Overview

• Reflux of gastric or intestinal fluid into the esophageal lumen.
• Incidence unknown; probably more common than clinically recognized.
• Transient relaxation of the gastroesophageal sphincter or chronic vomiting may permit reflux of gastrointestinal juices into the esophageal lumen. Reflux is common in dogs with sliding hiatal hernias. A small amount of gastroesophageal reflux is a normal phenomenon in dogs and cats.
• Gastric acid, pepsin, trypsin, bicarbonate, and bile salts are all injurious to the esophageal mucosa with prolonged or repetitive contact.
• Esophagitis resulting from reflux may vary from mild inflammation of the superficial mucosa to severe ulceration involving the submucosa and muscularis.

Signalment

• Dog and cats; male or female.
• No breed predilections reported.
• May be associated with congenital hiatal hernia seen in Chinese Shar-Pei dogs and other brachycephalic breeds.
• Occurs at any age; younger animals may be at increased risk because of developmental immaturity of the gastroesophageal sphincter.
• Young animals with congenital hiatal hernia may also be at increased risk.

Signs

Causes & Risk Factors

• Anesthesia with relaxation of lower esophageal sphincter tone.
• Retained gastric contents.
• Foreign body ingestion with esophagitis.
• Pill ingestion in cats especially associated with tetracyclines.
• Acquired or congenital hiatal hernia.
• Chronic vomiting with secondary esophagitis.

Differential Diagnosis

• Oral or pharyngeal disease
• Ingestion of caustic agent
• Esophageal foreign body
• Esophageal tumor
• Megaesophagus-idiopathic; myasthenia gravis; vascular ring anomaly
• Hiatal hernia
• Gastroesophageal intussusception

CBC/Biochemistry/Urinalysis

Usually normal

Other Laboratory Tests

N/A

Imaging

• Survey thoracic radiography-usually unremarkable; may be air in the distal esophagus (nonspecific finding).
• Barium contrast radiography-reveals gastroesophageal reflux in some, but not all, animals; videofluoroscopy is superior to esophagram; aspiration pneumonia may be evident in the dependent portions of the lung.

Diagnostic Procedures

• Esophagoscopy-the best means of confirming reflux esophagitis-irregular mucosal surface with hyperemia or active bleeding in the distal esophagus. Refluxed gastroduodenal secretions may be seen pooling in the distal esophagus near the LES which may or may not be open.
• Radiography is of little value in confirming mucosal lesions of GER.

Drug(s)

• Oral sucralfate suspension (0.5–1 g PO q8h).
• Gastric acid antisecretory agents-H2 blockers: ranitidine (1–2 mg/kg PO q12h); famotidine (0.5-1 mg/kg PO, SC, IV q12–24h); proton pump inhibitors: omeprazole (0.7–1.5 mg/kg PO q24h); pantoprazole (1 mg/kg IV q24h).
• Prokinetic agents-cisapride (0.3–0.5 mg/kg PO q8–12h); ranitidine (1–2 mg/kg PO, IV, SC q8–12h); metoclopramide (0.5 mg/kg, PO, q6–8h or 1–2 mg/kg q24h as CRI).

Contraindications/Possible Interactions

Sucralfate suspension may interfere with the absorption of other drugs (e.g., cimetidine, ranitidine, omeprazole, cisapride).

Associated Conditions

• Hiatal hernia
• Administration of oral medications (pills) in cats and dogs

Age-Related Factors

May be worse in younger animals because of developmental immaturity of the gastroesophageal sphincter mechanism.

Zoonotic Potential

N/A

Pregnancy/Fertility/Breeding

N/A

Abbreviations

• GER = gastroesophageal reflux
• LES = lower esophageal sphincter

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