New Help for Dogs With Megaesophagus
Bailey Chair
There’s some exciting, hot-off-the-press news for dogs with megaesophagus. Researchers at the University of Missouri’s College of Veterinary Medicine have new insights about this frustrating and often devastating disease.
What is megaesophagus?
The term megaesophagus refers to weakness, dilation, and decreased motility of the esophagus, the muscular tube that normally propels food, water, and saliva efficiently from the throat down into the stomach. For dogs with megaesophagus, these swallowed materials either remain within the dilated esophagus or are regurgitated back up. Regurgitation resembles vomiting, but unlike vomiting, regurgitation tends to occur without warning. There’s no retching, grazing on grass, or assuming a particular body posture. Regurgitation takes everyone by surprise, including the dog.
As a result of this “surprise factor” the major life-threatening complication for dogs with megaesophagus is aspiration pneumonia. Food material can be readily and inadvertently inhaled into the lungs during a bout of regurgitation. Malnutrition can also be a significant issue for dogs with megaesophagus.
Causes of Megaesophagus
Megaesophagus tends to affect middle aged and older dogs, and there is no breed predilection. Most of the time, an underlying cause can’t be found, and the disease is referred to as, “idiopathic megaesophagus.” Diseases that can cause megaesophagus include:
- Myasthenia gravis: a neuromuscular disease
- Addison’s Disease: a hormonal disorder
- Esophagitis: inflammation of the lining of the esophagus
- Esophageal tumors
- Esophageal foreign bodies
- Esophageal trauma
Standard treatment
Treatment of idiopathic megaesophagus revolves around maintaining the dog in an upright position following mealtime so as to allow gravity to help move swallowed food, water, and saliva down into the stomach. The usual recommendation is to maintain the dog in an upright position for approximately 20 minutes following meals. Bailey Chairs (see photo) have been specifically designed for dogs with megaesophagus. They comfortably keep the dog upright and eliminate the need for direct human supervision throughout the process.
A new diagnostic test
New diagnostic testing and treatment described by folks at the University of Missouri College of Veterinary Medicine focus on an anatomical structure called the lower esophageal sphincter (LES). This sphincter acts like a valve between the end of the esophagus and the stomach, opening when food and water are swallowed and then closing so that food is not refluxed from the stomach back into the esophagus.
It turns out that some dogs with megaesophagus have LES dysfunction- their sphincters remain closed, even during the swallowing process. The researchers have been very clever in figuring this out. Using fluoroscopy (a type of video x-ray) they observe the “flight pattern” of swallowed food material as it travels down the esophagus. Such fluoroscopic swallowing studies have been around for a long time, but what’s new about the Missouri technique is how the dogs are restrained. Traditionally, dogs are held on their sides for these swallowing studies, a far cry from how dogs normally position themselves for swallowing. This new research has employed a nifty holding chamber developed to allow the dogs to eat and be restrained for the fluoroscopy in a normal upright position. This technique is providing much more accurate information about esophageal and LES function.
A new treatment
The Mizzou team has fashioned their treatment protocol for dogs with LES dysfunction after what is being done in human medicine. Using endoscopy, in which a long video telescope device is inserted into the esophagus, the LES is manually expanded via a technique called balloon dilation. Next, Botox is injected into the LES. This chemical paralyzes the sphincter muscles, allowing the LES to remain open. Thus far, some of the treated dogs have shown marked improvement. As Dr. James Schachtel, a member of the research team has stated,
This approach gives these dogs a chance, whereas a lot of them didn’t have much of one. 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.
While not all dogs with megaesophagus are candidates for this therapy, it is wonderfully refreshing to finally have a new strategy to treat this frustrating disease.
Do you have a dog with megaesophagus? If so, what has your experience been like? The University of Missouri team encourages veterinarians, pet owners and breeders to contact them about their megaesophagus testing and treatment protocol. You can do so by calling the Small Animal Hospital at 573-882-7821.
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
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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 http://www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.
Hello, I wanted to chime in as I completely understand the frustration of having a dog diagnosed with ME and then the challenge of “what do we do now?” and getting what we referred to as “the face”. Either the vet had no clue or they were about to tell us our adorable beloved puppy should be put down.
