Acid reflux in dogs
By Ness
Bird - Nutrition Adviser and RVN CertCFVHNut ©
Acid reflux
is the reverse-flow of stomach acid or intestinal fluids into the oesophagus
(gullet) which causes painful inflammation of the mucosal lining. Chronic
reflux is known as gastro-oesophageal reflux disease (GERD).
Causes can include:
- Anaesthesia – Incorrect positioning can relax the gastro-oesophageal sphincter (the opening between the stomach and oesophagus), and not fasting
beforehand
can exacerbate reflux.
- Hiatal hernia – Usually congenital (a birth defect) and hereditary (e.g. in the British Bulldog and Shar Pei), although it can be acquired via injury. The
- Hiatal hernia – Usually congenital (a birth defect) and hereditary (e.g. in the British Bulldog and Shar Pei), although it can be acquired via injury. The
obstructive, partially protruding stomach can impair or weaken the gastro-oesophageal
sphincter’s ability to close.
- Weak
oesophageal sphincter – Reflux is very common in babies. Puppies are vulnerable
too because the sphincter is naturally laxer whilst it is still
developing.
This usually improves with maturity, but some adult dogs may not develop such
an efficient mechanism as others.
- A higher than normal amount of gastrointestinal fluid production – This can result from stress, bacterial infection, feeding your dog spicy food or too
- A higher than normal amount of gastrointestinal fluid production – This can result from stress, bacterial infection, feeding your dog spicy food or too
much oily food.
Stomach ulcers and cancer can also be causative since they increase the
production of a hormone called gastrin which in turn increases
acid production.
- Prolonged acid production – This can be caused by a diet which is too high in fibre because the food remains in the stomach for longer, and acid
- Prolonged acid production – This can be caused by a diet which is too high in fibre because the food remains in the stomach for longer, and acid
production
continues until it is empty.
- Accumulation of secreted acid in the stomach – This may be as a result of irregular meals or long periods between feeds.
- Vomiting – Although vomiting is often symptomatic of acid reflux, it can also be causative because of the damage it can inflict on the oesophagus. There
- Accumulation of secreted acid in the stomach – This may be as a result of irregular meals or long periods between feeds.
- Vomiting – Although vomiting is often symptomatic of acid reflux, it can also be causative because of the damage it can inflict on the oesophagus. There
are
multiple conditions that manifest in vomiting including the ingestion of a
caustic or toxic substance, oesophageal or intestinal foreign bodies,
pancreatitis, megaoesophagus, protozoal parasites, cancer and food allergies.
Repeated vomiting (or regurgitation) in dogs requires veterinary
intervention
so that underlying causes can either be ruled out (e.g. in the event of simple
“hunger sickness”) or be diagnosed and treated appropriately.
It is also
important to bear in mind that inadequate acid production can result in similar
symptoms to those of an excess. When a dog is infected with
H. pylori, these
bacteria secrete an enzyme called urease which converts urea to ammonia. The
ammonia reduces the stomach acidity and this may be
mistaken for acid reflux.
Medicines intended for reflux can be harmful to dogs with insufficient gastric
secretions. This is one reason why we do not
recommend trying to treat the
condition yourself using the various over-the-counter preparations intended for
people. Furthermore, some products
contain inappropriate ingredients for dogs
(e.g. xylitol; an artificial sweetener which is toxic to canines) or have
unsuitable nutrient values (e.g. too much
calcium).
Bilious
vomiting syndrome is caused by the leakage of bile into the stomach. Bile is
produced in the liver, stored in the gall bladder, and released into the small
intestine where it is involved with the digestion of fat. Bilious vomiting is
typically associated with the dog having an empty stomach, but can also be
associated with the consumption of a large volume of fatty food, spicy food or
indigestible material (e.g. grass), or excessive water intake. Careful
nutritional management is often successful in resolving the problem, but again,
it is important to seek veterinary advice in order to rule out more serious
conditions affecting the stomach, intestine and / or gastrointestinal motility.
Medication may be necessary to alleviate the symptoms and help the dog feel
more comfortable.
Symptoms of acid reflux may include vomiting or regurgitation
of food, vomiting of bile, a high temperature, dysphagia (difficulty
swallowing), excessive salivation / lip licking, bad breath, coughing / gulping
/ burping, abdominal noises and discomfort. Crying, adopting an unusual stance
and inappetence may all be signs of pain. Prolonged inappetence can result in
weight loss.
A diagnosis
of acid reflux may often be confirmed by closely observing the symptoms (a
video recording can be helpful for your vet since episodes are often sporadic
and your dog may not be presenting typical signs at the time of the
consultation) and listening to the chest for abnormal sounds after feeding. It
is also a good idea to keep a note of the tim-ing of the symptoms in relation
to the mealtimes, and if you feed a varied diet, details of which foods seem to
worsen or improve matters. Your vet may want to take a blood sample (high calcium,
low magnesium and low vitamin B12 are significant) and / or carry out an
endoscopic examination. This involves passing a tiny camera down the oesophagus
in order to visualise the mucosal lining and look for any irregularity to its
surface or bleeding. Depending on the findings, further diagnostics may be
needed since reflux may be symptomatic of an underlying medical condition.
