Megaesophagus in dogs | Dr. Justine Lee, DACVECC, DABT, Board-certified Veterinary Specialist
Was your dog just diagnosed with megaesophagus, a dilated flaccid esophagus which lacks muscular contraction? The esophagus, the tube that carries food and water from the mouth to the stomach, can become inappropriated dilated, causing food to be regurgitated (not vomited!) back up. With regurgitation, there is no “warning” or retching – food or liquid just “blurbs” back up suddenly. Unfortunately, megaesophagus can shorten the life-span of dogs, as it can cause secondary aspiration pneumonia chronically.
There are numerous published causes of megasophagus including:
- Hypoadrenocorticism (rare)
- Hypothyroidism (rare)
- Myasthenia gravis
- Polymyositis
- Lead poisoning
- Persistent right aortic arch (in puppies)
- Congenital causes
- Dysautonomia
- Vagal nerve dysfunction
- Systemic lupus erythematous
- Gastric dilatation and volvulus
- Thymoma
- Pyloric stenosis
- Tetanus
- Botulism
BTW, veterinary professionals, here’s a great article by DVM360 on this disease here. Pet owners, here’s a great article by board-certified veterinary internists at PetPlace.com here.
Well, there may finally be a some good news. In a recent press release by the Veterinary Health Center (VHC) at the University of Missouri’s College of Veterinary Medicine, they have a new approach to treating one type of canine megaesophagus. Check out the press release below on the use of botox to help treat this!
Photo credit: MU College of Veterinary Medicine
October 18, 2016
Press release
A partnership between the VHC’s Small Animal Internal Medicine, Radiology, Surgery, and Nutrition services and an investigator in the Otolaryngology-Head and Neck Surgery department at the university’s School of Medicine has resulted in the discovery of a breakthrough treatment for a subpopulation of dogs with megaesophagus. The Mizzou team has identified a defect of the lower esophageal sphincter (LES) as a potential treatable cause of megaesophagus. Megaesophagus (ME) refers to a large, dilated esophagus with poor or no motility preventing normal passage of food and liquid into the stomach. With ingesta not reaching the stomach to produce the sensation of being full, the dog will continue to eat. As a result, the esophagus enlarges greatly. Dogs end up not getting enough calories so they waste away. Dogs with ME also regurgitate large amounts of undigested food and some of that material can be inhaled into the lungs. This inhalation can result in aspiration pneumonia, a dangerous additional symptom that kills many affected animals.
“In general, dogs with megaesophagus typically die of malnutrition, aspiration pneumonia, or are euthanized because the owners are told they have a terrible prognosis,” according to Associate Professor Carol Reinero, DVM, PhD, an internal medicine specialist helping coordinate the efforts of the multidisciplinary team. “We’re taking a closer look at a subpopulation of dogs with idiopathic megaesophagus, which means we don’t know what causes it. We run all of our traditional tests, but we’ve never been able to find an underlying cause. Now with our video fluoroscopic swallow studies, we have identified an abnormality that we believe is driving the problem: an LES-achalasia-like syndrome.”
The LES acts as a valve between the esophagus and the stomach, opening when food and water are swallowed, then clamping tight so food doesn’t come back from the stomach into the esophagus. In dogs afflicted with megaesophagus caused by an achalasia-like syndrome, the LES remains closed. “Video fluoroscopic swallow studies have been around a long time,” Reinero said. “The problem with prior protocols is they did not represent normal eating and drinking behaviors. Those tests had very little to do with reality. A dog had to be restrained, lying on its side, and syringe-fed barium, which was not palatable even when mixed with food. If dogs don’t eat during the swallow study you’re not going to get a diagnostic study.” In order to receive a better diagnostic result, the Mizzou collaborative research team blended innovation with adaptation, developing new techniques and tools while borrowing procedures from human medical practices to diagnose and treat this type of canine ME.
