Page 624 - Problem-Based Feline Medicine

616 PART 9 CAT WITH SIGNS OF GASTROINTESTINAL TRACT DISEASE

most helpful in identification of esophageal stricture Prophylactic antibiotics that are effective against
formation. pathogens present in the oral mucosa are only indicated
(amoxicillin, clavamox, cephalexin, clindamycin) in
Definitive diagnosis of esophagitis, and any complica-
severe esophagitis cases where mucosal damage is so
tions associated with it, is achieved by endoscopic
severe that normal mucosal defenses are compromised.
examination of the esophagus and biopsy.
Reduction of gastric acidity with histamine-2 blockers
Note: a normal-appearing mucosa does not rule out
(famotidine 0.5–1.0 mg/kg PO q 24 h) or protein pump
esophagitis. However, in most cases, mucosal ery-
inhibitors (omeprazole 1 mg/kg PO q 24 h) is also indi-
thema, hemorrhage and increased friability are
cated, especially if gastroesophageal reflux disease is
common findings.
suspected.
Differential diagnosis Mucosal cytoprotectants, such as sucralfate
(250–500 mg PO q 8–12 h made into a slurry) have also
Essentially any cause of regurgitation or chronic vom- been recommended to reduce further mucosal injury,
iting should be considered as a differential because the however their effectiveness is questioned.
signs are so non-specific and many overlap with other
Drugs that increase lower esophageal sphincter
diseases.
tone, metoclopramide (0.1–0.2 mg/kg PO q 12 h) and
cisapride (5 mg/kg PO q 12 h), are indicated when
Treatment acid reflux is suspected and may be required long-
term to prevent disease recurrence in cats with this
Treatment of esophagitis is first aimed at correcting
disease.
the underlying cause. If the cause cannot be identified
and corrected, management of the esophagitis will be In all cases, the treatment should be continued for at
extremely difficult. least 2–3 weeks beyond the resolution of clinical
signs to prevent recurrence and allow complete healing
Symptomatic therapy then is used to control the
of the tissue.
inflammatory process that is ongoing in the
esophageal mucosa. This type of approach will require
both “resting” the esophagus and pharmacologic Prognosis
therapy.
The prognosis is good in cats with mild esophagitis or
In cats with mild esophagitis, simply withdrawing when severe esophagitis is managed aggressively and
food for 24–48 hours is often sufficient to allow does not result in stricture formation.
mucosal healing. Upon re-feeding, the diet should be a
In cases of esophagitis that develop strictures, the
soft, low-fat, non-abrasive food that will not re-injure
prognosis is guarded to fair. See section on stricture
the tissue.
management for details.
When severe esophagitis is present, feeding should be
administered via alternative feeding methods.
ESOPHAGEAL FOREIGN BODY**
Provide enteral nutrition via a gastrostomy or
jejunostomy tube (pharyngostomy or nasogastric Classical signs
tubes will continue to irritate the esophagus and may
● Acute onset of regurgitation is the most
allow continued gastroesophageal reflux) or use total
common sign.
parenteral nutrition if the cat is also vomiting.
● Gagging or retching are also observed,
Corticosteroids (0.5–1.0 mg/kg PO q 12 h) are indi- especially when the object is in the cranial
cated if stricture formation is expected to occur, but esophagus.
will not help in cases where a stricture has already ● Rarely, acute respiratory distress may also
occurred and may reduce healing in severe cases, so occur.
must be used with caution.