-sided gastropexy is not required for successful surgical repair of hiatal hernia in dogs provided oesophagopexy and phrenoplasty are performed.

Addition of a metoclopramide constant rate infusion to prevent ptyalism, regurgitation and vomiting in brachycephalic dogs undergoing spinal surgery

OBJECTIVE

To assess whether adding metoclopramide to a protocol of maropitant and pantoprazole would reduce incidence of ptyalism, vomiting and regurgitation in brachycephalic dogs undergoing thoracolumbar spinal surgery.

STUDY DESIGN

Randomized blinded controlled trial.

ANIMALS

A total of 43 brachycephalic dogs undergoing thoracolumbar spinal surgery.

METHODS

In addition to a standardized anaesthetic regimen, dogs were randomized to be administered either a 2 mg kg-1 day-1 metoclopramide constant rate infusion (CRI) or a saline solution at an equivalent infusion rate, started after anaesthetic induction and discontinued 5 hours after tracheal extubation. The presence of vomiting, regurgitation and pytalism, and short form of the Glasgow Composite Pain Scale pain scores were assessed by a blinded observer hourly for 4 hours, starting 1 hour postextubation.

RESULTS

Regurgitation occurred in six dogs postoperatively; three dogs were in the placebo group and three in the metoclopramide group. The odds ratio (OR) of regurgitation after surgery did not differ between groups [OR: 0.76, 95% confidence interval (CI): 0.13-4.3, p = 0.76]. The odds of observing ptyalism at 3 and 4 hours was approximately 15 times less than 1 hour postoperatively (both OR: 15.4, 95% CI: 1.8-130.7, p = 0.012) and did not differ based on the addition of metoclopramide (OR: 0.73, 95% CI: 0.07-8.0, p = 0.79). The odds of observing pain did not change over time and did not differ based on the addition of metoclopramide (OR: 0.71, 95% CI: 0.12-4.2, p = 0.71). Vomiting did not occur during the study (0.0%, 95% CI: 0.0-8.2%). No adverse effects were observed during the study period in either group.

CONCLUSIONS AND CLINICAL RELEVANCE

The addition of a metoclopramide CRI to maropitant and pantoprazole did not result in a significant reduction in ptyalism or regurgitation in brachycephalic dogs undergoing thoracolumbar spinal surgery.

A correlation of computed tomographic esophageal hiatal cross-sectional surface area between brachycephalic and nonbrachycephalic cats

In humans and dogs, especially brachycephalics, enlargement of the esophageal hiatus and insufficiency have been correlated with decreased lower esophageal sphincter pressure and increased frequency of gastroesophageal reflux. In cats, it has been suggested that gastroesophageal reflux occurs frequently with upper airway obstruction, including brachycephalics. Therefore, the purpose of the study was to determine whether the esophageal hiatal cross-sectional surface area (EH-CSA) differs between brachycephalic and nonbrachycephalic cats. Clinical records and CT images of cats that underwent thoracic, abdominal, and entire skull CT at multiple centers between January 2015 and September 2022 were retrospectively reviewed. Esophageal hiatal parameters (EH-CSA, EH-long axis diameter, and EH-short axis diameter) and craniometric indices (cranial index, skull index, and facial index) were measured by using multiplanar reconstruction, and the correlation of craniometry with EH-CSA was investigated. Ninety-eight cats (group 1: 42 brachycephalic cats and group 2: 56 nonbrachycephalic cats) were included. Esophageal hiatal cross-sectional surface area in brachycephalic cats was significantly larger than that in nonbrachycephalic cats. The EH-CSA significantly increased with the craniometric indices tending to increase with brachycephalism. The present study contributes to the veterinary literature by providing the EH-CSA as anatomical evidence that could likely correlate to gastroesophageal reflux predisposition in brachycephalic cats.

