Small Animal Internal Medicine

Megaesophagus (ME) is a condition in which the esophagus loses the ability to contract and move food down into the stomach. Subsequently the esophagus becomes dilated and any food or water that is consumed will simply remain within the esophagus until it is passively regurgitated. Regurgitation often occurs unexpectedly and may come as a surprise to the animal or occur while they are sleeping. They are therefore unprepared to close off the opening to their windpipe and can inhale the food or water. As a result they often develop severe pneumonia. This pneumonia and the decision to euthanize because of pneumonia is the leading cause of death in animals with megaesophagus.    

Megaesophagus can occur due to a large number of underlying diseases. Diseases that your veterinarian may test for include myasthenia gravis, hypothyroidism, hypoadrenocorticism, toxicities, infectious disease, or other neuromuscular diseases. In most cases of puppies the cause is often congenital but in some cases the esophagus can be constricted by an abnormal blood vessel formation (vascular ring anomaly).  If this is present then surgery may be an option. In most adult dogs ME occurs due to an unknown cause, termed idiopathic, and treatment is focused on supportive care.

Treatment for ME focused mostly on treating any underlying conditions contributing to the formation of ME and managing the pet’s food and water intake and home environment. There are no medications that work specifically to improve the function of the esophagus. As medical therapy options are limited, the burden of care falls mainly on the shoulders of an owner. Dedication, attention to detail, and consistency are key to keeping a dog with ME healthy at home. Some important aspects of home care are discussed below.   

Anything that is offered for oral consumption, including food, water, or medications, must be offered in an upright position. The Bailey chair is a great option for most dogs, especially larger breeds, and smaller breeds can often be held in an upright position by their owners. Some dogs may do well standing on a ladder or step stool and adjustments may need to be made for dogs with orthopedic issues. Every dog is different so any method that works is acceptable. Dogs may need to stay in this upright position for 10-30+ minutes to allow gravity to move material through the esophagus into the stomach. This again remains true for any food, water, or medications. Below are suggested resources to help you manage your pet’s condition and to connect with others whose pets have the same or similar diseases. Treats should ideally be avoided except when offered in the vertical feeding position. However, if desired and tolerated, treats may be given. Good options for dogs with ME are Gerber Graduates puffs or yogurt melts (or equivalent) which dissolve immediately in the mouth or lickable treats such as PetSafe Lickety stik or Leanlix. Remember that every dog is different and may not be able to tolerate these treats. Always consult your veterinarian if you are unsure if these treats are safe for your dog.    

One of the first things to determine for your pet is which food consistency works best for them. This varies pet to pet and you will need to experiment with different types of food. Possible choices include a blended slurry, canned food, meatballs, or soaked kibble. Animals with megaesophagus are unlikely to be able to eat a normal dry kibble. Remember that even water cannot be consumed normally. Some dogs may even require thickeners to be added to their water or may need to consume gelatin cubes to supplement water intake. In dogs that cannot tolerate water consumption at all, fluids can be given under the skin to maintain hydration. Dogs should not have free access to a water bowl or they should be discouraged from drinking water by receiving all needed water with the daily feedings. Be sure to ask your veterinarian how much water your pet should be receiving every day. This amount may need to be increased or supplemented in hot weather or after activity.

Many dogs with ME struggle with saliva accumulation as saliva will also not be moved down to the stomach. This can cause coughing (clearing the throat), sneezing, or potentially regurgitation and possible aspiration as this saliva can become very thick and ropey. Many dogs may need to wear a neck hug or inflatable e-collar to keep the head elevated when at rest. This will help drain saliva away from the throat where it causing irritation and may help prevent aspiration if regurgitation occurs while a dog is laying down. 

It is uncommon for ME to resolve spontaneously except with very specific underlying diseases and prognosis for this condition has long considered to be quite poor. However, with better understanding of the condition and improvements on how we manage ME at home, lifespan can stretch to several years or even for a full normal lifespan. Discuss all underlying conditions and the severity of your pet’s condition with your veterinarian to better determine what prognosis can be expected for your individual pet.    

Supplies to Have at Home

  • Bailey Chair – These can be built at home or purchased online. A great website for purchasing a chair is baileychairs4dogs.comInstructions for building your own can be found at issuu.com/editorgrn/docs/bailey_s_chair_instructionsAdditionally, you can often find Bailey chairs for sale on ebay or even amazon.com. 
  • Inflatable E-collar or neck hug – These collars help elevate your dogs head while sleeping and may cut down on regurgitation and possible aspiration at night on even during the day while crated.  Possible options for inflatable collars include Kong Cloud, Pro-collar, or BooBooLoon. Wagtailfarms.com can custom make neck hugs for your pet. 

Resources and Websites

What to Watch for at Home

  • While our goal is to limit the amount of regurgitation your pet has, it is likely that you can at least expect some to happen. Some dogs may regurgitation daily or weekly or may go months between episodes. 
  • If you do notice that the amount of regurgitation worsens this could indicate that something has changed or that we need to adjust their management plan. Some dogs may require changes in food consistency throughout their lifetime. Please contact your veterinarian to discuss options if this occurs. 
  • Also monitor for signs of pneumonia such as lethargy, inappetence, increased breathing rate or effort, breathing with head or neck extended, pale or blue gums/tongue, coughing, fever, or any other concerning change in behavior. If these are noted or if your dog does not seem to be acting normal, contact a veterinarian immediately.  
Washington State University