Our Goldendoodle was diagnosed with ME around 5 months old. After seeing a specialist to confirm yes it was ME when we asked “now what” we pretty much got a “good luck with it”. We considered the Bailey Chair but figured we try what we had at home first. So here are is a list of things we do if it could possibly help someone else. Oh, and our pooch is going on 7 years old this Jan. and is a healthy 85 lb boy so don’t give up hope!
1: We feed him on a full size step stool. His hind legs are on the ground and his front legs are on the second step. If you go this route you may want to buy a cheap door mat with rubber bottom as he feels more secure without his hind legs sliding out behind him on hard woods.
2: We also buy Nature’s Recipe Easy to Digest dog food with a larger kibble sizes. (but this is not a must it just was one we found with the largest kibble size). We put his food each night in a large container and soak it. The kibble size swells, absorbs the water and it makes the food heavier. We do break his meals up to 4 times a day (I know, may not be something everyone can do but smaller meals do seems to help. Even if it’s a morning feed, get home from work feed and then an early evening feed).
3: We got him the food bowl from Petsmart that has the large nubs in the middle. Eating around the nubs takes longer and keeps him upright longer.
4: We also give him a 20 mg Famotidine antacid pill in his morning and evening food. (generic form is sold in most grocery stores and it is not expensive). The antacid makes a big difference in his comfort level. We do hold his food bowl when he eats so he does not have to bend over but it takes him at most 2 to 3 minutes to eat each time. After he is finished we have him stay on the stool and rub his chest until we hear him usually hiccup and then burp. (sometimes the burps sound like a 21 year old who just chugged a beer. Hearing a dog ‘let it rip” can cause quite a bit of humor especially if you have young kids in your home!) After some good hiccups and usually but not always a burp, he is good to go. You can literally hear the food go down sometimes when he is eating.
5: Petsmart has the elevated water bowls. They come on a stand with an adjustable height. Highly recommend.
Now things we learned the very hard way on!
No extra treats. They come back up. Especially no people food.
As a puppy he would eat bark and sticks… again, always came back up. Add a bunch of water to it and it usually was a lovely mud/chewed bark pile around 3 AM on the bedroom carpet . By the way Petsmart also carries a fabulous carpet cleaner called “Dang, which end did that come from?” No joke, that’s the name!
No bones that can be broken down. Go for antlers or nylabones that are the VERY hard. Basically any toy that can be ingested is a no go. GoDog makes some good ones.
Lastly be patient. We were devastated at his diagnosis and felt very lost on what to do. Try different things as no dog is the same. Every one asked “what is his life expectancy?” our answer now is “a long time”.
Thank you for this informative article! Loving a dog with megaesophagus has it’s ups and downs and one of the most frustrating aspects was the initial diagnosis very early on and coming across multiple vets who hadn’t seen many, if any, cases and recommended euthanasia. The feeling of helplessness was overwhelming and the need to educate ourselves was intimidating at times. Articles like yours not only give hope that the condition is more mainstream but also that pet owners don’t have to do all of the educating of themselves!
I had a 9-year old beagle who developed megesophagus. I managed to keep him alive for 9 months before he developed pneumonia. I had my brother build a step stool with a flat top that held his bowl. He stood on the top step and ate. Then I rocked him back and held him upright until he burped. Once he burped, I could let him down on all fours.
Hi Lois. I’m sorry for what you and your pup are going through. Every case is different in terms of prognosis. I strongly encourage you to contact the Bailey Chair company to see what they have to offer for such a tiny pup. Also, if at all possible, I encourage you to get a second opinion from a veterinarian who specializes in internal medicine (www.acvim.org) just to feel more confident that you are doing all you can. Best of luck to you and your puppy. Dr. Nancy
What would be required is the specialized fluoroscopic testing I described in my blog post. Any chance you live close to Missouri?
He might be Mike. Without the specialized testing described in this article, you wouldn’t be able to know. Any chance you live close to Missouri? Best wishes to you and your Lab.
Hi Beth,
Boy oh boy, it sounds like you and your little dog have been through a lot. Any chance you live close enough to Missouri to take her there for some diagnostic testing?
