Esophagitis may be caused by chemical injury from ingested substances, gastroesophageal reflux (secondary to general anesthesia,
hiatal defects, persistent vomiting, malpositioned nasoesophageal/pharyngostomy tubes), or esophageal foreign bodies.
Disturbances in esophageal motility may accompany esophagitis regardless of the cause. The reported prevalence of acute
esophagitis is low; however, this is likely an underestimation due the subtlety of clinical signs and radiographic findings
associated with this disorder. Clinical signs vary as to the type of chemical injury, severity of inflammation, and extent
of esophageal involvement. Esophagitis is an endoscopic diagnosis that does not require mucosal biopsy. Mucosal abnormalities
that may be observed include increased erythema, erosions, and alterations in mucosal texture. Lesions are usually evident
in the distal esophagus, adjacent to and including the LES.
Treatment - Mild esophagitis frequently resolves with minimal treatment other than dietary management. Provide frequent, smaller-sized
meals of a low-fat, high-protein content to enhance LES tone and to minimize reflux. Animals having more severe esophagitis
will require drug therapy and gastrostomy tube feeding. Sulcralfate suspension (0.5-1.0 g PO TID) is the most beneficial and
specific therapy for reflux esophagitis. Administer metoclopramide (0.1-0.2 mg/lb per os, SC, TID) or cisapride (0.05-0.25
mg/lb per os BID) to decrease esophageal reflux (by increasing LES pressure) and to promote gastric emptying. Gastric acid
secretory inhibitors (ranitidine 0.5 -1.0 mg/lb PO or IV BID; famotidine 0.25-0.5 mg/lb PO SID; omeprazole 0.35 mg/lb PO SID)
should be given to decrease acidity of gastric juice. The duration of drug therapy is empirical and varies with severity of
signs and endoscopic lesions. Mild lesions are treated for 5-7 days; moderate-to-severe esophagitis is treated for 2-3 weeks.
The prognosis in most cases of esophagitis is good with appropriate medical therapy. Animals having severe disease warrant
a guarded prognosis as stricture or segmental or generalized hypomotility may occur.
Esophageal Foreign Bodies
Foreign bodies are a common cause for esophageal dysphagia in the dog but are rare in cats. They usually lodge at points of
minimal esophageal distension including the thoracic inlet, at the base of the heart, or at the diaphragmatic hiatus. The
most common objects ingested are bones, fish hooks, needles, sticks, and play toys. Retained foreign bodies cause partial
or complete mechanical obstruction. Muscle spasm and tissue edema occur around the foreign body making passage of the object
down the esophagus more difficult. Mucosal abrasion, laceration, and perforation may occur with sharp or angular objects which
are lodged intraluminally. The severity of clinical signs is related to the size of the foreign body and duration of esophageal
obstruction. Most dogs and cats with large esophageal foreign bodies are presented for evaluation of acute onset of regurgitation,
dysphagia, odynophagia, gagging, and excessive salivation. Survey and contrast radiology show the presence of the foreign
material, aspiration pneumonia and/or evidence of perforation. Esophagoscopy should be performed to confirm the diagnosis
and to assess secondary mucosal damage.
Treatment - Esophageal foreign bodies are medical emergencies and should be promptly removed. Endoscopic removal of foreign bodies
using a flexible instrument which accommodates a variety of retrieval (grasping) instruments is usually successful. Thoroughly
evaluate the esophageal mucosa following foreign body extraction for hemorrhage, lacerations, and perforations. Obtain post-procedural
thoracic radiographs to access for pneumomediastinum/pneumothorax. Restrict food or water for 24 hours depending on the extent
of esophageal trauma. Animals with severe mucosal damage will require complete esophageal rest and gastrostomy tube feedings.
Initiate medical therapy for esophagitis. Esophageal perforations are successfully treated with broad-spectrum antibiotics
such as ampicillin (11 mg/lb SC, IM, IV TID). The prognosis after endoscopic foreign body removal is generally excellent.
Significant esophageal trauma or large perforation carries a guarded prognosis.