MEGA ESOPHAGUS, TREATMENT and MANAGEMENT
 

What is Mega Esophagus? The esophagus is the tube connecting the throat to the stomach.  When food is perceived in the esophagus, neurologic reflex causing muscle contraction and relaxation lead to rapid transport of the food into the stomach, like an elevator going down. Other reflexes prevent breathing during this swallowing process to protect the lungs from aspiration. When these reflexes are interrupted such as by disease in the esophageal tissue or nerve disease, the esophagus loses its ability to transport food.  Instead the esophagus loses all tone and dilates.  Also, the reflex protecting the lung is disrupted and aspiration pneumonia commonly follows. Most cases involve young puppies (Great Danes, Irish setters, Austrailian Cattle Dogs, Golden Retreivers and German Shepherds are genetically predisposed).  In these cases the condition is believed congenital though it often does not show up until the pup begins to try solid food. Congenital megaesophagus is believed to occur due to incomplete nerve development in the esophagus. The good news is that nerve development may improve as the pet matures.  Prognosis is thus better for congenital megaesophagus than it is for megaesophagus acquired during adulthood. The above condition is treatable.  Treatment takes dedication, love and hard work. The Diagnostic Plan First, the megaesophagus must be diagnosed.  This is done radiographically.  If megaesophagus is not obvious on plain films, it is better not to use contrast (Barium) studies if possible. This is because megaesophagus patients have the tendency to inhale or "aspirate" food contents that back up in their throats.  This is dangerous enough when the material is simply food but if barium is present and becomes inhaled, the body has great difficulty removing it from the lungs. Still, sometimes this is the only way to see the megaesophagus. Treatment This puppy needs to be on a liquid diet consisting of ground kibble and lots of water fed before it sets up.  Feed the dog in an elevated position. Ideally, the pet should be kept in this position for 10-15 minutes after the meal.  Vomiting versus Regurgitation Most people do not realize that there is a difference between these two actions. Vomiting is an active process. There is gagging, heaving, and retching as the body actively expels stomach contents.  Regurgitation is passive. For whatever reason, food is swallowed from the mouth but never really goes anywhere beyond that point.  Food sits in the esophagus until it simply falls back out the mouth at some point.  In the dog, megaesophagus is the most common cause of regurgitation. FEEDING Feed Iams puppy food ground up in the blender - 1/2 cup ground kibble mixed with warm water and given immediately. Feed frequently. Small meals (1/2 cup ground kibble with warm water in a 1 quart food pan with at least an inch of water) fed as close as every 3 hours  .    Very few dogs diagnosed with Megaesophagus will manage well with two meals per day.   5 feedings is what a puppy should get daily and will need to be maintained this way throughout its life.  Kibble given in plenty of water may satisfy most of the water requirement to stay hydrated, but always have fresh water available. Feed as small volume as possible per meal, based on the highest number of feedings that can be achieved for that day. (Add: the importance of resting the digestive system).  If you put this dog on normal full kibble feedings at anytime it will enlarge the esophagus  so much that it will fill up the lung area and the dog can die from aspiration pneumonia. Feeding your dog in an upright position is helpful. Dependent upon severity of the main symptom markers (1) regurgitation, (2) ability to gain weight, (3) ability to maintain weight, the upright position should be: Minimally 45 degrees. This is known as elevated feeding, whereby your dog's head and neck are well above the stomach region.  This method may work well enough for some. Maintain the vertical upright feeding position after the last swallow to further increase digestive potential.   Having your dog remain in a supine, near vertical position after the meal (ex: 5-10min., 15-20 being better) is also very helpful. The digestion process is far from over after that last swallow!  Holding this position longer will allow gravity to further improve the digestion miracle you are trying to achieve.  Vertical feeding will work best for the majority!   "Vertical" indicates that the dog's spine is 90 degrees or nearly straight up. To increase calorie intake you can use the following: Stat Ensure Nutri-Cal Vitacal Nutristat Do not give any bones or rawhide to a dog with mega esophagus as they tend to ingest parts of these items.  This can cause severe vomiting and injury to an already flacid esophagus. Hotdogs & Cheese cut into pellet sized pieces are fine training aids and can be used for an occasional treat.  Do not give too many at one time.