Page 681 - Cote clinical veterinary advisor dogs and cats 4th

312 Esophagitis

PEARLS & CONSIDERATIONS • Prevent animals from eating bones, rocks, Client Education
fish hooks, and other foreign objects. • It is important to give water after administra-
Comments
VetBooks.ir Esophageal strictures should be referred as soon inhibitor and a gastric prokinetic before • If any evidence of esophageal dysfunction
• Routine administration of a proton pump
tion of oral medications.
anesthetic procedures is controversial but
or dysphagia is noted after an anesthetic
as possible to specialists who have extensive
procedure, notify the veterinarian at once.
experience with them. Do not attempt to dilate
associated gastroesophageal reflux. If
a stricture unless one has the equipment and may lessen the frequency of anesthesia- • Long-term management of patients with
substantial experience. perianesthesia gastroesophageal reflux is partially resolved strictures requires strict,
suspected, the esophagus should immedi- lifelong dietary management.
Prevention ately be washed out with water and antacid
• Animals should be fasted before general therapy begun. SUGGESTED READING
anesthesia to reduce risk of reflux. Bissett SA, et al: Risk factors and outcome of
• Position anesthetized patients to reduce Technician Tips bougienage for treatment of benign esophageal
risk of gastroesophageal reflux and inflate • Watch closely for any evidence of anesthesia- strictures in dogs and cats: 28 cases (1995-2004).
endotracheal tube cuff appropriately. associated reflux. J Am Vet Med Assoc 235:844-850, 2009.
• Patients should receive food or water after • Always give cats fluid or food after admin- AUTHOR: Michael D. Willard, DVM, MS, DACVIM
administration of oral medications to prevent istering pills. EDITOR: Rance K. Sellon, DVM, PhD, DACVIM
capsules or tablets from lodging in the
esophagus (especially cats).

Esophagitis Bonus Material Client Education
Online
Sheet

BASIC INFORMATION Clinical Presentation or alkaline fluid or with caustic agents (e.g.,
detergents, alkalis, acids) causes mucosal
Definition HISTORY, CHIEF COMPLAINT damage and inflammation sometimes extend-
Acute or chronic inflammation of the esopha- • Mild esophagitis may be subclinical. ing to the deeper layers of the esophagus.
gus, classically secondary to gastric acid (often • Clinical signs may include • Volume, frequency, and duration of contact
due to reflux or persistent vomiting), foreign ○ Increased swallowing motions, ptyalism of noxious material with the esophagus affect
bodies, or medications ○ Inappetence, hyporexia, and/or odynopha- the severity of esophageal damage.
gia (discomfort when swallowing) due to • Hypersensitivity might (?) predispose to
Synonyms pain eosinophilic esophagitis.
Gastroesophageal reflux, reflux esophagitis ○ Regurgitation (mild to severe) or vomiting
○ Reluctance to move or lie down
Epidemiology ○ Cats may vocalize after eating as an DIAGNOSIS
SPECIES, AGE, SEX indication of esophageal pain. Diagnostic Overview
Dogs and cats of any age and either sex • Affected patients may have a history that Diagnosis can be suspected based on a sug-
reveals risk factors (see Risk Factors above). gestive history (dysphagia after anesthesia or
GENETICS, BREED PREDISPOSITION protracted vomiting) or response to treatment,
Brachycephalic dogs may be prone to hiatal PHYSICAL EXAM FINDINGS but other diseases may respond to therapy for
hernia, which can cause reflux esophagitis. May be normal; abnormalities may include esophagitis. Esophagitis can be easily confirmed
• Thin body condition by direct endoscopic visualization. Biopsy is
RISK FACTORS • Dehydration
• General anesthesia, even of short duration • Ptyalism
○ Most commonly reported cause of reflux • Pharyngitis, stomatitis, and/or glossitis
esophagitis in the dog and cat • Cranial abdominal/thoracic discomfort
• Hiatal hernia or other causes of lower ○ Hunched-up appearance
esophageal sphincter (LES) dysfunction ○ Guarding or pain on palpation
• Esophageal foreign body
• Oral medications (e.g., tetracyclines, cipro- Etiology and Pathophysiology
floxacin, nonsteroidal antiinflammatory drugs Etiology:
[NSAIDs]) given without being followed by • Premedications (atropine, benzodiazepines,
food or water administration phenothiazines, opioids) and anesthetic
• Persistent vomiting induction agents may decrease LES tone,
• Gastric hyperacidity (e.g., gastrinoma) allowing gastroesophageal reflux.
• Pythium insidiosum infection • Anatomic abnormalities (e.g., hiatal hernia)
• Large cranial abdominal masses (e.g., primary can increase risk of reflux esophagitis.
hepatic tumors) that displace the stomach • Because of their pH or osmolarity, ingested
dorsally medications or chemicals can damage the
esophagus if retained in the esophagus for
ASSOCIATED DISORDERS long periods. ESOPHAGITIS Endoscopic view of a patient with
Benign esophageal strictures, especially sec- Pathophysiology: esophagitis. Note the longitudinal, darker, patchy areas
ondary to severe anesthesia-associated reflux • Esophageal mucosal contact with low-pH indicative of inflammation and mucosal erosion. Fluid
(p. 310) gastric fluid, pepsin, trypsin, bile salts, and/ pooling is apparent at the bottom of the image.

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