By Dr. Becker
Esophagitis is the term used to describe inflammation of the esophagus, which is the muscular tube that transports swallowed food and liquid from the mouth to the stomach.
Young pets with congenital abnormalities of the esophagus are at increased risk for esophagitis. In older animals, receiving anesthesia during surgery often causes the condition.
One potential complication of esophagitis is aspiration pneumonia, which occurs when a dog or cat is unable to swallow food or liquid properly. Also called inhalation pneumonia, this is a very serious condition in which substances such as vomit, food, foreign bodies, or regurgitated gastric acid are aspirated (inhaled) into the lungs, causing them to become inflamed and infected.
Causes of Esophagitis
In dogs and cats, gastroesophageal reflux (acid reflux) is most often the cause of esophagitis. Reflux is a condition in which stomach acid is able to pass backwards into the esophagus and irritate the tissue lining.
Other causes of esophagitis include ingestion of caustic substances, including prescribed medications; excessive, repetitive vomiting of acidic stomach contents; infections; cancer; and trauma from foreign objects.
Caustic substances that can cause esophagitis include the antibiotics tetracycline and doxycycline monohydrate. The problem occurs when a pill or capsule gets stuck in the esophagus for a period of time, and is seen more often in cats than dogs.
Esophagitis can also occur when a kitty licks a caustic substance such as a household chemical disinfectant or cleaning product from her fur during grooming. Often these kitties also develop glossitis (inflammation of the tongue) or stomatitis (a painful inflammatory condition of the mouth) as well, which are red flags that the esophagus may also be inflamed.
Regarding anesthesia-related esophagitis, dvm360 magazine explains:
"Perhaps the most worrisome cause of esophagitis secondary to gastroesophageal reflux is anesthesia. Some patients anesthetized for even the most routine procedures, such as spaying or neutering, will unpredictably experience severe gastroesophageal reflux during anesthesia.
"The problem is clinically silent when it occurs, but these patients typically have a poor appetite or anorexia immediately after surgery and in the days after surgery.
"This subtle sign is a first ripple in what can figuratively become a tidal wave. When esophageal inflammation persists, severe stricture can result."1
Esophagitis can also result from passing a feeding tube through the esophagus after surgery.
Symptoms of Esophagitis
There are several signs your dog or cat may be suffering from esophagitis:
Regurgitation Reluctance to move or lie down Increased swallowing Loss of appetite Increased drooling or other secretions coming from the mouth Weight loss Difficulty swallowing Coughing Pain while swallowing Fever Crying out during or after swallowing Neck is painful to the touch Extending the head and neck while swallowing Symptoms of pneumonia
Unless a dog or cat has pneumonia in addition to esophagitis, routine laboratory tests (complete blood count, biochemistry profile, and urinalysis) often return normal results.
X-rays – especially barium contrast x-rays – and ultrasound imaging may be helpful, but changes caused by esophagitis are usually subtle and not easy to detect by these methods.
Endoscopy is considered the best method for diagnosing esophagitis. The procedure involves passing an endoscope into the esophagus to visualize areas of inflammation. While rare, the endoscope can also be used to obtain esophageal tissue samples for biopsy, or to remove a foreign body.
The lesions caused by esophagitis can range from mild to severe. If symptoms are mild, your vet may suggest you treat your pet symptomatically and see if symptoms resolve.
Esophagitis Treatment Options
Treatment of esophagitis depends on its cause and the symptoms the patient is experiencing. Pets with mild esophagitis can be treated at home, but patients with complications, for example, pneumonia, will need to be hospitalized.
Treatment will focus on protecting the esophageal lining, decreasing gastric acid production, and pain management. Pets who cannot or should not try to swallow food or water for a few days may need to receive IV fluids and nutrition.
If the cause of your pet's esophagitis is determined to be gastroesophageal reflux (GERD), I recommend feeding a bland, low-fat, and low-to-moderate-protein diet served in small frequent feedings, along with gastric acid inhibitors, medications to coat and soothe the esophageal lining, GI motility drugs, and appropriate medications if an infection is present.
If antibiotics are given, probiotics should also be given. If H. Pylori is found (the bacteria associated with stomach ulcers), many holistic vets, including myself, have found better success using berberines (Oregon grape root), bismuth, and DLR (deglycyrrhizinated licorice root). Herbal tinctures of aloe and chamomile extracts, slippery elm mucilages, sodium bicarbonate (baking soda), or TCM elixirs may be beneficial as well.
After the esophagus has healed, I recommend transitioning your pet to a low-residue, balanced, and home-prepared diet consisting of cooked bland veggies and meats. I have found that many pets with GERD have underlying food sensitivities. To treat the root cause in those cases, I recommend eliminating allergenic ingredients like gluten, rice, soy, and all genetically modified (GM) foods. Eliminating all preservatives, colorings, additives, and emulsifiers is also a great idea.
In conjunction with nutritional management and normalization of gastric acid secretion, I have had success using acupuncture, and especially chiropractic care to control reflux.
What If My Pet's Esophagus Is Narrowed?
Generally speaking, pets with esophagitis who are diagnosed and treated quickly and aggressively will have a successful outcome. Dogs and cats with advanced disease, especially to the point where the esophagus has formed a stricture (narrowing), have a poorer prognosis.
If as a result of esophagitis, your pet's esophagus has narrowed, it will be necessary to alleviate the situation using a procedure to dilate the affected area.
This is typically accomplished by stretching the stricture with a balloon catheter, which is a tube that is placed in the esophagus and then advanced to the point of narrowing. The tip of the catheter is then inflated like a balloon, which stretches the esophagus and relieves the stricture. The procedure should only be performed by a veterinarian trained in the technique.
Other methods for treating esophageal strictures, including surgery, are thought to be less successful than ballooning.
Ballooning can't return your pet's esophagus to a normal state, but it can make it functional again. Some patients only need the procedure done once or twice, while others need repeated dilations.