Megaesophagus:::What is Canine Megaesophagus?:::

In which life stage was MegaE (not inc. other clinical conditions) dx'd?
Infancy (0 - 8 wks)
Puppyhood (8 wks - 10 months)
Adolescence (11- 18 months)
Young Adult (19 - 23 months)
Adult (2 yrs - 8 yrs)
Senior (9 yrs - Infinity)

Megaesophagus Survey

Method(s) Used to Determine Diagnosis

~ Please include all that apply ~

Age @ Diagnosis

Survey created 01 January 2008

Survey created 06 September 2006

Megaesophagus can rear it's ugly head during any life stage:

(1) infancy, (2) puppy, (3) adolescent, (4) young adult, (5) adult, or (6) senior

Megaesophagus is first classified as being one of two types:

(1) Congenital (2) Acquired or Idiopathic Mega-E.

The nomenclature for Mega-E

also seems to be interchangeable.

Here are the 'alternative'

-- sometimes interchangeable --

synonyms for "Megaesophagus"

. . . Hopefully I have them all.

Achalasia

Cardiospasm

Oesophageal atony

Oesophageal dilation

Oesophageal hypomotility

Oesophageal motility disorder

Idiopathic neuromuscular dysfunction

Esophageal aperistalsis

Dyssynergia esophagus

Note: In Britain, diseases like megaesophagus along with bodily parts like the esophagus are spelled by throwing in an unnecessary extra A or O,

as if they weren't hard enough to spell in the first place.

British spelling:

Oesophagus, Oesophageal

Spelling in the USA:

Esophagus, Esophageal

Abbreviations, UK:

megaO, shortest abbreviation? MO

USA: megaE, or ME

MegaTrivia

Read more about Doogal @ DogsDeserveBetter.Org

Contact Carrie, Doogal's foster Mums, with any

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Megaesophagus aspiration pneumonia myasthenia gravis regurgitation nausea digestive tract vomiting congenital idiopathic disease Gastric Bowel Colon esophagram endoscopy flouroscopy DNA Shar Pei genetic Gordon Irish Setter autosomal recessive dominant achalasia German Shepherd Irish Setter Labrador Retriever Great Dane Miniature Schnauzer Inherited disorders breed predisposition Addisons Hypoadrenocorticism adrenal glands corticosteroids Canine Diversity Cushings bloat hypothyroidism hypoadrenocorticism thyroid mendalian Inheritance Esophageal dilatation Washabau esophagitis Metoclopramide Reglan Gastroenteritis Hiatal hernia immune mediated intestinal bowel IBD laryngeal paralysis neuromuscular thallium lead toxins Malabsorption Syndrome Pancreatic Insufficiency polyneuropathy PRAA Stricture GI

Welcome to My World

canine meg·a·e·soph·a·gus

"Once you choose hope and knowledge,

anything is possible."

Management requires 'trial & error' & dedicated effort

Every dog will have its own idiosyncrasies in symptom response

Many are unfamiliar with this disorder - including some Veterinarians

Define Canine Megaesophagus (CME) & symptoms

Cite clinical conditions related to Megaesophagus

Explain all potential causes of Megaesophagus

Website Objectives:

Greenough's Eva Diva DreamWeaver

What do I do now?

First, don't panic! Your dog may be lightly afflicted and even if he or she is 'more severely' afflicted, there is definitely hope.

Here are a few suggestions others have found helpful:

You may bring a fresh sample of "vomit" for the veterinarian to examine

Note: The pH of vomit containing food is acid. The pH of regurgitated materials is higher." Taking a fresh sample to your veterinarian may help dethim/her ermine if your dog is regurgitating, or if it truly is vomiting. URL: WSU

Your dog may only regurgitate food. Or he/she may only regurgitate water Some regurgitate both food and water.

You may find it helpful to videotape a (water &/or food) 'vomit' session

Then take the videotape to your Veterinarian for his/her analysis.

You may think "acid reflux" and be correct.

Esophagitis due to gastric reflux is frequently associated with Mega-E. This means your dog may be experiencing 'heartburn' symptoms & this can be very painful.

You may have concluded that your dog has some sort of food intolerance

You may be correct. Often there are ingredients in common dog foods which

may cause an "allergic flare" *****(inflammatory) response.

