Page 627 - Problem-Based Feline Medicine

29 – THE CAT WITH SIGNS OF REGURGITATION 619

Treatment Clinical signs

Esophageal strictures can be corrected one of two ways: Early clinical signs include gastrointestinal tract signs
by balloon or bougie dilation or surgical removal. such as inappetance, salivation, vomiting and weight
loss.
Every effort to correct the problem by stretching the
strictured area with balloon catheterization or Other less common signs of lead toxicity include diar-
bougienage should be made, because of the difficulty rhea, and abnormalities of the hemogram are less com-
of the surgical procedure and the numerous complica- mon in cats than dogs (basophilic stippling, nucleated
tions associated with it. RBCs).

In most cases, multiple dilation procedures are In the late stages, other central nervous system signs
required to slowly stretch out the stricture site to an such as ataxia and seizures may occur.
approximately normal size.
Regurgitation secondary to megaesophagus is very
Balloon catheters dilate the stricture site with radial rare in cats.
forces and can be used endoscopically or fluoroscopi-
cally, thus providing better visualization of the site and
better control over the force exerted. Diagnosis
Serum blood lead levels are the definitive means of
Bougies dilate with longitudinal shearing and may
diagnosis of lead poisoning.
require multiple procedures. Bougies are associated
with a greater risk of tearing or perforation and thus The diagnosis is helped by a history of exposure to
balloon dilation is preferred. lead-containing paints usually associated with home
renovation or other objects such as batteries.
Corticosteroid therapy (1.0–2.0 mg/kg/day) to prevent
further fibrosis has been recommended but is controver- Signs of inappetence, weight loss and behavioral
sial and has not been proven effective in this regard. changes should prompt consideration of lead poisoning
as a differential.
In many cases of stricture, the inciting cause is long
resolved, but if esophagitis is ongoing due to gastric Hematologic findings are often absent.
reflux, this should be managed as well (see section
Survey radiographs in cats that have a history of regur-
under esophagitis).
gitation will reveal esophageal dilation or megaesoph-
Prognosis agus, and in long-standing cases, may reveal aspiration
pneumonia as well.
The prognosis is guarded for cats with esophageal stric-
tures. Many cats can be helped temporarily with dilation
procedures, but the stricture recurs or requires repeated ESOPHAGEAL NEOPLASIA* (SQUAMOUS
procedures to maintain an open esophageal passageway. CELL CARCINOMA, METASTATIC
NEOPLASIA)
LEAD POISONING*
Classical signs
Classical signs ● Regurgitation secondary to obstruction,
● Inappetance, weight loss. esophagitis or motility disturbances.
● Behavior changes (irritable, aggressive). ● Weight loss, inappetance and respiratory
● Regurgitation secondary to megaesophagus signs are also common.
is rare.
● Vomiting or diarrhea.
Clinical signs
● Seizures or other central nervous system
signs. Esophageal neoplasia creates an obstructive lesion that
is associated with regurgitation, especially after inges-
See main reference on page 596 for details. tion of food, and is typically seen in older cats.