Laparoscopic Treatment of Sliding Hiatal Hernia

Hiatal hernias result from a widening of the esophageal hiatus that leads to the displacement of the lower esophageal sphincter and stomach into the thoracic cavity. Clinical signs of regurgitation, gastroesophageal reflux, and esophagitis are managed medically, but surgery is considered in those that fail to respond to medical management. Surgical treatment of hiatal hernia can be performed laparoscopically. Treatment involves plication of the esophageal hiatus, as well as a pexy of the esophagus to the diaphragm and a left sided gastropexy. Outcomes with laparoscopic treatment are comparable to those performed via laparotomy.

Evaluating acidic gastroesophageal reflux with wireless pH monitoring in French bulldogs with sliding hiatal herniation

BACKGROUND

Sliding hiatal herniation (SHH) and gastroesophageal reflux (GER) commonly occur in French bulldogs. Wireless pH monitoring can quantitatively assess acidic GER in dogs affected by SHH.

HYPOTHESIS/OBJECTIVES

Measure acidic GER in French bulldogs with SHH, pre- and post-brachycephalic obstructive airway syndrome (BOAS) surgery, utilizing a wireless pH capsule (Bravo Calibration-free, Medtronic, Minnesota), and correlate with owners' observations of regurgitation.

ANIMALS

Eleven French bulldogs diagnosed with SHH via swallowing fluoroscopy.

METHODS

Prospective cohort study. A pH capsule was endoscopically placed in the esophagus. Up to 96 hours of data were acquired as the owner logged clinical signs. Spearman's correlation and Wilcoxon rank-sum tests evaluated factors correlated with acid exposure time (AET), defined by the % time pH < 4. In 4/11 dogs, Bravo monitoring was repeated 2-4 months after BOAS surgery.

RESULTS

Medians (Q1-Q3) for age and weight were 21 months (17-35.5) and 10.0 kg (8.9-11.5). BOAS severity was mild (3), moderate (4), or severe (4). Medians (Q1-Q3) for AET and reflux events were 3.3% (2.6-6.4) and 70 (34-173). Clinical score (P = .82) and BOAS severity (P = .60) were not correlated with AET, but age was negatively correlated (rho = -.66, P = .03). Median probability (Q1-Q3) that regurgitation was associated with a reflux event was 72.5% (0-99). Percent AET numerically improved in all 4 dogs that underwent BOAS surgery although not statistically assessed.

CONCLUSIONS AND CLINICAL IMPORTANCE

Wireless pH monitoring documented acidic GER in French bulldogs with SHH, captured subclinical events, and showed improvements after BOAS surgery.

The difference between two brachycephalic and one mesocephalic dog breeds' problem-solving performance suggests evidence for paedomorphism in behaviour

Despite serious health and longevity problems, small brachycephalic breeds are becoming increasingly popular among pet owners. Motivations for choosing short-nosed breeds have been extensively investigated in recent years; however, this issue has been addressed mainly by relying on owner reports, resulting in explanations of "cute looks", referring to the baby-schema phenomenon and "behaviour well suited for companionship". We aimed to compare the behaviour of two brachycephalic (English and French bulldogs) and one mesocephalic (Mudi) breed in a problem-solving context. The dogs were given the task of opening boxes containing food rewards. We investigated human-directed behaviour elements over success and latency (indicators of motivation and ability). We found that both English and French bulldogs were significantly less successful in solving the problem than mudis. Both brachycephalic breeds had longer opening latencies than the mesocephalic breed. Brachycephalic breeds oriented less at the problem box and more at humans present. In summary, the short-headed breeds were less successful but oriented much more toward humans than mesocephalic dogs. Owners might interpret these behaviours as "helplessness" and dependence. The results support the hypothesis that infant-like traits may be present not only in appearance but also in behaviour in brachycephalic breeds, eliciting caring behaviour in owners.

Influence of feline brachycephaly on respiratory, gastrointestinal, sleep, and activity abnormalities

OBJECTIVE

To determine the influence of brachycephaly on respiratory, gastrointestinal, sleep, and activity-related parameters in cats.

STUDY DESIGN

Prospective questionnaire-based study.

ANIMALS

A total of 194 BC and 1003 non-BC cats.

