What is GERD?
Gastroesophageal reflux disease (GERD) is a chronic condition in which stomach acid flows from the stomach to the esophagus (the tube that carries food from the mouth to the stomach). Normally, a valve called the lower esophageal sphincter prevents this reverse flow of stomach acid. In dogs with GERD, however, stomach acid passes through this sphincter and enters the esophagus.
Once in the esophagus, stomach acid is highly irritating. Stomach acid within the esophagus causes esophagitis (esophageal irritation), which is associated with a variety of clinical signs in dogs.
What are the clinical signs of GERD?
In humans, GERD is associated with the pain that is commonly referred to as heartburn. Our pets are unable tell us when they are uncomfortable, however. We have to look for more subtle cues of discomfort. Possible signs associated with GERD include:
- decreased appetite
- difficulty swallowing
- licking the lips
- change in bark
- chronic cough
- appearance of generalized discomfort
- pacing or restlessness at night
In severe cases, dogs may begin to lose weight because they are no longer taking in adequate nutrition.
Dogs with GERD may also regurgitate, especially after eating. Regurgitation is not the same as vomiting. Vomiting is an active process; there is an obvious abdominal heaving associated with vomiting. Regurgitation is a passive process; a dog will appear to simply open his mouth and material will come out. It is important to pay careful attention if to whether your dog is vomiting or regurgitating; if you are unsure, attempt to video an episode of regurgitation or vomiting. Your observations will help your veterinarian narrow down the list of possible causes of your pet’s illness.
How will my veterinarian diagnose GERD?
If your dog presents for gastrointestinal signs or nonspecific signs of pain, your veterinarian will probably begin with a physical exam and laboratory tests. On the physical exam, your veterinarian will attempt to localize pain and feel for abdominal masses, obstructions, or other abnormalities. Next, your veterinarian will perform laboratory tests. A complete blood cell count is used to assess your pet’s red blood cells, white blood cells and platelets. A serum biochemistry profile provides information about how your pet’s internal organs, such as the liver and kidneys, are functioning. A urinalysis helps your veterinarian assess your dog’s hydration and kidney function, while also ruling out a urinary tract infection as the cause of your pet’s discomfort.
Next, your veterinarian will likely recommend imaging. Tests such as radiography (X-rays) and ultrasound can allow your veterinarian to examine your pet’s chest and abdomen for signs of masses, infection, intestinal obstruction, and other abnormalities. There are a number of conditions that cause signs similar to GERD, so your veterinarian will rule out these conditions.
"Gastrointestinal reflux disease is often diagnosed
on the basis of endoscopy."
In most dogs with GERD, all of the above tests are normal. Your veterinarian will then probably refer you to a veterinary specialist to pursue more invasive gastrointestinal diagnostics. Gastrointestinal reflux disease is often diagnosed on the basis of endoscopy. Your dog will be anesthetized and a small camera will be passed down your dog’s esophagus. This camera will allow visualization of the esophageal inflammation caused by GERD, confirming the diagnosis.
How is GERD treated?
There are a number of different treatments for GERD. Most patients require a combination of treatments, each of which addresses the problem in a different way.
Antacid medications are often prescribed to decrease stomach acidity. These medications, which include famotidine (brand name: Pepcid®, Apo-Famotidine®), cimetidine (brand name: Tagamet®), ranitidine (brand name Zantac®), and omeprazole (brand names Gastrogard® and Prilosec®), decrease acid production. Reflux can still occur, but it will be less painful and less damaging to the esophagus.
Dogs with GERD also benefit from medication to strengthen the lower esophageal sphincter. These medications, such as cisapride (brand names: Prepulsid®, Propulsid®) and metoclopramide (brand names Reglan® and Maxolon®), help increase muscle tone at the sphincter, decreasing the likelihood that stomach acid will enter the esophagus.
Diet can also help reduce signs of GERD. Dogs with GERD often do best with a low-fat prescription diet. This helps reduce the production of stomach acid. Feeding small, frequent meals can also help reduce reflux into the esophagus.
Finally, despite all of these measures, it is likely that at least some degree of reflux will still occur. Sucralfate (brand names: Carafate® and Sulcrate®) is often prescribed to dogs with GERD and given as a slurry (suspended in water). This allows the sucralfate to coat the esophagus, protecting its delicate lining and slowing the progression of esophageal inflammation and ulcers.
In some cases, GERD is caused by an underlying anatomical abnormality, such as a hiatal hernia. If this is the case, your veterinarian may recommend surgical correction of the underlying defect.
What is the prognosis for dogs with GERD?
Most dogs experience a rapid improvement in clinical signs with treatment. Your veterinarian will monitor your dog’s progress and response to therapy. Your dog’s response to treatment will determine whether a short course of treatment is sufficient or whether your dog needs to remain on medications long-term.