Prevalence of Gastroesophageal Reflux in Cats During Anesthesia and Effect of Omeprazole on GastricpH

Abstract

BackgroundGastroesophageal reflux (GER) is poorly characterized in anesthetized cats, but can cause aspiration pneumonia, esophagitis, and esophageal stricture formation.ObjectiveTo determine whether pre‐anesthetic orally administered omeprazole increases gastric and esophageal pH and increases serum gastrin concentrations in anesthetized cats, and to determine the prevalence of GER using combined multichannel impedance and pH monitoring.AnimalsTwenty‐seven healthy cats undergoing elective dental procedures.MethodsProspective, double‐masked, placebo‐controlled, randomized clinical trial. Cats were randomized to receive 2 PO doses of omeprazole (1.45–2.20 mg/kg) or an empty gelatin capsule placebo 18–24 hours and 4 hours before anesthetic induction. Blood for measurement of serum gastrin concentration was collected during anesthetic induction. An esophageal pH/impedance catheter was utilized to continuously measure esophageal pH and detect GER throughout anesthesia.ResultsMean gastric pH in the cats that received omeprazole was 7.2 ± 0.4 (range, 6.6–7.8) and was significantly higher than the pH in cats that received the placebo 2.8 ± 1.0 (range, 1.3–4.1; P < .001). Omeprazole administration was not associated with a significant increase in serum gastrin concentration (P = .616). Nine of 27 cats (33.3%) had ≥1 episode of GER during anesthesia.Conclusions and Clinical RelevancePre‐anesthetic administration of 2 PO doses of omeprazole at a dosage of 1.45–2.20 mg/kg in cats was associated with a significant increase in gastric and esophageal pH within 24 hours, but was not associated with a significant increase in serum gastrin concentration. Prevalence of reflux events in cats during anesthesia was similar to that of dogs during anesthesia.

Chronic Gingivostomatitis with Esophagitis in Cats

“…Exposure to acid can further decrease sphincter pressure at the same time as injury to the mucous membrane, and the low pressure can increase the probability of additional reflux, which initiates a vicious cycle. At the time of recording, visual laxity of the esophageal sphincter was not evident in our study, even though acepromazine has been incriminated previously to affect its pressure Additionally, esophageal pH measurements did not indicate GER at the time of recording, based on previously reported literature . However, gastric pH was not recorded for the 2 groups.…”

“…At the time of recording, visual laxity of the esophageal sphincter was not evident in our study, even though acepromazine has been incriminated previously to affect its pressure 21 Additionally, esophageal pH measurements did not indicate GER at the time of recording, based on previously reported literature. 22 However, gastric pH was not recorded for the 2 groups. Taken together, visual laxity of the sphincter, abnormal pΗ measurements or refluxed material was not observed in our study, making the hypothesis of typical GER disease rather unlikely.…”

Clinical and radiographic findings in cats with aspiration pneumonia: retrospective evaluation of 28 cases

“…Abnormalities of oesophageal function, such as megoesophagus, reflux oesophagitis and myasthenia gravis, are also known contributors (Marik ). Dogs have been reported to have many of the same predisposing risk factors as humans, with the additional major category of recent vomiting and regurgitation (Strombeck & Harrold , Wilson & Walshaw , Kogan et al , , Ovbey et al , Garcia et al ). Similar predisposing factors were revealed in this population of cats with aspiration pneumonia, with recent vomiting and recent anaesthesia being the most common.…”

ACVIM consensus statement: Support for rational administration of gastrointestinal protectants to dogs and cats

“…Preanesthetic administration of IV esomeprazole at 12‐18 hours and 1‐1.5 hours before anesthetic induction to 22 dogs undergoing elective orthopedic procedures was associated with a significant increase in gastric and esophageal pH throughout the surgery procedure compared to a placebo group, but did not have an impact on the number of reflux events . Similarly, preanesthetic administration of 2 PO doses of omeprazole in cats at 18‐24 hours and 4 hours before anesthetic induction, respectively, was associated with significant increases in gastric and esophageal pH within 24 hours . Other preventive measures for decreasing reflux esophagitis in dogs undergoing surgery are administration of cisapride or metoclopramide, with cisapride being more effective …”