METHODS

Owners completed an online questionnaire regarding respiratory, gastrointestinal, sleep, and activity-related parameters. Response options were scored, and individual scores summed to give a total clinical severity score for each cat.

RESULTS

Brachycephalic cats had more frequent snoring (odds ratio [OR] 6.89; 95% confidence interval [CI]: 5.06-9.41), sneezing (OR 6.52; CI: 4.75-8.98), nasal discharge (OR 8.26; 95% CI 5.77-11.85), coughing (OR 1.75; CI: 1.17-2.59), and dyspnea (OR 5.32; CI: 3.42-8.28); shorter activity before becoming dyspneic (OR 2.71; CI: 1.93-3.79), slower recovery from activity (OR 3.17; CI: 2.19-4.57), lower activity levels (OR 2.16; CI: 1.59-2.95), and increased respiratory noise (OR 6.68; CI: 4.71-9.52); and more hypersalivation (OR 2.50; CI: 1.47-4.16), halitosis (OR 1.40; CI: 1.00-1.95), and difficulty chewing (OR 5.19; CI: 3.65-7.38). Median clinical severity scores were higher for BC cats than non-BC cats (p < .0001).

CONCLUSIONS

Brachycephalic cats (BC) were at risk for respiratory, gastrointestinal, and activity-related symptoms compared to non-BC cats.

CLINICAL RELEVANCE

Some BC cats exhibit clinically relevant symptoms and behaviors as reported by owners. Medical or surgical interventions may improve these symptoms and warrant investigation.

Ala vestibuloplasty improves cardiopulmonary and activity-related parameters in brachycephalic cats

OBJECTIVE

To evaluate the effects of ala vestibuloplasty on cardiopulmonary and lifestyle-related parameters in brachycephalic (BC) cats.

STUDY DESIGN

Prospective cohort.

ANIMALS

Client-owned BC cats (n = 19).

METHODS

Cats were assessed preoperatively by airway computed tomography (CT), endoscopy, contrast echocardiography, cardiac biomarkers, and structured owner questionnaire. Ala vestibuloplasty was performed bilaterally, and blood values, imaging, and owner questionnaire responses were re-evaluated 8-20 weeks postoperatively.

RESULTS

Cats were presented for predominantly respiratory clinical signs attributable to brachycephaly. Preoperatively, all cats had stenotic nares, prolonged normalized pulmonary transit time (nPTT) (mean 5.43 ± 1.10 s), and a hyperattenuating pulmonary pattern. No complications occurred following surgery. Postoperatively, nPTT (mean 3.89 ± 0.74 s, p < .001) and frequencies of sneezing (p = .002), snoring (p = .006), open-mouth breathing (p = .0004), and nasal discharge (p = .019) were decreased. Cats exhibited increased activity (p = .005), less frequent dyspnea during activity (p < .001), longer duration of activity before becoming dyspneic (p = .002), faster recovery from activity (p < .001), and decreased respiratory noise (p < .001). Median questionnaire scores improved from preoperative to postoperative (p < .001).

CONCLUSION

Anatomic, echocardiographic, and CT changes were common in this cohort of clinically affected BC cats. Pulmonary blood flow and respiratory function were improved after surgery.

CLINICAL SIGNIFICANCE

Stenotic nares are the predominant airway abnormality in BC cats. Ala vestibuloplasty is a safe procedure that improves cardiac and CT abnormalities and respiratory and other clinical signs in BC cats.

Effect of conventional multilevel brachycephalic obstructive airway syndrome surgery on clinical and videofluoroscopic evidence of hiatal herniation and gastroesophageal reflux in dogs

OBJECTIVE

To evaluate the effect of conventional multilevel surgery (CMS) for brachycephalic obstructive airway syndrome (BOAS) on associated sliding hiatal hernia (SHH) and/or gastroesophageal reflux (GER).

STUDY DESIGN

Prospective clinical trial.

ANIMALS

Sixteen client-owned dogs with clinical signs consistent with BOAS and associated SHH and GER.