Assistant Professor Teresa Lever, MS, PhD, from the Otolaryngology-Head and Neck Surgery department, spearheaded the development of trapezoidal holding chambers or kennels — which are now patented — where dogs walk in and are funneled to the narrow end of the enclosure. The animals are more naturally restrained and are given food that they consume while standing upright. Lever’s lab, in cooperation with an independent company that conducts feeding trials in dogs, also developed a number of different recipes and consistencies of food and liquid to optimize how well the dogs could take it down and discover which contrast agent was more palatable and effective.
“So, now we have these chambers, we have optimized palatable recipes, and we have experience in normal, healthy dogs without swallowing disorders, as well as lots and lots of patients coming in with other swallowing disorders,” Reinero said. “It was in the process of developing this protocol and having clinical patients come in when we recognized that LES-achalasia-like syndrome was the underlying cause of megaesophagus in some dogs. That’s when we began to adapt what they do with humans, a therapy where we’re opening or dilating the LES with Botox and/or balloon dilation.
“We perform an endoscopy to first dilate the LES and then administer Botox, which paralyzes the sphincter muscles that formerly wanted to remain closed. While we are still evaluating this procedure, we’ve had dogs with remarkable clinical improvement. Additionally, when we repeat the fluoroscopic studies, we can document an open LES. The patients that show improvement can be candidates for surgery, and that surgery is potentially curative,” Reinero said.
During a patient’s recovery, residents in the Nutrition Service monitor the dog’s weight and food intake. The amount of food an owner may give a pet might need to be altered every couple of days. James Schachtel, Bvet Med, MRCVS, is a Radiology resident and key collaborator in the study. “This approach gives these dogs a chance, whereas a lot of them didn’t have much of one,” Schachtel said. “At this time, it is early in the evaluation process, but it’s a novel approach that shows promise.
“This subpopulation can receive a really significant benefit from our direct ability to detect their malady. It can give them a really good quality of life. This is a revolutionary diagnostic technique for a disorder identified with a pathological outcome. It offers us the opportunity to use therapies that have been successful in people, so we’re optimistic we can experience similar success with canines,” Schachtel said. Schachtel will present an oral abstract of the swallowing protocol and early identification of the LES achalasia on Oct. 20 at the American College of Veterinary Radiation Annual Scientific Conference in Orlando.
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The Missouri team encourages veterinarians, pet owners and breeders to contact the VHC for information about the new diagnostic and treatment. To have a pet evaluated, contact the Small Animal Hospital at 573-882-7821.
I wish we were closer to you. We have an Olde English Sheepdog who is 6 1/2 now. He was just diagnosed a few months ago. This disease is so terrible (and expensive) and on a retired or low income makes it hard when you love your dog so much. I hope and pray a cure is found someday soon. Thank you for the research you are doing. 🙂
My jack Russell pokey was diagnosed as a pup.
He will be 14 tomorrow.
With feeding very small amount of pate’ at a time smeared flat on an elevated plate . And only biljac little jac soft treats..He still occasionally throws up….but I sit with him and make sure he doesn’t inhale it or try and re eat it..I know yuk
But carefully monitoring and with help of vets and dear friends at All Creatures Vet who give occasional meds if we think he has aspirated anything
He will be celebrating his 14th birthday tomorrow.
Megaespagus is NOT a death sentence.
He had an xray and ultrasound yesterday, he has a few issues, heart murmur and slight calcification on liver. Vet says for his age and with megaespagus he looks good.
O reading this makes me more confident that our dog will live a heathy life. He was just diagnosed with megaespagus today. I have done some research finding some scary stuff and some reassurance. If you have any suggestions for me please send them my way.
My dog suffered for four years before we figured out what he had. The bailey chair has saved his life! I highly reccomend feeding your pup in one. Also before bed we put a pillow (like the one people were on airplanes) on him to keep his head elevated. The improvements have been amazing!
How do you keep his head on the pillow? I have a two year old Goldendoodle which was diagnosed at six months. She has a problem at night because of the water she has drank after dinner. I do not put her in the Bailey chair when she drinks water and I believe this is the problem…..she is lying flat in her bed.
