Is It Vomiting or Is It Regurgitation?

Boomer, an adorable and effervescent young Cairn Terrier, was recently referred to me for vomiting of three days duration. This mischievous little boy raided the kitchen garbage the day before the vomiting began. Neither blood work nor abdominal X-rays performed by the referring veterinarian provided a diagnosis. When I questioned Boomer’s family, I learned that their dog was bringing up clear fluid after drinking and undigested food after eating. Additionally, none of the retching that dogs typically do right before vomiting had been observed. This history provided some big clues that redirected my thinking. Boomer was likely regurgitating rather than vomiting.

Vomiting occurs when food or liquid is expelled from the stomach or upper small intestine, and is preceded by some audible retching (no different than when you or I are nauseated and hovering over the toilet). The vomited material may consist of clear liquid if it originates from the stomach, yellow or green liquid if it originates from the small intestine, or food that appears undigested or partially digested.

Regurgitation differs from vomiting in that the expelled material almost always originates from within the esophagus- the muscular tube that propels food, water, and saliva from the mouth down into the stomach. The regurgitated material consists of water, saliva, or undigested food that comes spewing forth without any audible retching or warning. Regurgitation typically takes the dog and anyone in close proximity completely by surprise. Because the event is so sudden, the larynx (the opening to the windpipe) doesn’t have time to close, and some of the regurgitated material can be inhaled into the lungs resulting in aspiration pneumonia.

So, why is it important to differentiate whether my patient is regurgitating or vomiting? Here’s the reason. The tests for determining the cause of regurgitation are different than those used to determine the cause of vomiting. And the more wisely diagnostic tests are selected, the more expediently a diagnosis is established (better for my patient as well as my client’s pocket book). Diagnostic testing for regurgitation involves evaluation of the esophagus. Diagnostics for the vomiting patient evaluate the stomach and small intestine and screen for other diseases such as kidney failure, liver disease, and pancreatitis all of which can cause vomiting.

So, what ever happened with Boomer? Given his history, I recommended X-rays of his chest cavity (where the esophagus lives). Low and behold, the images revealed a piece of bone lodged within his esophagus. Using an endoscope (a long telescope device) and some fancy foreign body retrievers I was able to nonsurgically remove Boomer’s foreign body. We treated the resulting esophageal inflammation with medications and counseled his family on preventing their little darling from tampering with the garbage! Thankfully, Boomer experienced a complete recovery.

If ever you have a “vomiting” dog on your hands, carefully think about whether what you are observing is vomiting or regurgitation. Distinguishing the two will help point your veterinarian in the appropriate diagnostic direction.

Has your dog ever been evaluated for vomiting or regurgitation? If so, what was the outcome?

Best wishes,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot and Your Dog’s Best Health.   There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot and Your Dog’s Best Health are available at www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.

 

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12 Comments on “Is It Vomiting or Is It Regurgitation?

  1. Nice catch and good post. What would have happened if not diagnosed? Bone would pierced esophagus?

    Dr. Tony – how often do you have dogs come in the ER that were misdiagnosed?

  2. Dr. Kay,

    I heard you a few years ago on NPR’s – Diane Rehm Show. I really enjoyed the interview.

    It seems that Megaesophagus (a stretching/enlargement of the esophagus so that it loses its function to move food to the stomach) is being diagnosed more often in animals. People also have a better understanding about how to care for their animals. But from my experience, unfortunately, there are still primary care vets who are not accurately diagnosing this disorder. My German/Belgian Shepherd developed megaesophagus around 13 y.o. I knew she was not normal when I heard slight crackling sounds (like rice crispy sounds) coming from her mouth when she exhaled. It was more noticeable right after drinking water. Over time, her megaesophagus would get more severe and the food and water would come right back up (undigested). Her regular vet told me that she should take antacid (Pepcid) tablets every night before bed. It didn’t really help for a couple of reasons and it wasn’t addressing her problem. I fed her from elevated dishes which did help her. Also, I held and pointed her head up toward the ceiling for 3 to 5 minutes after eating, so the food could work its way down with gravity. That was critical so the food wouldn’t remain stationary in her throat. I learned from a few very smart people that dry dog food (kibble) was not helping her situation. They recommended that I change her diet to human grade foods. Before I switched foods, she experienced severe bloat. That’s when I knew I had no choice but to switch foods! When I did switch to humane grade food, I knew fairly quickly that it was the best decision for several reasons. 1) I could select each food and only those that would slide easily (e.g. soft boiled eggs, pumpkin, oatmeal, chicken). 2) I could control the quality and the nutritional aspect.
    3) Real people food was easier for her to digest. Also, I gave her enzymes, like Prozyme, with each meal to help her digestion and also for helping to retain nutrients. After I made these changes, I learned that Pepcid AC wasn’t needed. She was the best, and I miss her! I hope this information helps others.