METHODS

All dogs were treated with 1 or more components of CMS including soft palate resection, laryngeal ventriculectomy, and alaplasty. A standardized Dog Swallowing Assessment Tool (Dog SAT) questionnaire was completed by owners preoperatively and postoperatively. Videofluoroscopic swallow studies (VFSS) were used to evaluate esophageal motility, gastroesophageal reflux, and hiatal herniation preoperatively, and in a subset of dogs postoperatively. Upper gastrointestinal endoscopic studies were performed to document esophagitis and lower esophageal sphincter pathology.

RESULTS

All dogs were discharged from the hospital. One dog experienced aspiration pneumonia immediately postoperatively. Owner-assigned clinical scores improved in scores related to regurgitation after eating and regurgitation (P = .012) during increased activity/exercise (P = .002) between preoperative and postoperative time points. However, no improvement was detected in masked assessment of preoperative and postoperative VFSS studies in terms of GER frequency (P = .46) or severity (P = .79), SHH frequency (P = .082) or severity (P = .34) scores.

CONCLUSION

Owners of dogs treated with CMS perceived an improvement in clinical signs of SHH and GER that was not confirmed by VFSS studies.

CLINICAL SIGNIFICANCE

Conventional multilevel surgery in dogs with BOAS does not appear to consistently resolve SHH and GER, although clinical signs may improve.

Evaluation of aerodigestive disease and diagnosis of sliding hiatal hernia in brachycephalic and nonbrachycephalic dogs

Background

Aerodigestive diseases (AeroD), hybrid disorders between the respiratory and gastrointestinal (GI) tracts, may present without GI signs. Sliding hiatal hernia (sHH) is an important AeroD in brachycephalic dogs linked to respiratory pathology. The spectrum of other AeroD and respiratory clinical signs (CS) in brachycephalic and nonbrachycephalic dogs with sHH is unknown.

Objectives

Characterize CS of AeroD in dogs with sHH, compare CS between brachycephalic and nonbrachycephalic dogs, and compare thoracic radiographs and videofluoroscopic swallow study (VFSS) for diagnosing sHH.

Animals

Sixty‐seven client‐owned dogs with sHH.

Methods

Medical records of dogs with sHH presented to the veterinary teaching hospitals at Auburn University and the University of Missouri between 1 January 2009 and 31 December 2020 were retrospectively reviewed. Between group, comparisons were made using Mann‐Whitney test, Chi‐square analysis, and Spearman correlation (P < .05).

Results

Dogs with sHH presented with exclusively GI signs (28/67), mixed respiratory and GI signs (22/67), or with exclusively respiratory signs (17/67). Wheras brachycephalic dogs were not significantly more likely to present with respiratory CS (P = .145), they were younger (P < .001), and more likely to present in respiratory distress (P = .02), and with radiographic evidence of aspiration pneumonia (P < .001) compared to nonbrachycephalic dogs. Six of 12 dogs with normal thoracic radiographs having sHH presented with respiratory CS. For detection of sHH, VFSS was superior to radiographs (P < .001).

Conclusions and Clinical Importance

Dogs with sHH may present with exclusively respiratory signs. Respiratory signs may be more severe in brachycephalic compared to nonbrachycephalic dogs. Videofluoroscopic swallow study was superior to thoracic radiographs for detection of sHH in dogs.

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.

Variations in facial conformation are associated with differences in nasal microbiota in healthy dogs

BACKGROUND

Extrinsic and intrinsic factors have been shown to influence nasal microbiota (NM) in humans. Very few studies investigated the association between nasal microbiota and factors such as facial/body conformation, age, and environment in dogs. The objectives are to investigate variations in NM in healthy dogs with different facial and body conformations. A total of 46 dogs of different age, living environment and from 3 different breed groups were recruited: 22 meso-/dolichocephalic medium to large breed dogs, 12 brachycephalic dogs and 12 terrier breeds. The nasal bacterial microbiota was assessed through sequencing of 16S rRNA gene (V1-V3 regions) amplicons.

RESULTS

We showed major differences in the NM composition together with increased richness and α-diversity in brachycephalic dogs, compared to meso-/dolichocephalic medium to large dogs and dogs from terrier breeds.

