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 wondering if you could share your expertise and provide any advice on managing these issues. I was worried that he would inhale some of it and end up with pneumonia.  🩺💊💉Best regards,#OliverTheFrenchie #BulldogMegaesphagus #BulldogPrevention🐶

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 made up of layers of smooth muscle that contract and relax in coordinated movements, known as peristalsis, to propel food toward the stomach.

The esophagus is lined with a mucous membrane that helps lubricate and protect the passage of food. Additionally, the lower end of the esophagus has a sphincter (muscular ring) that acts as a valve, preventing the backflow of stomach contents into the esophagus.

Overall, the canine esophagus plays a crucial role in the digestion process, ensuring the smooth and efficient transport of food from the mouth to the stomach.

The esophagus is the tube that connects the mouth to the stomach.

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

Bulldog Gastroesophageal Reflux Disease (GERD)

Gastroesophageal Reflux Disease (GERD) happens due to a faulty valve between the stomach and esophagus named the lower esophageal sphincter (LES). In a healthy bulldog, this valve prevents acid flow from going upward to the esophagus, but if the value is not tight and the seal becomes loose, stomach acids can splash upward back into the esophagus, causing irritation and inflammation (esophagitis).

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

Bulldog GERD Cause and Contributors

• 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 disorder characterized by an abnormally large, dilated, distended esophageal pouch. This pocket traps chewed food and liquid in the esophagus, preventing it from continuing to slide downstream onto the stomach.

Megaesophagus in Bulldogs and French Bulldogs / CAUSE:

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).

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 

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

Bulldog Megaesophagus PRESENTATION:

• 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

Bulldog Regurgation Versa 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

Megaesophagus in Bulldogs: ASPIRATION PNEUMONIA

In brachycephalic breeds like French bulldogs, and English Bulldogs, regurgitated, undigested food may inadvertently enter the trachea, leading to its passage into the lungs. This occurrence, known as aspiration, often results in inflammation and subsequent infection in the lower airway, medically termed “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

Megaesophagus in Bulldogs and French PREVENTION & TREATMENT:

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 carried out in an elevated position, utilizing gravity to guide the meal downward toward the stomach.

A custom “Baily” chair that places your bulldog in an upright position is recommended for this purpose.

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:
  • Reglan
  • Cernia
• Anti-Acid/Reflux:
  • Pepsid-C (Famontadine)
  • Omeprazole
• Other:
  • Cisapride
  • Viagra (esophageal sphincter),

VIAGRA TREATMENT FOR BULLDOG MEGAESOPHAGUS

Sildenafil, widely recognized under the brand name Viagra for its role in treating erectile dysfunction by enhancing blood flow, was initially developed for cardiovascular conditions, with its use in managing erectile dysfunction emerging as an unintended discovery.

Originally, Viagra was utilized in both humans and pets to address pulmonary hypertension, as it aids in relaxing the smooth muscles in the lungs, thereby reducing the heart’s workload. Recent findings have shown its effectiveness in treating certain cases of megaesophagus in dogs, particularly by relaxing and dilating the blood vessels around the esophageal sphincter and enhancing the movement of the esophagus.

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

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.

MEGAESOPHAGUS CONTRAST RADIOGRAPH TIP:

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

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

BULLDOG MEGAESOPHAGUS  FOOD CONSISTENCY TIP:

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

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

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

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.

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

MEGAESOPHAGUS & GERD  BLENDED DIET

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.