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Esophagitis 313

○ Flexible endoscopic biopsy of canine Recommended Monitoring
esophageal mucosa is extremely difficult • Normal eating without dysphagia, ptyalism,
VetBooks.ir organisms such as yeast (Candida) or • Inappetence, dysphagia, ptyalism, or Diseases and Disorders
or regurgitation usually implies resolution.
in most animals but occasionally reveals
regurgitation necessitates re-examination
eosinophilic infiltrate.
○ Biopsy may be important in cats with
for stricture or persistent inflammation.
chronic inflammation at the LES, which • Strictures may cause regurgitation beginning
may not be grossly obvious. days to 4 weeks after injury.
• Fluoroscopy often needed to detect LES
dysfunction not due to hiatal hernia PROGNOSIS & OUTCOME
TREATMENT • If inflammation is not severe, is recognized
early and treated appropriately, and the
Treatment Overview inciting cause can be controlled, prognosis
Goals of therapy are to protect the esophageal is usually good.
mucosa from further damage, decrease the • Prognosis is guarded if the cause cannot be
amount and frequency of reflux, and eliminate resolved, esophagitis is severe, or patient
ESOPHAGITIS Endoscopic view of a patient with acid from reflux. develops severe esophageal strictures.
ulcerative esophagitis demonstrating multifocal areas
of hemorrhage and hyperemia. Ulcers are apparent Acute General Treatment
as deep depressions in the esophageal wall on the PEARLS & CONSIDERATIONS
left edge of the image (arrows) and at the 1-o’clock • Lessen or eliminate gastric acid secretion.
position (single arrow). Mucosal hemorrhages are ○ Currently available H2-receptor antago- Comments
also evident as darker, thin, circumferential streaks nists are ineffective and not recommended. • Prevent prolonged contact of medication
and pinpoint lesions on or near the gastroesophageal ○ Proton pump inhibitors (e.g., omeprazole with esophageal mucosa by administering
sphincter. Bleeding and/or hyperemia is not due to 1-2 mg/kg PO q 12h): most effective water (e.g., 5-10 mL by syringe) after any
endoscopy in normal dogs because the stratified class of drugs; requires 2-5 days to reach tablet or capsule given without food.
squamous epithelium of the esophageal mucosa is maximal efficacy, but immediate effects • Consider reflux esophagitis in patients
relatively tough. are superior to H2-receptor antagonists showing ptyalism, inappetence, or regurgita-
• Minimize reflux by increasing LES tone and tion shortly after anesthesia.
keeping stomach empty.
necessary to diagnose eosinophilic esophagitis • Prokinetic drugs (metoclopramide Prevention
(rare). 0.2-0.5 mg/kg PO or SQ q 8h; cisapride • Fast animals before general anesthesia.
0.1-0.25 mg/kg PO q 8-12h; erythromycin • Routine preanesthetic use of proton pump
Differential Diagnosis 0.5-1.0 mg/kg PO or IV q 8h; ranitidine inhibitors and prokinetic drugs will probably
• Esophageal foreign body: odynophagia (pain 2.2-4.4 mg/kg PO or IV q 8-12h). decrease (not eliminate) the incidence/severity
on swallowing) and/or regurgitation • Sucralfate suspension (0.25-1 g/PATIENT PO of anesthesia-associated gastroesophageal
• Megaesophagus: regurgitation q 8h) reflux.
• Vomiting ○ Especially helpful to reduce discomfort if • Esophageal lavage and suction is helpful in
• Neoplasia or mass lesions (esophageal intra or patient is painful patients that are known to have regurgitated
extralumenal; extraesophageal): regurgitation • A 4% viscous lidocaine or 2% lidocaine jelly during anesthesia.
• Vascular ring anomaly: regurgitation at 4-5 mL/kg PO q 6h for severe pain
• Hiatal hernia: regurgitation Technician Tips
• Gastroesophageal intussusception (rare) Chronic Treatment If a dog or cat shows any signs of dysphagia,
• Thermal esophageal damage (e.g., tube • Treat until esophagitis resolves. ptyalism, or regurgitation after anesthesia, notify
feeding with excessively hot liquids [rare]) • Indefinite prokinetic and antacid therapy may the clinician immediately.
be needed when chronic lower esophageal
Initial Database dysfunction does not resolve and is not Client Education
• CBC, serum biochemistry profile, urinalysis: amenable to surgical resolution. Administer water (e.g., 5-10 mL by syringe
results often normal trickled in the cheek pouch) after any tablet
• Survey thoracic radiographs are seldom Nutrition/Diet or capsule given without food.
diagnostic but might show esophageal • Feed a moderate- to high-protein, low-fat
dilation. diet, which increases lower esophageal tone SUGGESTED READING
• Contrast esophagram sometimes demon- and encourages gastric emptying. Zacuto AC, et al: The influence of esomeprazole
strates retention of barium on the esophageal • Rarely, need to place gastrostomy tube to and cisapride on gastroesophageal reflux during
mucosa, mucosal ulceration or hyperplasia, ensure nutrition and ability to medicate anesthesia in dogs. J Vet Intern Med 26:518-525,
or decreased esophageal motility. anorexic patients that regurgitate everything 2012.
given orally (p. 1109).
Advanced or Confirmatory Testing AUTHOR: Michael D. Willard, DVM, MS, DACVIM
EDITOR: Rance K. Sellon DVM, PhD, DACVIM
• Esophagoscopy (p. 1098) allows definitive Possible Complications
diagnosis, exclusion of other disorders, and Esophageal stricture formation
evaluation of extent and severity.

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