CONCLUSION

Healthy brachycephalic breeds and their unique facial conformation is associated with a distinct NM profile. Description of the NM in healthy dogs serves as a foundation for future researches assessing the changes associated with disease and the modulation of NM communities as a potential treatment.

Digestive Diseases in Brachycephalic Dogs

In addition to presenting with respiratory signs, many dogs with brachycephalic airway obstructive syndrome show digestive tract signs related to the same conformational abnormalities. A detailed diagnostic investigation is usually required, including clinicopathologic analyses, thoracic radiographs, fluoroscopic studies, abdominal ultrasound examinations and both upper airway and gastrointestinal tract endoscopy. In most cases, medical therapies are successful in managing clinical signs, but surgery can occasionally be required to resolve hiatal hernia or pyloric stenosis. In determining prognosis, the features of each individual case should be considered, with the overall prognosis depending on the severity and extent of all the identified lesions.

Esophagitis in Cats and Dogs

Esophagitis in cats and dogs is a consequence of increased exposure of the esophageal mucosa to gastroduodenal reflux. Causes can include anesthesia-related reflux, frequent vomiting, or lodged foreign bodies. An exception is eosinophilic esophagitis, an emerging primary inflammatory disease of the esophagus with a presumed allergic etiology. Reflux esophagitis owing to lower esophageal sphincter incompetence is often suspected; a tentative diagnosis can be made by endoscopic assessment, wireless esophageal pH-monitoring, or histologic examination. Because it can be difficult to distinguish diet-responsive upper gastrointestinal disease from esophagitis, response to treatment with gastric acid suppressants is needed to confirm the tentative diagnosis.

Diagnosis and treatment of gastro-oesophageal junction abnormalities in dogs with brachycephalic syndrome

OBJECTIVES

To determine whether there is a benefit of using pre- and postoperative antacid treatment in dogs undergoing surgery for brachycephalic syndrome. To assess the use of an obstruction manoeuvre during endoscopy for the detection of dynamic gastro-oesophageal junction abnormalities.

MATERIALS AND METHODS

Thirty-six client-owned brachycephalic dogs were prospectively included in a randomised trial. Antacid treatment was randomly prescribed in 18 dogs before and after surgery while the other 18 dogs did not receive any gastrointestinal medical treatment. At presentation, at the time of surgery and at recheck, digestive clinical signs and gastro-oesophageal junction abnormalities were assessed using specific scores. Gastro-oesophageal junction abnormalities were assessed during endoscopy in standard conditions as well as during endotracheal tube obstruction. This manoeuvre was also applied in an unrelated control group.

RESULTS

The results suggest a beneficial effect of antacid treatment on the improvement of digestive clinical signs and lesions in dogs with brachycephalic syndrome undergoing surgery. At postsurgical control 83% of dogs had a digestive clinical score ≤1 in the treated group in contrast to 44% in the non-treated group and 39% of dogs had a gastro-oesophageal abnormalities score (during obstruction manoeuvre) ≤1 in the treated group in contrast to 16.7% in the non-treated group. The use of the obstruction manoeuvre during endoscopic assessment in a control group revealed that gastro-oesophageal junction movements are negligible in healthy animals.

CLINICAL SIGNIFICANCE

The addition of antacid treatment during the pre- and postoperative period for brachycephalic dogs undergoing surgery may result in a faster and greater improvement in treated dogs. The obstruction manoeuvre is an interesting technique to improve detection of gastro-oesophageal junction abnormalities.

Laparoscopic correction of sliding hiatal hernia in eight dogs: Description of technique, complications, and short-term outcome

OBJECTIVE

To describe a novel laparoscopic technique to treat sliding hiatal hernia in dogs.

STUDY DESIGN

Retrospective case series.

ANIMALS

Eight dogs with sliding hiatal hernia treated with laparoscopy.

METHODS

Surgery reports were reviewed for technique description and animal outcomes.

