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

Abstract

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.

Long-term management of a dog with idiopathic megaesophagus and recurrent aspiration pneumonia by use of an indwelling esophagostomy tube for suction of esophageal content and esophagogastric tube feeding

“…Depending on the cause, ME is classified into primary ME, which is idiopathic, or secondary ME, which occurs in conjunction with other diseases including myasthenia gravis, hypoadrenocorticism, dysautonomia, polyradiculoneuritis, hypothyroidism, polymyopathies and esophageal cancer [ 1 , 2 , 4 , 6 , 9 , 10 , 11 , 15 ]. A recent study reported that most cases of canine ME were idiopathic (IME) (76%), and the rest were secondary ME (24%), mainly involving myasthenia gravis [ 7 ]. While the treatment for secondary ME is dependent on the underlying disease, there is no curative treatment for IME.…”

“…However, patients with severe ME may develop weight loss, weakness and often complicated aspiration pneumonia (AP) [ 3 , 5 ]. The prognosis of ME is poor, and the median survival time has been reported to be 90 days in dogs [ 7 ]. The prognosis is especially poor in ME with complicating AP, and their median survival time is reported as 16 days [ 7 ].…”

“…The prognosis of ME is poor, and the median survival time has been reported to be 90 days in dogs [ 7 ]. The prognosis is especially poor in ME with complicating AP, and their median survival time is reported as 16 days [ 7 ].…”

“…IME is known as a disease with poor prognosis, especially in cases with complicating AP [ 7 ]. Conventional treatments including upright feeding do not reduce the frequency of regurgitation and the risk of AP.…”

Rapid Resolution of Megaesophagus by Low-dose Levothyroxine in a Hypothyroid dog with Mitral Valve Degeneration

“…Survey radiographs revealed gasfilled and overdistended esophagus and no evidence of pneumonia (Figure 1A and B). Based on a history of regurgitation and the identification of esophageal dilation on survey radiographs without chemical restraint (Manning et al, 2016), thus megaesophagus (ME) was diagnosed. For identifying comorbidities or concurrent diseases which could be a primary cause of ME, the diagnostic evaluations included blood analyses including complete blood counts, serum biochemistry and electrolytes, echocardiography, thyroid profiling, adrenocorticotropic hormone (ACTH) stimulation test, and an acetylcholine receptor antibody tittering.…”