Gastroesophageal Reflux Disease (GERD) in Non-Brachycephalic Dogs

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, and 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 pain, commonly called heartburn. Our pets cannot tell us when they are uncomfortable though, so we must look for more subtle cues of discomfort. Possible signs of GERD in pets 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 lose weight because they are no longer getting adequate nutrition.

Dogs with GERD may also regurgitate, especially after eating. Regurgitation and vomiting are not the same. Vomiting is an active process that involves obvious abdominal heaving. Regurgitation is a passive process in which a dog appears to simply open its mouth and material comes out. It is important to carefully watch your dog to determine whether they are vomiting or regurgitating; if you are unsure, take video of the event. Your observations will help your veterinarian narrow down the possible causes of your pet’s illness.

How will my veterinarian diagnose GERD?

If your dog shows 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 (CBC) 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 are functioning, such as the liver and kidneys. 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.

After that, your veterinarian will likely recommend imaging. Tests such as radiography (X-rays) and ultrasound allow your veterinarian to examine your pet’s chest and abdomen for masses, infection, intestinal obstruction, and other abnormalities. There are several conditions that cause signs similar to GERD, so your veterinarian will rule out these conditions.

In most dogs with GERD, all the above tests are normal. Your veterinarian will then probably refer you to a veterinary specialist to pursue more invasive gastrointestinal diagnostics. GERD is often diagnosed based on endoscopy. For an endoscopy, your dog will be anesthetized, and a small camera will be passed down your dog’s esophagus. This camera will allow the veterinarian to see the esophageal inflammation caused by GERD, confirming the diagnosis.

How is GERD treated?

There are several treatments for GERD. Most dogs 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 names: 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.

If the inflammation of the esophagus is severe, or if the dog also has aspiration pneumonia (lung inflammation due to breathing in stomach contents), antibiotics may also be prescribed. As well, IV (intravenous) fluids, anti-nausea medications, and pain medications may be prescribed.

Diet can also help reduce signs of GERD. Dogs with GERD often do best with a low-fat prescription diet, as it helps reduce the production of stomach acid. Feeding small, frequent meals can also help reduce reflux into the esophagus.

Finally, despite all these measures, it is likely that at least some reflux will still occur. To protect the esophagus, sucralfate is often prescribed (brand names: Carafate® and Sulcrate®). Sucralfate and given as a slurry (suspended in water), which 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. In this case, your veterinarian may recommend surgical correction of the underlying defect.

What is the prognosis for dogs with GERD?

With treatment, most dogs have a rapid improvement in clinical signs. Your veterinarian will monitor your dog’s progress and response to therapy. Your dog’s response will determine whether a short course of treatment is sufficient or whether your dog needs to remain on medications long-term.