RESULTS

Six dogs were brachycephalic. Dogs were placed in right lateral oblique recumbency. Four dogs were placed in a reverse Trendelenburg position to visualize the esophageal hiatus. A single port was placed 2 cm caudal to the last rib on the left side. An extra cannula was added in four dogs. A large-bore orogastric tube was introduced in five dogs and used in four dogs to reduce the hernia. A unidirectional nonabsorbable barbed suture was used for the closure of the esophageal hiatus and the esophagopexy. A left-sided gastropexy was performed for all the cases. The gastropexy was performed with a gastrostomy tube to bypass the esophagus in four dogs. Intraoperative complications included pneumothorax in three dogs. Conversion was elective in three cases and emergent in one case. Clinical signs were recorded as improved in each dog. The median follow-up time was 16.5 days (range, 9-264).

CONCLUSION

Hiatal hernia repair was performed laparoscopically in this population. Repair included a combination of esophageal plication, esophagopexy, and left-sided gastropexy. Reverse Trendelenburg animal positioning and orogastric tube placement facilitated the reduction of the hernia.

CLINICAL SIGNIFICANCE

Laparoscopy is an option for the treatment of sliding hiatal hernia in dogs.

Aerodigestive Disease in Dogs

Aerodigestive disorders (AeroDs) in people encompass a wide range of clinical syndromes, reflecting the complex relationship between the respiratory and digestive tracts. In veterinary medicine, aspiration is used interchangeably with aspiration pneumonia. Although aspiration pneumonia is a common disorder in dogs, it does not reflect the breadth of AeroDs. Unfortunately, AeroDs rarely are investigated in veterinary medicine because of lack of clinical recognition, limitations in available diagnostics, and the fact that AeroDs may be caused by occult digestive disease. Recognizing patients with AerodD represents an area of significant clinical importance that may provide additional areas of clinical intervention.

Computed tomographic comparison of esophageal hiatal size in brachycephalic and non-brachycephalic breed dogs

OBJECTIVE

To determine whether an anatomical difference in esophageal hiatus (EH) size exists between brachycephalic and nonbrachycephalic dogs.

STUDY DESIGN

Retrospective clinical study.

ANIMALS

Client-owned dogs (n = 87).

METHODS

Clinical records and images of dogs that underwent computed tomography between June 2015 and September 2018 were reviewed. For the first part of the study, EH and aortic (Ao) cross-sectional surface areas were measured in brachycephalic (group 1) and nonbrachycephalic dogs of similar body size (<15 kg) without respiratory or gastroesophageal (GE) signs (group 2) by using multiplanar reconstruction. Esophageal hiatus:aortic ratio was calculated. In the second part of the study, absolute EH measurements were also compared in weight-matched (WM) dogs (8-10 kg) from groups 1 and 2.

RESULTS

Mean (±SD) of EH:Ao values for group 1 (8.1 ± 2.8) were higher (P < .0001) than those for group 2 (3.7 ± 1.1). In addition, EH measurements of 20 WM dogs in group 1 were higher than those of 20 dogs in group 2 (P < .05).

CONCLUSION

Esophageal hiatus cross-sectional surface area (directly and indirectly measured) in brachycephalic dogs was considerably larger than that in nonbrachycephalic dogs of generally similar body size.

CLINICAL SIGNIFICANCE

Results of this study provide evidence to support the existence of a specific anatomical factor that could likely correlate to functional GE alterations (eg, regurgitation, gastroesophageal reflux, and sliding hiatal hernia) commonly seen in brachycephalic dogs.

Characteristics and long-term outcomes of dogs with gastroesophageal intussusception

OBJECTIVE

To determine long-term outcomes and factors associated with those outcomes in dogs with gastroesophageal intussusception (GEI).

ANIMALS

36 dogs with GEI evaluated at 16 veterinary hospitals from January 2000 through January 2018.

PROCEDURES

Medical records of included dogs were reviewed to collect information regarding signalment, clinical signs, physical examination findings, blood work and diagnostic imaging results, surgical findings, and outcome. Factors were evaluated for associations with various outcomes.

