Esophagitis

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Esophageal foreign body obstruction leading to esophagitis[1]
Esophageal scarring secondary to esophagitis in a dog[1]

Esophagitis refers to any inflammatory or infectious disease of the canine esophagus characterized by regurgitation.

An inflammatory reaction in the esophageal mucosa can be initiated by contact with allergenic foods, toxins and infectious agents as well as peristaltic interruption, interference and neuropathy. Regardless of cause, the inflammatory state results in mucosa edema, peristaltic dysfunction, dysphagia and pain.

Gastric acid (pH< 4.0) has been shown to play a crucial role in the development of esophagitis, but regurgitated bile could also be linked to various detrimental mucosal reactions[2].

Causes include:

Complications include esophageal stricture, megaesophagus, esophageal perforation, esophageal fistula formation and aspiration pneumonia[10].

Clinical signs in affected dogs include regurgitation, coughing, dysphagia and weight loss, often associated with recent general anesthesia[11].

Diagnosis usually requires clinical signs supported with evidence of inflammatory and delayed esophageal transit using barium-meal radiographs. Definitive diagnosis usually requires visual confirmation using endoscopy and forceps biopsy for histological analysis.

A differential diagnosis would include megaesophagus and Spirocerca lupi infection.

Treatment usually requires antiemetic drugs such as metoclopramide, antacids (e.g. sucralfate, omeprazole) and antimicrobial drugs.

In cases of esophageal foreign body obstruction, immediate surgical removal is imperative in order to minimize scarring of the esophageal mucosa and cicatrization, leading to long-term esophageal motility problems.

If esophageal stricture has occurred, esophageal bougienage is usually required to mechanically dilate the muscle.

The use of prednisolone is required in cases of eosinophilic[12], lymphocytic or plasmacytic enteritis at doses of 1 mg/kg orally every 12 hours.

A bland protein diet (e.g. chicken and rice) may also be required until inflammation has resolved.

A good outcome with esophagitis is defined as tolerance of solid food with regurgitation less than once a week. Complete resolution of symptoms may required 1 - 2 months, depending on severity[13].

References

  1. 1.0 1.1 4Shared
  2. Szentpali K et al (2001) Bile-induced adenosine-triphosphate depletion and mucosal damage during reflux esophagitis. Scand J Gastroenterol 36:459-466
  3. Milner RJ et al (2004) Bisphosphonates and cancer. J Vet Intern Med 18(5):597-604
  4. Hofmeister AS et al (2006) Toxicosis associated with ingestion of quick-dissolve granulated chlorine in a dog. J Am Vet Med Assoc 229(8):1266-1269
  5. Lux CN et al (2012) Gastroesophageal reflux and laryngeal dysfunction in a dog. J Am Vet Med Assoc 240(9):1100-1103
  6. Panti A et al (2009) The effect of omeprazole on oesophageal pH in dogs during anaesthesia. J Small Anim Pract 50(10):540-544
  7. Tanishima Y et al (2010) Effects of half-solid nutrients on gastroesophageal reflux in beagle dogs with or without cardioplasty and intrathoracic cardiopexy. J Surg Res 161(2):272-277
  8. Han E (2003) Diagnosis and management of reflux esophagitis. Clin Tech Small Anim Pract 18(4):231-238
  9. Mylonakis ME et al (2004) A comparison between ethanol-induced chemical ablation and ivermectin plus prednizolone in the treatment of symptomatic esophageal spirocercosis in the dog: a prospective study on 14 natural cases. Vet Parasitol 120(1-2):131-138
  10. Zacuto AC et al (2012) The influence of esomeprazole and cisapride on gastroesophageal reflux during anesthesia in dogs. J Vet Intern Med 26(3):518-525
  11. Wilson DV & Walshaw R (2004) Postanesthetic esophageal dysfunction in 13 dogs. J Am Anim Hosp Assoc 40(6):455-460
  12. Mazzei MJ et al (2009) Eosinophilic esophagitis in a dog. J Am Vet Med Assoc 235(1):61-65
  13. Bissett SA et al (2009) Risk factors and outcome of bougienage for treatment of benign esophageal strictures in dogs and cats: 28 cases (1995-2004). J Am Vet Med Assoc 235(7):844-850