You may have decided you need to feed smaller meals more frequently

You are definitely correct. Feeding smaller meals more frequently should reduce symptoms to a varying degree, dependent upon other variable factors.

You may not know to feed elevated (45 degrees) or vertical (90 degrees)

As soon as you have secured your appointment with your Vet, try feeding the

next meal "chin up"! Gravity is absolutely one of the "best friends" for your best friend. Feeding elevated or vertical while waiting for your appointment should

not hurt your dog, even if Megaesophagus is not the diagnosis.

Go to your first appointment prepared

YOU are your dogs best friend and ally. Your Vet is his second best friend.

Together you will form a team to get this all sorted out. Be patient with your Vet. You may want to ask, "Could this be Megaesophagus?" Remember, Mega-E is not dx'd every day . . . thank d-o-g! Go to your appointment refreshed. Sleep deprivation due to night-time regurges is fairly common. This is yet another symptom that could help your Vet determine his/her definitive dx.

Understand that there could be another, underlying cause

In some cases this could actually be a good thing! Your Vet. may refer you to a specialist to rule out -- or in -- any other potential primary causes for the symptoms you have noticed. There are ten conditions that are most common, and your dog may have one of those ten, but there are others which are found more infrequently. The ten most common conditions, of which your dog may have one,,, or *none*, are listed at the top of the "Clinical Conditions" page.

Megaesophagus may be further complicated by:

(1) Lower Esophageal Sphincter

(2) Gastric Emptying & Ulceration (strictures can form if esophagitis is severe)

(3) Motility Disorders (gnrl. term used to describe problems with peristalsis)

(4) Esophageal Obstruction or Strictures (surgical correction is possible)

(5) Medication Induced (Epi)

(6) Chemical, Botulinum Toxin, or Lead Induced Metal Toxicity or Neuropathy

(7) H. Pylori Infection (successful treatment is possible)

(8) Swallowing Disorder (Cricopharyngeal Achalasia - surgical correction is possible)

(9) Diaphragmatic (1) and/or Hiatal Herniations (2) (surgical corrrection is possible)

* Note: See Greenough's Eva Diva - Our Experience

(10) PRAA or Vascular Ring Anomaly (surgical correction is possible)

(11) Inflammatory Bowel Disease (IBD), Small Bowel & Colonic

(12) Secondary Clinical Conditions (see 10 most common conditions)

Three Surveys Have Been Created:

Out of genuine concern & realization that a way must be found to help encourage the scientific community to grant further research funding for Megaesophagus & Myasthenia Gravis.

To help 'discovery' be obtained that these dogs are living proof that being diagnosed with Megaesophagus is not a death sentence -- they can and do live well beyond the estimated 'guarded prognosis' lifespan -- with proper care.

To ascertain whether or not fewer dogs in more recent times may be euthanized due to Megaesophagus than may have been calculated in the past. (Locate statistic, source, year)

To hopefully recognize that there may be more dogs dx'd as having either Megaesophagus and/or Myasthenia Gravis than has been previously reported.

~ ~ ~ ~ ~

Please checkmark all that apply, answering honestly.

Thank You!

Note: The date within each survey auto updates each time this page is updated. A creation date notation has been made below each survey.) All answers are exclusively confidential to you as the contributor.

Clinical Conditions Related to MegaE

Sign Page:

Canine, Vomiting or regurgitation, emesis

CONSULTANT

Dr. Maurice E. White

A Diagnostic Support System

for Veterinary Medicine

em·e·sis (m-ss): n. pl. em·e·ses (-sz)

The act of vomiting.

Before reading the text and viewing the x-rays, please understand that

esophageal achalasia is considered by some to be a rare occurrence,

and to be the rarest of all esophageal abnormalities.

However, there seems to be a faction of the veterinary who may commonly refer to megaesophagus as achalasia.

The x-ray studies of the esophagus are shown

closer to the bottom of

the page.

Esophageal achalasia and secondary megaesophagus in a dog

Understanding "Regurge"

Differentiating 'regurge' from vomiting

Regurge may signal weak esophagus

Food comes out before it goes down

GRAVITY is GRrrr-eat!