Best wishes,
Dr. Nancy
Our girl is a Chihuahua Jack Russell mix. Diagnosed with Mega-E July 2014 at 2 years old. Couldn’t tolerate anything by mouth so we went the feeding tube route to save her life. 6 months into use of the feeding tube I experimented with trying to syringe feed gruel by mouth and she tolerated it fine. Feeding by mouth again lasted close to a year then she couldn’t tolerate anything by mouth again. Re-installed low profile feeding tube and that is where we are now 6 months later. Occasionally I will try to see if she can tolerate an oral feeding but it’s not been successful again. Have tried different consistencies as well. Would be very interested in knowing if the lower closed sphincter is my girls problem.
We have a 10 year old Lab with ME, and he has been treated at NC STATE VET HOSPITAL, they’ve really helped only we don’t use a Bailey Chair, we’ve had a elevated bowl stand built and use a pro collar after he eats. Is he a candidate for this treatment.
How do we determine if our ME dog is a good candidate for this treatment?
I have a 5 week old Australian Shepherd pup who was diagnosed with this last week. what is the expected lifespan for him, I was informed there is no cure, no surgeries and that most die around 6 months. I am trying to figure out how to make a chair that can be adjusted as he grows, Is their any type of group that may lend shairs out?
Thanks
Hi Jodi,
Glad to hear that your Cosmo is doing reasonably well because of your vigilant management. You might want to consider calling the veterinary college in Missouri (number provided at end of my blog post) to see if Cosmo might be a candidate for testing and treatment.
Best wishes,
Dr. Nancy
Our Cosmo was born with ME would this treatment help him? He does well with limiting of water and elevated eating. From what I see with other ME dogs he has a milder case. We don’t change his routine or food unless absolutely necessary.
Hi Meagan. Way to take the bull by the horns, so to speak. Managing megaesophagus and myasthenia gravis can be very challenging. Your dog is so lucky to have you. I hope he does indeed thrive.
Best wishes,
Dr. Nancy
Thank you for this blog! In July, my dog was diagnosed with ME, secondary to MG. We are still working to balance the MG medications and dealing with ME issues, but we have hope that he will continue to thrive. Thank you so much for the information – I’ve shared it with friends and family. I can’t believe how little is known about this disease. A few months ago, I knew nothing. Now, it is my world.
Hi Kirsty. So sorry you and your pup are dealing with this. I would not rule out a LES issue. I encourage you to contact the folks in Missouri via the number I provided at the end of the article. Best of luck to you. Dr. Nancy
Glad that things worked out really well for Banjo!
Our Banjo had sphincter issues, it wouldn’t open. He was a puppy. He was put on cisapride, this helped a lot. He doesn’t need it anymore.
My pup was diagnosed with congenital ME at 12 weeks. she has vomit on a 3 day cycle. could the LES play a part with the.vomit.
Hi Suzy,
You have asked some TERRIFIC questions. Yes, the paralyzed LES does allow for reflux, but I suspect this is the lesser of the two evils in dogs with LES dysfunction. Yes, I suspect this could be a neurological process. I don’t know if the congenital form of the disease is associated any more or less with LES dysfunction. This would be a good question for the researchers (as are your other questions!). I encourage you to call the number I referenced at the end of my blog post.
Warm best wishes,
Dr. Nancy
Hi Pat. You are correct, megaesophagus can be a congenital condition (something a pup is born with). The article on this topic did not specify the work done on congenital versus acquired cases. I encourage you to call the number I referenced. Let me know what you learn. Best wishes to you and your pup. Dr. Nancy
My mega-e pup was born with this condition and was diagnosed at 12 weeks old. Your article references mega-e as being a condition of middle-age or older dogs. Is this new technique only applicable to middle-age or older dogs? There are so many pups with congenital idiopathic mega-e.
This is very exciting!! Question: if the LES is paralyzed to stay open, doesn’t that leave it open for reflux? Also, could this be a neurological issue as well? And as far as congenital ME is concerned – wouldn’t the idiopathic LES be somehow connected to the heredity process, i.e., just showing up later in life instead of congenitally? So why wouldn’t stem cells be studied and used to possibly grow new nerve endings that can communicate with the LES and the esophageal muscles themselves?
Thanks you!