Megaesophagus and GERD in Bulldogs and Fr. Bulldogs

Dr. Kraemer 🚑,

My Fr. Bulldog, Oliver, has been retching and passively regurgitating his entire meal soon after finishing his food. From your article, I suspect it might be the megaesophagus or GERD.

Oliver is such an important part of our family ❤️. I was worried that he would inhale some of it and end up with pneumonia. 

Best regards,#OliverTheFrenchie #BulldogMegaesphagus #BulldogPrevention 🛡️

Introduction to Megaesophug in Bulldogs and Fr. Bulldogs

The bulldog esophagus is a muscular tube that serves as a vital part of the digestive system in dogs. It connects the throat (pharynx) to the stomach, facilitating the passage of ingested food and liquids.

BULLDOG ESOPHAGUS ANATOMY

The esophagus is a muscular tube that connects the mouth to the stomach, playing a critical role in the digestive process by transporting food and liquids. It’s composed of layers of smooth muscle that work together in coordinated movements, known as peristalsis, to propel the food downward.

Lined with a mucous membrane, the esophagus is designed to lubricate and protect food passage. At its lower end, the esophagus features a muscular ring called the lower esophageal sphincter (LES), which functions as a valve to prevent stomach contents from flowing back into the esophagus, maintaining the efficiency of digestion.

Bulldog Megaesophagus and GERD 5 X MUST KNOW

1. The most common cause of Megaesophagus in bulldogs is brachycephalic obstructive airway syndrome (BOAS)
2. The whole mark of the Megaesophagus is regurgitation
3. Regurgitation often leads to aspiration pneumonia, a potentially deadly disease
4. Care includes weight management, the timely repair of BOAS, and elevated upright feedings
5. Prevention and Care include Dr. Kraemer’s Megaesphagus and GERD Bundles 

Members of this bulldog community prefer prevention over RX

What is Bulldog Gastroesophageal Reflux Disease (GERD)?

Gastroesophageal Reflux Disease (GERD) in bulldogs occurs when the lower esophageal sphincter (LES), a valve between the stomach and esophagus, malfunctions. Normally, this valve prevents stomach acids from flowing back into the esophagus. However, if the LES becomes loose or does not close properly, it allows stomach acids to splash back upward, leading to irritation, inflammation, and esophagitis. This condition can cause significant discomfort and potentially lead to further complications if left untreated.

 🚨GERD===> vomiting, gastric reflux===>esophagitis===>megaesphgus

WHAT CAUSES BULLDOG & FR. BULLDOG GERD?

There are multiple underling case of bulldog GERD inculding:

• Loose LES (lower esophageal sphincter)
• Hiatal hernia
• Obesity
• Certain diets
• Drugs like NSAIDs
• BOAS (brachycephalic obstructive airway syndrome)

Bulldogs and French Bulldogs MEGAESOPHAGUS

Megaesophagus in Bulldogs and French Bulldogs is a medical condition where the esophagus becomes abnormally enlarged, dilated, and forms a distended pouch. This esophageal pocket traps chewed food and liquids, preventing them from moving efficiently down to the stomach. As a result, your bulldog may experience regurgitation, difficulty swallowing, and inadequate nutrition due to the inability to properly transport food to the stomach for digestion.

What Causes Megaesophagus in Bulldogs and French Bulldogs?

While megaesophagus in most canine breeds is primarily attributed to neuromuscular disease and GERD, the predominant cause in bulldogs is commonly associated with Brachycephalic Obstructive Airway Syndrome (BOAS).