Congenital Megaesophagus

Even though symptoms may not have been recognized during infancy, but *are* recognized while he or she is either still a puppy or young adolescent, and no trauma or injury is indicated, in this scenario Megaesophagus is generally accepted as being "congenital" (birth defect(s)). Sometimes there is another primary condition such as PRAA, diaphragmatic herniation, hiatal herniation. In such instances, Megaesophagus may be a secondary congenital condition.

Acquired Idiopathic Megaesophagus

During life stages (4) young adult, (5) adult, and (6) senior, when injury or trauma seemingly are not indicated, and no other tributary disease state can be found.

Primary or Secondary Megaesophagus?

Lastly, discovery must be made as to whether or not Megaesophagus is a primary or secondary condition. Are there other causes to which the symptoms of Megaesophagus can be attributed? This question is best answered via diagnostics.

Achalasia or Megaesophagus?

CAM Therapies

Complimentary & Alternative Medicine

CAM 'integrative' type possibilities for therapy could include one or a combination of: acupuncture, acupressure, chiropractic, homeopathy, herbal medicine, and nutritional changes.

Acupressure

Acupuncture *1

Acupuncture *2

Herbology

Homeopathy

Naturopathy

VOM (Veterinary Orthopedic Manipulation)

TCM (Traditional Chinese Medicine)

TCVM (Traditional Chinese Vet Medicine)

Pet Massage

WSAVA Acupuncture/Megaesophagus

Acadamy of Veterinary Homeopaths (Referral Search)

Veterinary Botanical Medical Association

Long Island Health Associates (Megaesophagus/Achalasia)

AVHMA

Exploration of alternative

& complementary areas

of health care in veterinary medicine

American Veterinary Chiropractic Association

International Veterinary Acupuncture Society

Clinical Conditions Related to MegaE

Esophageal Achalasia Dog

Megaesophagus Symptoms

There *are* methods you can implement to slow -- or halt -- the progression of the syndrome, but first you must learn to recognize the symptoms (see list above).

Regurgitation? Not Vomiting?

Regurgitation may be the first sign you notice. Either food or water, sometimes both, may be regurgitated. Regurge is a "passive" act -the stomach muscles typically do not contract or heave. The food brought up by regurgitation is usually undigested, may have a tubular shape, and is often covered with a slimy mucous. He/she will often try to eat the regurgitated material.

Megaesophagus by Definition:

Mega ("enlarged") esophagus is actually a collective term used to describe several esophageal disorders & malformations, but yes, it does mean enlarged. As well as the "mega" enlargement (dilation), the esophagus typically is lacking normal peristaltic ("waves of muscular contraction") function, thus becoming an inert tube, unable to propel ("motility disorder") food to the stomach. In essence, the esophagus is paralyzed ("vagal afferent innervation") to a varying degree. Food and/or liquid can thus remain in the esophagus-- sometimes minutes, sometimes hours, or yes -- even days.

Megaesophagus is classified as a gastrointestinal (alimentary sys./digestive tract) disorder, and often has neuromuscular and respiratory 'linkage'. Mega-E may also be a degenerative neural condition, but this is not always the case. It is a clinical disorder (disease) that can be, *but is not always*, progressive in nature.

Human Achalasia = esophageal hypomotility, increased LESP

(meaning Lower Esophageal Pressure)

Canine Megaesophagus = esophageal hypomotility, sometimes

increased LESP, sometimes decreased LESP

Surgery, Human Achalasia:

(Laproscopic) Cardioplasty, Roux-en-Y partial gastrectomy

(also thoracoscopic)

Hellers Myotomy

Fundoplication (dor) (toupet/birdbeaked E/dilated Sigmoid)

Esophageal Dilatation

Esophagocardiomyotomy

Esophagectomy

- - - - -

Surgery, Canine Megaesophagus:

Balloon dilation (stricture), n(diaphragmatic herniation), n(hiatal herniation), n(PRAA)

esophagopexy, gastropexy

Anesthesia also requires special measures in Megaesophagus dogs.

Note: Sometimes while a dog is under anesthesia for surgery, gastric reflux can cause stomach acids to pool in the esophagus -- this can lead to Megaesophagus.

It is important to never force feed a dog

who has Mega-E. Force feeding could

easily increase the chance of ASPIRATION!

