Dr. Becker Article: Symptoms of GERD - Excessive Licking, Coughing, Swallowing...

[Wylie's Mom]

I thought this was an excellent article on GERD and its symptoms in dogs:

Does Your Pet Lick and Cough Incessantly? It Could Mean This...

By Dr. Becker

Gastroesophageal reflux disease – also known as GERD, reflux esophagitis, or acid reflux – is a condition in which there is an uncontrolled backflow of gastric or intestinal fluids into the esophagus, which is the tube that connects the throat to the stomach. Gastrointestinal fluids – which include stomach acid, pepsin, bile, and other components – can damage the mucosal lining of the esophagus and cause inflammation, a condition called esophagitis.

GERD is seen in both dogs and cats. Younger animals with congenital (present at birth) hiatal hernias are at increased risk.

Causes of Gastroesophageal Reflux in Pets

Acid reflux can occur when a pet is given anesthesia that causes the esophageal sphincter to relax, creating an opening between the stomach and the esophagus. This most often happens when a patient is improperly positioned while undergoing anesthesia on the surgery table, or when an animal isn’t fasted properly before receiving anesthesia.

The congenital condition known as hiatal hernia is thought to increase the risk for esophageal reflux. A hiatal hernia is a protrusion of abdominal contents into the chest cavity through the esophageal hiatus, a natural opening through the diaphragm. Young pets are at greater risk of developing this condition because their esophageal sphincters are still developing.

Long-term or chronic vomiting is another risk factor for GERD, along with cancer of the esophagus, and the presence of esophageal foreign bodies.

Symptoms of GERD

Symptoms of reflux include regurgitation of fluid, mucus, and undigested food.

It’s important to note that regurgitation is different from vomiting. Vomiting is an active process -- you can typically see your pet’s abdomen or chest heaving as his body prepares to rid itself of something. If you’re lucky, you notice the signs in time to grab some tissue because you know it’s coming.

Regurgitation, on the other hand, is spontaneous. Your pet is walking through the room and suddenly, up it comes. At times your pet may swallow before anything escapes her mouth. Other times, regurgitation may cause fluid to fly out of her mouth without warning.

Another symptom of acid reflux is excessive salivation. There can also be loss of appetite, weight loss, and persistent gulping or lip licking. I sometimes call it “air licking,” where an animal is constantly swallowing and licking, swallowing and licking.

Some pets with GERD self-soothe by licking weird objects like the carpet or the couch. There can also be pain on swallowing or really hard swallowing, as well as a non-progressive but persistent cough.

Diagnosing Acid Reflux in Pets

The most accurate method for diagnosing esophageal reflux is a procedure called an esophagoscopy, which involves using an internal camera to view the lining of the esophagus to look for changes in the mucosal membrane or active bleeding.

Other tests your veterinarian may run include a complete blood count (CBC), a biochemical profile, a urinalysis, chest X-rays, and an esophagram (which is actually a barium swallow). Your vet might also perform a fluoroscopy, which is a procedure that allows visualization of the barium as it travels down the esophagus.

Other causes for your pet’s symptoms can include having swallowed a caustic agent, a foreign body or tumor in the esophagus, a disease of the throat or mouth, or megaesophagus -- a condition in which the muscles of the esophagus don’t function properly while moving food down to the stomach.

Treatment Options

Most pets with gastroesophageal reflux don’t need to be hospitalized unless the condition is severe and requires nutritional support through a stomach tube or intravenous (IV) feeding.

Traditional home care typically includes a low-fat, low- to-moderate-protein diet served in small frequent feedings, along with gastric acid inhibitors, medications to coat and soothe the esophageal lining, GI motility drugs, and antibiotics if an infection is present. If antibiotics are given, probiotics should also always be given.

After the esophagus has healed, I transition my patients to a low-residue, balanced, home-prepared diet consisting of cooked bland veggies and meats. I have found that many pets with GERD have underlying food sensitivities. To treat the root cause in those cases, I recommend eliminating allergenic ingredients like gluten, rice, soy, and all genetically modified (GM) foods. Eliminating all preservatives, colorings, additives, and emulsifiers is also a great idea.

The best long-term treatment I have found for many GERD patients may surprise you. In conjunction with nutritional management and normalization of gastric acid secretion, I have had success using acupuncture, and especially chiropractic to control reflux. I see the most consistent positive changes in the number of reflux episodes when chiropractic care is initiated.

I’m not a licensed animal chiropractor nor am I certified in spinal manipulation therapy, but I work with a doctor who is. And I refer many of my long distance patients to gifted chiropractors in their area who have helped to significantly reduce the intensity and frequency of their pet’s acid reflux. Controlling episodes of reflux has dramatically improved the quality of life for those animals.

Additional Suggestions

--Many patients benefit from the addition of colostrum, bentonite clay, bismuth, and probiotics to their diet. You can also submit a simple NutriScan saliva test to help pinpoint your pet’s food hypersensitivities. Then if your dog or cat does have food intolerances, you can customize a diet to reduce the recurrence of GERD in the future.

--Interestingly, I have found that hypochlorhydria, which is lack of sufficient stomach acid, has also contributed to acid reflux in pets, as well as the additional symptoms of burping, gas, and abdominal bloating. It’s important to know which of these situations is affecting your pet, however, since a lack of stomach acid is treated very differently from an overproduction of acid. Giving supplements to increase gastric acid production to an animal that has an ulcer or esophagitis will obviously make matters much worse.

--I also recommend evaluating your pet’s source of water. Offering fluoride-free water is really important for all animals, but especially those dealing with GERD.

--If an animal has a hiatal hernia or other condition that is contributing to the reflux, it will need to be repaired in order to resolve symptoms of GERD.

--Pets with reflux should be handled very carefully when undergoing anesthesia.

--It’s also very important to avoid late-night feedings, as they tend to relax the esophageal sphincter while the animal is sleeping, which can contribute to worse reflux in the morning.