Go to Wag Tails and they make neck hugs for pets with Megaesophagus!
My Labrador was diagnosed with ME about one year ago. After trying many things at night to prevent him from regurgitating, I bought one of those blue donut round pillows (from Walmart – about $10.00) that you put around their neck usually for surgery healing etc. He sleeps with that on every night and that prevents him from laying flat with his head down. We’ve finally been able to get sleep now and not lose his food! Doesn’t look like it is the most comfortable but he has adjusted and has been able to put some weight back on. I also feed him at least four times a day, about every three hours,, along with water, in his Bailey chair and that has saved his life. This is a terrible disease for our little guys to have to go through!
My 4 month old husky mix puppy was jusy diagnosed with ME. I am just researching everything now and I have found mixed information regarding treatment. The one consistency has been the Baily chair. I am lookibg to try and order one, but why are they made to open from the front and not the back? Is it not more natural for the dog to walk in forward and stand up to the food? So I may make one myself. Next, my vet said to give him antacids but then I read where that is not a good idea because the natural acid in the stomach makes it kess likely for bacteria to grow leading to the pnuemonia. I also understand there are different kinds. I am assuming Kenai, my puppy has the kind he is born with since this is a problem he has had since we rescued him. Additionally I hear there are medications, surgeries, and other treatmennts and I am curious what the sucess rates are, where to find a doctor near me that specializes in this, and what other options we have.
It might be from a persistent right aortic arch and needs to be assessed ASAP if you want to consider surgery. SUrgery can be curative if it’s a PRRA, but NOT so if you wait.
Comment *Hello, my puppy was diagnosed with this disease when he turned 12 weeks old. He’s now only 14 weeks old and we are ordering him a bailey chair like suggested from our veterinarian. He does regurgitate often, especially right after eating and drinking, when he barks, gets too excited. Me and my fiance are trying to do everything we can to help him with it and to try and get him to slow down his eating as well as not get overly excited after eating or bark etc.. my fiance read something about a new surgery for this that we are more than interested in getting for him if it’s going to make his quality of life better and longer. We just want to help him. So could you maybe fill me in on your experiences with this in dogs you’ve taken care of. And also about the surgery that has came out now please. Thank you so much and I look forward to hearing from you soon.
This is all very new to us as our 3 year old Pit Bull was just diagnosed. The vet didn’t even come in to talk to me about the Barium xeay, results and what to do next. Instead he had a vet tech tell us the diagnosis of ME and that labs were taken and will be sent out to test for issues with her thyroid as a cause. I had to ask questions and she had to go in the back to ask and come back and give me an answer. When the lab results came back 2 days later, a tech sent an email saying the thyroid is fine and to Google the Bailey Chair for feeding. That’s all we have been told and we feel so defeated. I have been looking for a vet near us that specializes in ME and thus far no luck. This site and 2 others have been the most helpful and I just want to say thank you from the bottom of my heart.
Heyyy!!! Okay so Botox?! My dog is 6 and a half and his ME is congenital – we’ve got it dialed with his Bailey chair and we are managing it but, if there’s a way to stop him from puking I’m sooo in!! Any more information would be so helpful!!
Let me know if you find anything…Comment
My almost 2 yr old German Shepard was diagnosed in April and his last X-ray showed that it has gotten worse. The vet said it’s the worst case he’s ever seen. I have tried everything anyone has recommended but the weight just keeps falling off of him. I think we are at our last option because it seems like he is suffering most days. Please, if anyone out there has any suggestions I would love them because even his vet who treats many ME dogs said it’s a miracle I kept him alive this long
My Wire Fox Terrier has this condition having been diagnosed it and has been prescribed a medicine 3 times a day with food but this is useless and just a money making scam as the bottle costs £135.00 Uk pounds and it lasts just over a month. He is ok in the house and running round garden like a bullet but as soon as we go out for walks this is when he throws up. Doing some research if there is a medical procedure out there? Any suggestions?