The Immune Mediated Disorder Aspect

Immune diseases of the dog are placed into six different categories:

(1) type I or allergic conditions;

(2) type II or auto- and allo-antibody diseases;

(3) type III or immune complex disorders;

(4) type IV or cell-mediated immune diseases;

(5) type V conditions or gammopathies; and

(6) type VI or immunodeficiency disorders.

Note: This section is being developed (1/27/2008)

WSAVA 2001 - Autoimmune Disease with Oral ComponentsThe clinical signs include pain, undulating fever, dysphagia, and megaesophagus. Diagnosis is by eosinophilia on the CBC, leukocytosis, increases in ALT, ...

www.vin.com/VINDBPub/SearchPB/Proceedings/PR05000/PR00068.htm - 34k

http://www.siriusdog.com/articles/hereditary-congenital-diseases-dog-2.htm

http://www.canine-epilepsy-guardian-angels.com/ImmuneSystem.htm

http://www.canine-epilepsy-guardian-angels.com/ThyroidDisease.htm

http://www.critterchat.net/immune.htm

Allergic Pneumonia

Myasthenia (auto)

Hypothyroidism (auto)

Addisons

Immune Mediated SLE (see also:

http://www.videxgsd.com/immune_system_problems.htm)

autoimmune/neuromuscular

http://www.siriusdog.com/articles/canine-immune-system-disease-resistance.htm

Immunity

by Mimi Cary, PhD Biochemistry (Immunology)

Rabies Challenge Fund and information

Gastritis

Emaciation

Listlessness

'Water gorging'

Loss of appetite

Nasal discharge

Rapid weight loss

Difficulty sleeping

Slow or halted growth

Regurgitation of water

Regurgitation of solids

Sudden change in voice

Chronic hyper salivation

Sour or foul smelling breath

Passive expelling of mucous

Tires easily - muscle weakness

Intolerance of certain dietary fats

Passive expelling of digestive fluid

Puffing of the cheeks on expiration

Stretching the neck out as far as it will go

Gurgling sounds (foreign matter in lungs -- AP)

Touch sensitivity -- chest cavity and/or abdomen

Appearance of nausea in presence of food aromas

Dry, unproductive retching and/or soft, moist cough

May detect a faint 'clicking' sound upon movement

Difficulty in swallowing (may be both exaggerated & frequent)

Abnormal movement when walking: may indicate muscle weakness & even dysphagia

"Megaesophagus is the most

common cause of regurgitation

in dogs."

~ Mary Labato, DVM

Tufts University School

of Vet.erinary Medicine

Twenty-seven (27!) Symptoms

that can indicate Megaesophagus

(Megaesophagus ~plus~related disorders)

Mega-E can be life threatening

or fatal if left unattended.

PLEASE consult with your DVM & Specialists

Find a Specialist Near You

(American College of Veterinary Internal Medicine Foundation)

Locate Emergency/Critical Care Near You

(The Veterinary Emergency & Critical Care Society)

When I started researching for details about Mega-E, it wasn't long before I realized that information seemed contradictory at times and confusing at others. As one Mega-E Mom so aptly stated, "The more I read, the less I knew ...

... or wanted to know. "

It is hoped that these

pages will help you

better understand

the disorder(s).

Don't miss Eva's Story

Click here

Mega-E Support Group

FACT

Congenitally affected dogs are usually (but not always) clinically affected by age 12 weeks.

Milder cases may not be totally obvious until approximately one year of age. The symptoms may have been weak, but were present all along -- just somehow missed. If your dog is in this age range and was recently dx'd , please think back. How much time have you been able to spend observing your pup for symptoms?

Read Plato's Story, in which the definition of 'idiopathic' at a Vet. Sci. teaching hospital is redefined. To them, idiopathic really means "we are idiots" -- the cause is there but we can't find it! Some believe later onset or 'idiopathic' megaesophagus could be a milder form of the disease/disorder that is also genetically attributed, but has delayed onset.

As Megaesophagus is often classified as an esophageal developmental abnormality, it is also believed by many

to be "most likely' genetic".

~ ~ ~

Learn more here and here.

Although breed predispositions are recognized for many GI disorders, in most cases the scientific studies to establish inheritance have not yet been done.