1. MEGAESOPHAGUS DUE TO BOAS:

In bulldogs and French bulldogs, the primary cause of megaesophagus is acid reflux due to brachycephalic airway syndrome, of which the primary contributors are:

➡️ Elongated Soft Palate

➡️ Stenotic Nares

➡️ Others:

• Everted Laryngeal Saccules
• Hypoplastic Trachea
• Laryngeal Collapse
• Swollen Nasal Turbinate
• Obstructing Aberrant Nasal Turbinate’s (CAT)
• Laryngeal Obstruction
• Oropharyngeal Narrowing

BOAS induce anatomical and physiological changes that ultimately ends in megaesophagus

Those BOAS changes include:

1. Airway compression abnormalities
2. Airway resistance
3. Negative intra-airway pressure
4. Intradominal pressure
5. High vasovagal tone

🚨BOAS===>gastric reflux===>esophagitis===>megaesphgus===>regurgitation 

2. MEGAESOPHAGUS DUE TO TO NON-BOAS MEDICAL CONDITIONS

Several less common potential diseases can lead to megaesophagus, including:

• Esophageal obstructions due to a foreign body
• GERD
• Esophageal obstructions due to stricture or mass
• Neuromuscular diseases
• Infectious diseases
• Immune system abnormalities
• Hormonal disorders, and toxins
• Diaphragmatic Hernia
• Esophageal and gastric Sphincter problems

What are The Symptoms of Bulldog and Fr. Bulldog Megaesophagus?

➡️ REGURGITATION: undigested whole food

➡️ HACKING and RETCHING

➡️ WEIGHT LOSS

➡️ DYSPHAGIA: Difficulty swallowing

➡️ COUGH: mostly due to the aspiration of acid and food to the lungs

What is The Difference between Regurgitation and Vomiting?

Some bulldog owners fail to distinguish between regurgitation and vomiting.

It’s crucial to recognize the clear differences and understand the distinct underlying causes of each.

VOMITING BULLDOG:

• STOMACH: food that reaches the stomach interacts with digestive juices and is mixed up with bile
• CONTRACTION & EXPULSION: involve retching, nausea  with forceful stomach contractions, and expulsion
• COMMON TO:
  • gastritis
  • gastroenteritis
  • viral, bacteria
  • dietary indiscretion
  • food poisoning

REGURGITATING BULLDOG:

• ESOPHAGUS: food that never reached the stomach, therefore is whole in appearance
• PASSIVE EXPULSION: effortless expulsion passive
• COMMON TO:
  • Megaesophagus

How Bulldog Megaesophgus Cause ASPIRATION PNEUMONIA?

In brachycephalic breeds like French bulldogs, and English Bulldogs, regurgitated, undigested food can accidentally enter the trachea, which may then pass into the lungs. This condition, known as aspiration, often causes inflammation and infection in the lower airway, leading to a serious condition called aspiration pneumonia.

🚨BOAS===> vomiting, gastric reflux===>esophagitis===>megaesphgus===>regurgitation===>aspirating===>pneumonia

Megaesophagus in Bulldogs and French Bulldogs: DIAGNOSIS

Many tests should be considered, but the most important ones for bulldogs and French bulldogs are:

1. NOSE AND SOFT PALATE EVALUATION

Evaluation of the soft palate and larynx is critical in the case of bulldog megaesophagus since it’s the leading cause of this condition.

2. CONTRAST RADIOGRAPHS:

Chest and abdominal X-rays, including barium contrast swallowing

3. OTHER IMAGING:

Endoscopy and ultrasound.

How to Prevent and Treat Megaesophagus in Bulldogs and French Bulldogs?

Managing the megaesophagus in bulldogs requires multiple steps;

1. MEGAESOPHAGUS DIETS:

Try feeding smaller meals with simple ingredients and blending your diet into a grueling consistency.

Raise the food and give only a little at a time, as demonstrated in this video

2. BULLDOG MEGAESOPHAGUS UPRIGHT FEEDING:

For bulldogs with megaesophagus, feeding should be done in an elevated position to use gravity to help move food toward the stomach. A custom “Bailey” chair is recommended, which places your bulldog in an upright position, ensuring that meals are more easily guided downward into the stomach.

3. MEGAESOPHAGUS SOFT PALATE & NARES REPAIR:

Elongated palates and stenotic nares are among the most prevalent causes of megaesophagus in bulldogs and French bulldogs. Therefore, it’s crucial to have them corrected promptly by a skilled bulldog surgeon.