RESULTS

Median age of dogs with GEI was 13.2 months, and males (72% [26/36]) and German Shepherd Dogs (33% [12/36]) were most common. Vomiting (67% [24/36]) and regurgitation (33% [12/36]) were the most common clinical signs. Ten of 36 (28%) dogs were euthanized without treatment, and 26 (72%) underwent treatment (25 surgically and 1 endoscopically). Twenty-three of the 26 (88%) treated dogs survived to discharge; median survival time was 995 days. At last follow-up, 15 of the 23 (65%) surviving dogs remained alive and 8 (35%) had died for reasons related to persistent regurgitation (n = 6) or reasons unrelated to GEI (2). Of the 10 dogs for which owners were contacted, 7 had persistent regurgitation, the severity of which was reduced through managed feedings. Dogs with acute (≤ 7 days) clinical signs or a previous diagnosis of megaesophagus were more likely to have persistent regurgitation than were dogs without these factors.

CONCLUSIONS AND CLINICAL RELEVANCE

Treatment should be considered for dogs with GEI given the high rate of survival to discharge and median survival time. Although persistent regurgitation was common after treatment, a satisfactory outcome was possible with medical management, including managed feedings and medications.

Comparison of clinical, endoscopic, and histologic features between dogs with chronic gastritis with and without lymphofollicular hyperplasia

OBJECTIVE

To compare clinical, endoscopic, and histopathologic features between dogs with chronic gastritis (CG) with and without lymphofollicular hyperplasia (LFH).

ANIMALS

64 and 56 dogs with CG with (cases) and without (controls) LFH, respectively.

PROCEDURES

The medical record database of a referral clinic was searched to identify dogs that underwent endoscopic examination of the upper portion of the gastrointestinal tract and were subsequently determined to have CG with or without LFH between October 2006 and February 2011. Signalment and clinical, endoscopic, and histologic findings were compared between cases and controls. Logistic regression was used to identify factors associated with CG with LFH.

RESULTS

Compared with controls, cases were significantly younger and more likely to be of a brachycephalic phenotype. The proportions of dogs with a poor body condition or diarrhea were significantly lower and the proportions of dogs with inspiratory dyspnea, exercise intolerance, or hyperemia and discoloration of the gastric mucosa were significantly higher for the case group, compared with the control group. Inspiratory dyspnea, gastric mucosal hyperemia, and gastritis severity were positively associated, whereas poor body condition was negatively associated, with CG with LFH on multivariable logistic regression.

CONCLUSIONS AND CLINICAL RELEVANCE

The strong positive association between inspiratory dyspnea and CG with LFH suggested that the condition may be a consequence of an increase in negative intrathoracic pressure rather than a distinct clinical entity. Prospective studies are warranted to elucidate the mechanism by which inspiratory dyspnea contributes to the development of CG with LFH.

Evaluation of metabolic profile and C-reactive protein concentrations in brachycephalic dogs with upper airway obstructive syndrome

Background

Brachycephalic dogs have abnormal breathing patterns similar to those in humans with obstructive sleep apnea syndrome. Obstructive sleep apnea syndrome is associated with dyslipidemia, hyperglycemia, and insulin resistance. Despite the fact that anatomic and functional alterations are well described in brachycephalic dogs, little is known about the consequences of upper airway obstruction on systemic inflammatory response and metabolic profile.

Objectives

To describe history, clinical presentation, and anatomic abnormalities; to evaluate systemic inflammatory response and metabolic profile; and to identify possible associations among clinical signs, anatomic abnormalities, inflammatory response, and metabolic profile in brachycephalic dogs with airway obstruction.

Animals

Thirty purebred brachycephalic dogs with brachycephalic airway obstructive syndrome (BAOS).

Methods

Prospective study. The following information was recorded and studied: respiratory and digestive signs, airway and digestive endoscopic anomalies, presence or absence of tracheal hypoplasia, histologic evaluation of gastrointestinal tract biopsy specimens, serum concentrations of C‐reactive protein (CRP), fructosamine, insulin, glucose, triglyceride, cholesterol, and plasma concentrations of lipoprotein classes.

