Peer-reviewed veterinary case report
Treatment options for dogs with lower esophageal sphincter
By Grobman, M E et al.·Published in Journal of veterinary internal medicine·2019·Department of Veterinary Medicine and Surgery·View original on PubMed →
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Original publication title: Mechanical dilation, botulinum toxin A injection, and surgical myotomy with fundoplication for treatment of lower esophageal sphincter achalasia-like syndrome in dogs.
- Species:
- dog
Plain-English summary
A group of 14 dogs with a condition called lower esophageal sphincter achalasia-like syndrome (LES-AS) were treated for severe regurgitation and difficulty swallowing. After receiving a procedure to stretch the esophagus and an injection of botulinum toxin A, all the dogs showed improvement within about three weeks, with a significant increase in body weight and a decrease in regurgitation by 80%. Although the underlying issues with the esophagus remained, six of the dogs went on to have surgery that provided lasting benefits. Overall, the treatments helped these dogs feel better and eat more comfortably.
People also search for: dog regurgitation treatment · botulinum toxin for dogs · dog swallowing problems surgery
Abstract
BACKGROUND: Megaesophagus (ME) carries a poor long-term prognosis in dogs. In people, lower esophageal sphincter (LES) achalasia is a rare cause of ME that may respond to targeted intervention. Dogs with lower esophageal sphincter achalasia-like syndrome (LES-AS) have been described recently, warranting investigation of analogous targeted treatment. HYPOTHESIS/OBJECTIVES: Evaluate response of dogs with LES-AS to LES mechanical dilation and botulinum toxin A (BTA) injections, with or without surgical myotomy and fundoplication. We hypothesized that clinical and videofluoroscopic swallow study (VFSS) features of LES-AS would improve after treatment targeting functional LES obstruction. ANIMALS: Fourteen client-owned dogs with LES-AS diagnosed by VFSS. METHODS: Retrospective study. Dogs diagnosed with LES-AS underwent treatment between April 2015 and December 2017. Outcome measures included client perception of clinical severity, body weight (BW), body condition score (BCS), regurgitation frequency, and VFSS parameters (ME, esophageal motility, gastric filling). Dogs with positive responses were considered candidates for LES myotomy with fundoplication. RESULTS: By a median IQR of 21 (IQR, 14-25) days after mechanical dilation and BTA, clients reported clinical improvement in 100% of dogs, BW increased 20.4% (IQR, 12.7%-25%), pre- and post-treatment BCS was 3 (IQR, 3-4) and 5 (IQR, 4-5), respectively, and frequency of regurgitation decreased by 80% (IQR, 50%-85%). Duration of effect was 40 (IQR, 17-53) days. Despite clinical improvement, ME and abnormal esophageal motility persisted in 14 dogs. Six dogs subsequently underwent myotomy and fundoplication and maintained improvement observed after mechanical dilation and BTA. CONCLUSIONS AND CLINICAL IMPORTANCE: Dogs with LES-AS experienced significant, temporary, clinical improvement after mechanical dilation and BTA. Preliminary results suggest myotomy with fundoplication provide lasting clinical benefit despite persistence of ME.
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Search related cases →Original publication on PubMed: https://pubmed.ncbi.nlm.nih.gov/30968469/