Clinical factors associated with death before discharge and overall survival time in dogs with generalized megaesophagus

McBrearty, Alix; Ramsey, Ian; Courcier, Emily; Mellor, D. J.; Bell, R. H.

doi:10.2460/javma.238.12.1622

Cited by 37 publications

(58 citation statements)

References 15 publications

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“…Megaesophagus can be congenital or acquired [23]. Acquired megaesophagus is classified as idiopathic or secondary to other diseases such as myasthenia gravis [24, 25] (with or without thymic neoplasia [26, 27]), hypoadrenocorticism [7, 28, 29], hypothyroidism [30–32], tetanus [33], and dysautonomia [34, 35] to name a few.…”

Section: Radiographymentioning

confidence: 99%

“…Since the right middle lung lobe is a common site for aspiration, the left lateral thoracic view is essential for complete assessment of the lung (Figure 2) [38]. When megaesophagus is identified, the presence of aspiration pneumonia has a negative association with survival time [23]. In cases where the cause for dysphagia is not clear on survey radiographs, barium contrast studies should be postponed if severe aspiration pneumonia is present, as aspiration of barium during the imaging procedure will further compromise lung function.…”

Section: Radiographymentioning

confidence: 99%

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Imaging Evaluation of Dogs and Cats with Dysphagia

Pollard

2012

ISRN Veterinary Science

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Section: Radiographymentioning

confidence: 99%

Section: Radiographymentioning

confidence: 99%

Imaging Evaluation of Dogs and Cats with Dysphagia

Pollard

2012

ISRN Veterinary Science

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“…Megaesophagus (ME) in dogs is a motility disorder of the esophagus that carries a poor long‐term prognosis with death frequently reported secondary to respiratory complications, malnutrition or both, or euthanasia because of poor quality of life . For dogs with idiopathic ME, interventions are limited in part because of a lack of understanding of the underlying disease mechanisms.…”

Section: Introductionmentioning

confidence: 99%

Mechanical dilation, botulinum toxin A injection, and surgical myotomy with fundoplication for treatment of lower esophageal sphincter achalasia‐like syndrome in dogs

Grobman

Hutcheson

Lever

et al. 2019

Veterinary Internal Medicne

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Background Megaesophagus (ME) carries a poor long‐term prognosis in dogs. In people, lower esophageal sphincter (LES) achalasia is a rare cause of ME that may respond to targeted intervention. Dogs with lower esophageal sphincter achalasia‐like syndrome (LES‐AS) have been described recently, warranting investigation of analogous targeted treatment. Hypothesis/Objectives Evaluate response of dogs with LES‐AS to LES mechanical dilation and botulinum toxin A (BTA) injections, with or without surgical myotomy and fundoplication. We hypothesized that clinical and videofluoroscopic swallow study (VFSS) features of LES‐AS would improve after treatment targeting functional LES obstruction. Animals Fourteen client‐owned dogs with LES‐AS diagnosed by VFSS. Methods Retrospective study. Dogs diagnosed with LES‐AS underwent treatment between April 2015 and December 2017. Outcome measures included client perception of clinical severity, body weight (BW), body condition score (BCS), regurgitation frequency, and VFSS parameters (ME, esophageal motility, gastric filling). Dogs with positive responses were considered candidates for LES myotomy with fundoplication. Results By a median IQR of 21 (IQR, 14‐25) days after mechanical dilation and BTA, clients reported clinical improvement in 100% of dogs, BW increased 20.4% (IQR, 12.7%‐25%), pre‐ and post‐treatment BCS was 3 (IQR, 3‐4) and 5 (IQR, 4‐5), respectively, and frequency of regurgitation decreased by 80% (IQR, 50%‐85%). Duration of effect was 40 (IQR, 17‐53) days. Despite clinical improvement, ME and abnormal esophageal motility persisted in 14 dogs. Six dogs subsequently underwent myotomy and fundoplication and maintained improvement observed after mechanical dilation and BTA. Conclusions and Clinical Importance Dogs with LES‐AS experienced significant, temporary, clinical improvement after mechanical dilation and BTA. Preliminary results suggest myotomy with fundoplication provide lasting clinical benefit despite persistence of ME.

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“…Acquired idiopathic megaesophagus carries a poor to guarded prognosis. The median survival time from hospital admission (or diagnosis) to death or euthanasia ranges from 1 to 3 months with an overall case fatality rate of 74% . Regurgitation is the most common clinical sign observed in dogs with megaesophagus and aspiration pneumonia is the most common cause of death .…”

mentioning

confidence: 99%

“…Regurgitation is the most common clinical sign observed in dogs with megaesophagus and aspiration pneumonia is the most common cause of death . Dogs with megaesophagus and concurrent radiographic evidence of aspiration pneumonia have a 7.69 fold increased risk of dying before discharge from the hospital and are 2.2 times as likely to die at any given time point as compared to dogs without aspiration pneumonia …”

mentioning

confidence: 99%

Intermittent At‐Home Suctioning of Esophageal Content for Prevention of Recurrent Aspiration Pneumonia in 4 Dogs with Megaesophagus

Manning

Birkenheuer

Briley

et al. 2016

Veterinary Internal Medicne

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BackgroundMegaesophagus carries a poor to guarded prognosis due to death from aspiration pneumonia. Options for medical management of regurgitation are limited to strategic oral or gastrostomy tube feeding.ObjectivesTo describe the use and efficacy of intermittent esophageal suctioning to prevent regurgitation and associated episodes of aspiration pneumonia in dogs with megaesophagus.AnimalsFour dogs with acquired idiopathic megaesophagus and recurrent aspiration pneumonia.MethodsRetrospective review of medical records of dogs with megaesophagus in which intermittent suctioning of esophageal content was employed for management of recurrent aspiration pneumonia.ResultsIntermittent suctioning of the esophagus was initiated in 4 dogs after failure of strict gastrostomy tube feeding failed to prevent regurgitation and repeated episodes of aspiration pneumonia. Suctioning was accomplished by esophagostomy tube in 3 dogs and per os in 1 dog. After initiation of esophageal suctioning, dogs survived for a median of 13.5 additional months (range, 10–30 months) during which time 2 dogs had no additional episodes of aspiration pneumonia and 2 dogs had infrequent episodes of pneumonia, but aspiration was suspected to be a contributing factor in their death. Complications included clogging of the esophagostomy tube, esophagostomy site infections, and esophagitis.Conclusions and Clinical ImportanceUse of intermittent esophageal suctioning in dogs with megaesophagus that continue to regurgitate despite gastrostomy tube feedings can reduce or abolish clinical episodes of aspiration pneumonia.

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Clinical factors associated with death before discharge and overall survival time in dogs with generalized megaesophagus

Abstract: Radiographic evidence of AP and the age at onset of clinical signs were the only variables found to be significantly associated with survival time in this study, and this should be considered when advising on prognosis in dogs with megaesophagus.

Cited by 37 publications

References 15 publications

Imaging Evaluation of Dogs and Cats with Dysphagia

Imaging Evaluation of Dogs and Cats with Dysphagia

Mechanical dilation, botulinum toxin A injection, and surgical myotomy with fundoplication for treatment of lower esophageal sphincter achalasia‐like syndrome in dogs

Intermittent At‐Home Suctioning of Esophageal Content for Prevention of Recurrent Aspiration Pneumonia in 4 Dogs with Megaesophagus

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