Results

A high proportion of dogs (76.7%) had gastrointestinal signs. Esophageal deviation, atony of the cardia of the stomach, and distal esophagitis were the most common endoscopic anomalies detected. Twenty‐six (86.6%) dogs had different degrees of laryngeal collapse. Gastrointestinal histologic evaluation identified mostly chronic inflammation. Glucose, fructosamine, triglycerides, cholesterol, CRP, pre‐beta, beta lipoproteins, and chylomicrons were increased to a variable extent. Significant associations among clinical signs, anatomic abnormalities, CRP, and metabolic profile were not found.

Conclusion and Clinical Importance

Despite the presence of inflammation and some mild metabolic derangements, the clinicopathological variables evaluated did not offer valuable information in dogs with BAOS.

Retrospective analysis of esophageal imaging features in brachycephalic versus non-brachycephalic dogs based on videofluoroscopic swallowing studies

Background

Idiopathic esophageal dysmotility (ED) is increasingly recognized in young dogs of brachycephalic breeds. Few studies have objectively associated specific videofluoroscopic swallowing study (VFSS) features with brachycephaly, leading to under‐recognition of ED in brachycephalic breeds.

Hypothesis/objectives

To describe and compare VFSS in brachycephalic dogs versus non‐brachycephalic dogs presented for dysphagia or regurgitation, and to investigate associations between these imaging findings and patient signalment.

Methods

Retrospective analysis of VFSS of dogs presented for dysphagia or regurgitation (not megaesophagus) from 2006 to 2017. Cases were divided into brachycephalic and mesaticephalic breeds. The VFSS were reviewed using a standardized protocol by 2 examiners. Esophageal motility was assessed using specific criteria, and particular imaging features were noted and graded. Fisher's exact test was used to determine associations among signalment (including brachycephaly), final diagnosis, outcomes, and ED features.

Results

Thirty‐six dogs were included (n = 10 normal, n = 26 presumed ED). Twenty dogs (77%) with presumed ED were brachycephalic with a median age of 1 year (range, 0.2‐10.5 years). Most common were prolonged esophageal transit time (ETT; n = 21/26), decreased propagation of secondary peristaltic waves (n = 20/26), and gastroesophageal reflux (GER; n = 18/28). Eight dogs (all brachycephalic) had hiatal herniation (HH). Morphological esophageal variations were only observed in brachycephalic dogs. Brachycephaly was significantly associated with ED (P = .005), prolonged ETT (P = .41), GER (P = .02), and HH (P = .03).

Conclusions and Clinical Importance

The majority of dogs with presumed ED was young and brachycephalic and had specific abnormalities that were less frequent in mesaticephalic dogs with regurgitation or dysphagia.

Consequences and Management of Canine Brachycephaly in Veterinary Practice: Perspectives from Australian Veterinarians and Veterinary Specialists

This article, written by veterinarians whose caseloads include brachycephalic dogs, argues that there is now widespread evidence documenting a link between extreme brachycephalic phenotypes and chronic disease, which compromises canine welfare. This paper is divided into nine sections exploring the breadth of the impact of brachycephaly on the incidence of disease, as indicated by pet insurance claims data from an Australian pet insurance provider, the stabilization of respiratory distress associated with brachycephalic obstructive airway syndrome (BOAS), challenges associated with sedation and the anaesthesia of patients with BOAS; effects of brachycephaly on the brain and associated neurological conditions, dermatological conditions associated with brachycephalic breeds, and other conditions, including ophthalmic and orthopedic conditions, and behavioural consequences of brachycephaly. In the light of this information, we discuss the ethical challenges that are associated with brachycephalic breeds, and the role of the veterinarian. In summary, dogs with BOAS do not enjoy freedom from discomfort, nor freedom from pain, injury, and disease, and they do not enjoy the freedom to express normal behaviour. According to both deontological and utilitarian ethical frameworks, the breeding of dogs with BOAS cannot be justified, and further, cannot be recommended, and indeed, should be discouraged by veterinarians.