Esophageal Disease

37 Esophageal Disease



Anthony P. Carr



1. What are typical signs of esophageal disease?

Dogs with esophageal disease will often regurgitate. Regurgitation must be distinguished from vomiting. On occasion, dogs will present for respiratory problems caused by aspiration during regurgitation. Dysphagia, salivation, and odynophagia (painful swallowing) are other symptoms that can be present. Esophageal disorders can be secondary to a variety of systemic disorders, so that the clinical signs of these diseases may predominate.


2. What is megaesophagus?

Megaesophagus refers to a generalized hypomotile and dilated esophagus. Megaesophagus can be congenital or acquired, with the latter being most common. This needs to be differentiated from mere dilation (e.g., with aerophagia) and focal involvement. As an example, persistent right aortic arch will cause prolonged esophageal obstruction, which leads to dilation and hypomotility in the area cranial to the obstruction. An insignificant cause of transitory megaesophagus may be observed on thoracic radiographs taken during general anesthesia.


3. What is the most common cause of megaesophagus?

Most cases are idiopathic. The most common cause identified is myasthenia gravis; in most cases, this is a focal form with signs limited to the esophagus. It has been identified commonly in German Shepherds, though any breed can develop this problem.


4. What other causes are there for megaesophagus?

In very young animals, consideration would have to be given to congenital megaesophagus. This is seen with increased frequency in Irish Setters, German Shepherds, Great Danes, Shar-Peis, Miniature Schnauzers, and Fox Terriers.


In adult animals, neuromuscular disease can result in megaesophagus. In addition to myasthenia gravis (generalized or focal form), polymyositis, dysautonomia, and systemic lupus erythematosus can lead to megaesophagus. Hypoadrenocorticism has been linked to this disease as well, both the typical form with mineralocorticoid and glucocorticoid deficiency as well was the atypical form in which only glucocorticoids are lacking. Toxicity from lead and organophosphates are potential causes that need to be ruled out.


5. How is megaesophagus diagnosed?

The diagnosis of megaesophagus is usually straightforward in an animal with appropriate clinical signs. Thoracic radiographs should reveal the dilated and air-filled esophagus. Radiographs should be examined in detail for any evidence of aspiration pneumonia as well. Contrast studies of the esophagus are usually not needed and may not be desirable because of the high risk of aspiration in these dogs. Contrast can help to determine esophageal motility or highlight the organ in those cases in which the esophagus cannot be visualized clearly.

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Jul 31, 2016 | Posted by in INTERNAL MEDICINE | Comments Off on Esophageal Disease

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