  3. Hi Kate,

    I’m so sorry to hear about what you and your beloved dog went through. It sounds like you are experiencing considerable guilt. I encourage you to remind yourself of the intentions you had for your dear dog- no doubt they were nothing but the best.

    Take good care,

    Dr. Nancy

  4. The result was my 5 year old Pit Bull had an intestional torsion which was not picked up until after our second trip to the emergency vet, 18 hours later. 80% of her small intestine was dead when they went in for exploratory surgery. I was given the wrong odds of survival by the emergency vet and when the critical care vet (at the hospital she was transferred to) gave me the correct statistics, I felt horrible for putting her through the surgery and keeping her alive for 5 days.
    I knew something was wrong, she was showing all the signs of bloat, except for the distended stomach. X rays showed no bloat, but it also didn’t show the twisted intestine.
    It’s been a month and I still beat myself up for putting her through all she went through.

  5. This is an important distinction. Years ago, I thought my Lab was vomiting when she was actually regurgitating food. This delayed the vets. They couldn’t make a diagnosis until they realized I didn’t know the difference. It turned out she had megaesophagus.

  6. Wow! What timing you have and a great toilet pic to accompany it!

    Katie, the lupus child, ate a cicada AND a katydid the other night. Insects are fun after dark since they gather by the back porch light and the cicadas make that funny noise when she pounces on them! About 30 to 45 minutes later, up came the yellowy-greenish fluid and a couple of insect legs……..

    Nice article. I’m a subcriber for life!

    Nancy

  7. Hi Stephani,

    Thanks for your comments and I’m glad to hear that things have worked out reasonably well for you and your dog. I was up until midnight last night removing an esophageal foreign body (a large piece of rawhide) from a 5 lb. Maltese. I always keep my fingers crossed that there will be no stricture formation.

    Best wishes,

    Dr. Nancy

  8. I have a dog that came inside and started regurgitating white foam (his esophageal lining?). He had a full esophageal blockage (nothing could pass) from swallowing a piece of stuffed toy (please note that this took over 24 hours to diagnose, since stuffed toys do not show up on regular x-rays).

    After having the blockage removed, he developed an esophageal stricture about the size of a drinking straw. I decided to not have dilation surgery done and now, a year later, the scar tissue has softened and he is able to pass soft food that is larger than the stricture (pieces about twice the size of the stricture – larger than that and he regurges them).

    He is happy and healthy (and a small dog – 17 pounds), so feeding him a thinned diet is easy. The only problem is that if he is given something too large, he is in pain until he brings it back up. So, I have to be vigilant when people want to give him treats – I break them up tiny or tell him to chew it – we learned chewing on command.

  9. Thanks, Dr. Kay for passing along this valuable piece of medical info! Not only is it important for owners to be able to know the difference and be able to tell their pet’s health care providers what is going on, as your Boomer story points out, it is important for veterinarians themselves to be able to tell the difference.

    While teaching veterinary students at Purdue, I often grill them on whether the patient we are seeing is vomiting or regurgitating, and few think to ask the right questions at first. Hopefully, more folks will be helping us make this distinction in the future.

  10. Dr. Kay, this is a great description of the difference between vomiting and regurgitation. I had no idea there was a difference until about six years ago when my senior Golden Retriever began having a series of very puzzling symptoms that progressed rapidly to crisis proportions. Among the symptoms was regurgitation, and she was subsequently diagnosed with megaesophagus, secondary to myasthenia gravis. Before she could be fully diagnosed, however, she did aspirate and spent a week in critical care with aspiration pneumonia. What a scary experience. I learned just how quickly pneumonia can come on and how potentially deadly it can be. Thankfully, my girl pulled through and with appropriate medication and careful management of her feeding protocol she did very well for several more years.

  11. Michelle regurgitated some of her food for her puppies while they were in the process of weaning off mothers milk. I mentioned this to our veterinarian he was quite worried “domestication has taken away the need to do that”. The puppies were happy to eat it up (at least there was no need for me to clean up the mess).

  12. Yes! My dog was diagnosed with mega-esophagus about 8 months after we adopted her. We suspected something was wrong the first day we had her home. We had a barium x-ray done and it did not seem to show an enlarged esophagus. We had a regular x-ray repeated about 8 months later and it showed very slight enlargement.

    I always say that regurgitation is passive. You don’t see the “heaving” or major motions in the abdomen like you do with puking. Often people will notice their dog jumping off the couch or a step and some food will seem to plop out of the mouth. You might also see a lot of licking and swallowing, as if there is thick mucous in the throat.

    Our dog’s megaesophagus is very mild — in fact her most recent x-ray looked completely normal! — and when she does regurgitate, it’s a small amount and is usually when her digestive system in general is upset. We feed her upright.

    To anyone whose dog is diagnosed with mega-e, it is NOT a death sentence! It IS very treatable, but will require a change in how you feed your dog. That’s all! In a strange way, once you have a feeding system down, it brings you closer to your dog. There is a Yahoo! group dedicated to mega-esophagus and it provides unparalled support and advice.