4. BULLDOG, MEGAESOPHAGUS and GERD RX

Various Rx might be required to help reduce vomiting, acidity, and gastric reflux

➡️ Antiemetics (anti vomit):

• Reglan
• Cernia

➡️ Anti-Acid/Reflux:

• Pepsid-C (Famontadine)
• Omeprazole

➡️ Other:

• Cisapride
• Viagra (esophageal sphincter)

VIAGRA TREATMENT FOR BULLDOG MEGAESOPHAGUS:

Sildenafil, commonly known as Viagra, was originally developed to treat cardiovascular conditions, with its role in managing erectile dysfunction being a later, unintended discovery. Beyond its well-known use, sildenafil is also employed in both humans and pets to address pulmonary hypertension by relaxing the smooth muscles in the lungs and reducing the heart’s workload.

🔍 Recent research indicates that sildenafil may be beneficial in treating certain cases of megaesophagus in dogs. It works by relaxing and dilating the blood vessels around the esophageal sphincter, thereby enhancing the esophagus’s movement and improving the passage of food.

MEGAESOPHAGUS and GERD THERAPEUTIC SUPPLEMENTS:

• Dr. Kraemer’s V4B Bully Probiotics Bundle helps balance the gut microbiome
• V4B Bully Immune Support and Anti Oxidants help boost the immune system
• V4B Bully HEMP Calm & Relax and Bully StressLess help reduce anxiety

 

Megaesophagus in Bulldogs and French Bulldogs / TIPS & WARNINGS:

Here are a few megaesophagus and GERD tips and warnings courtesy of Dr. Kraemer

#1 🩺 MEGAESOPHAGUS WHOLE vs. DIGESTED FOOD TIP:

In cases of bulldog megaesophagus, the material expelled after regurgitation is typically whole, meaning it is undigested. This regurgitation occurs shortly after your dog has eaten. In contrast, vomiting involves the expulsion of partially or fully digested content, often mixed with yellow bile.

#2🩺 MEGAESOPHAGUS CONTRAST RADIOGRAPH TIP:

Chest and abdominal radiographs combined with barium dye contrast material are recommended when diagnosing megaesophagus in bulldogs and French bulldogs.

#3 🩺 GERD & MEGAESOPHAGUS UPRIGHT FEEDING TIP

For serious cases of bulldog megaesophagus, I recommend a special chair that forces your bulldog puppy to eat in an upright, near-vertical position.

Try to keep your bulldog puppy at that elevated position for an additional 10 minutes after feeding

#4 🩺 BULLDOG MEGAESOPHAGUS  FOOD CONSISTENCY TIP:

For Megaesophagus in Bulldogs and French Bulldogs, I recommend a blend prescription smooth watered-down gruel puree-like diet.

#5 🩺 MEGAESOPHAGUS & GERD SLOW FEEDER TIP:

For megaesophagus and GERD, I recommend using an elevated slow feeder, as demonstrated in this photo. You can purchase a specialized slow feeder or utilize something like a cupcake baking plate. Elevating the feeder can be achieved using a step or by hand-feeding from a higher position for effective management

#6 🩺 BULLDOG GERD and MEGAESOPHAGUS RX TIP:

You can also add a daily promotility medication such as anti-vomit, anti-reflux, or anti-acid medication.

🚫 Remember, prescription medication can have long-lasting side effects

#1 ⚠️ GERD and MEGAESOPHAGUS PNEUMONIA WARNING:

Aspiration pneumonia cases require aggressive antibiotic therapy and may also require hospitalization, which includes:

• oxygen supplementation
• injectable nausea and anti-vomiting medication
• intravenous fluid therapy
• nursing care

All bulldog aspiration pneumonia should be considered serious and potentially life-threatening.

#2 ⚠️ BULLDOG MEGAESOPHAGUS & GERD BOAS WARNING:

Bulldogs and French Bulldog puppies suffering from Brachycephalic syndrome, like the elongated palate, stenotic nares, and hypoplastic trachea are at a higher risk of incurring megaesophagus

#3 ⚠️ MEGAESOPHAGUS & GERD  BLENDED DIET WARNING:

Large, dry, lumpy foods are more likely to get trapped in the dilated pocket of the megaesophagus; the food should be smooth and have an even consistency. You can blend it in a food processor or soak it in water.