In
mild cases (particularly in situations whereby a dog is an irregular eater and
vomiting bile when his stomach is empty) nutritional management and / or drug
therapy may be employed first to determine whether careful dietary modification
can help without the need for diagnostic measures.
Medications
used for the treatment of reflux include:-
- Ranitidine (e.g. Zantac) – Typically used for stomach ulcers, and to treat internal inflammation and reduce stomach acidity by inhibiting the H2 receptor
- Ranitidine (e.g. Zantac) – Typically used for stomach ulcers, and to treat internal inflammation and reduce stomach acidity by inhibiting the H2 receptor
responsible for histamine release.
- Sucralfate (e.g. Antepsin) – Attaches to proteins excreted at ulcer/inflammatory sites and provides protection from the stomach acid.
- Omeprazole (e.g. Losec) – A proton pump inhibitor that reduces the amount of gastric acid. Whilst it is often considered the most effective medication
- Sucralfate (e.g. Antepsin) – Attaches to proteins excreted at ulcer/inflammatory sites and provides protection from the stomach acid.
- Omeprazole (e.g. Losec) – A proton pump inhibitor that reduces the amount of gastric acid. Whilst it is often considered the most effective medication
for
reflux, it does not agree with every dog, and is not suitable for long-term
use.
- Metoclopramide – A gastrointestinal pro-kinetic agent that improves the movement of stomach contents through the intestines and also strengthens the
- Metoclopramide – A gastrointestinal pro-kinetic agent that improves the movement of stomach contents through the intestines and also strengthens the
gastroesophageal sphincter.
- Slippery elm (e.g. Dorwest Tree Barks Powder) – A natural remedy that has a soothing effect on the digestive tract. It is intended to slow the passage of
- Slippery elm (e.g. Dorwest Tree Barks Powder) – A natural remedy that has a soothing effect on the digestive tract. It is intended to slow the passage of
food so
should not be used in conjunction with medications such as metoclopramide which
speed it up.
- Antibiotics – Administered in the event of bacterial infection if present.
- Probiotics – Helps to rebalance the gut bacteria, and supportive in the case of many digestive conditions (although not in the event of acute
- Antibiotics – Administered in the event of bacterial infection if present.
- Probiotics – Helps to rebalance the gut bacteria, and supportive in the case of many digestive conditions (although not in the event of acute
pancreatitis).
More research is needed, but gut bacteria are increasingly being implicated in
stress management, and probiotics may potentially help with
both the cause and
effect of reflux.
The
nutritional management of reflux may include:-
- Feeding a diet with reduced protein and fat levels such as the Arden Grange Light and / or Arden Grange Partners Sensitive canned food – Protein
- Feeding a diet with reduced protein and fat levels such as the Arden Grange Light and / or Arden Grange Partners Sensitive canned food – Protein
stimulates the
secretion of the gastric acid, whilst fat decreases the strength of the muscle
between the stomach and oesophagus.
- Feeding soft foods – The oesophagus may be sore and inflamed as a result of acid damage, so wet foods are preferable (particularly during early
- Feeding soft foods – The oesophagus may be sore and inflamed as a result of acid damage, so wet foods are preferable (particularly during early
recovery). Dry
food may be soaked with hot water for about ½ hour prior to serving to soften
it. Soft food also eases the initial workload of the digestive
enzymes, which
can be beneficial for any dog with a compromised digestion.
- A review of feeding times – Smaller more frequent meals can be especially beneficial if a dog is vomiting bile as a result of having a very empty stomach.
- A review of feeding times – Smaller more frequent meals can be especially beneficial if a dog is vomiting bile as a result of having a very empty stomach.
Large meals
can exacerbate reflux because an overly full stomach places excessive pressure
on the diaphragm, causing acid to travel upwards. Although
an evening meal can
be helpful in bridging the gap between teatime and breakfast, this meal should only
be a small one because lying down can relax the
oesophageal sphincter.
- Addressing inappetence – Irregular mealtimes can exacerbate reflux. Insufficient nutrition can also result in weight loss, constipation, loss of energy and
- Addressing inappetence – Irregular mealtimes can exacerbate reflux. Insufficient nutrition can also result in weight loss, constipation, loss of energy and
dietary deficiencies. The chosen product therefore needs to be highly
palatable. Do be wary of very concentrated dry foods however due to their
typically
higher fat content.
- Feeding a highly digestible, low residue diet – A diet which is highly fibrous can exacerbate reflux, but dogs do need a moderate level of fibre. It is best to
- Feeding a highly digestible, low residue diet – A diet which is highly fibrous can exacerbate reflux, but dogs do need a moderate level of fibre. It is best to
avoid
large amounts of fruit and vegetables even if pulped or well-cooked, and
discourage grass eating. Diets such as Arden Grange that include beet
pulp are
a good option because they contain a good balance of soluble and insoluble
fibre at a moderate level. Soluble fibre is used for the production of
short-chain fatty acids (which supply energy to the friendly bowel flora) and
to promote good gut motility, whilst insoluble fibre ensures an optimal transit
time of food within the intestine.
- A review of treats and extras – This is important because many popular treats are high in fat (e.g. peanut butter used to stuff feeding toys and cheese /
- A review of treats and extras – This is important because many popular treats are high in fat (e.g. peanut butter used to stuff feeding toys and cheese /
sausage used
as high value training rewards). Lower fat alternatives might include the Arden
Grange Light Crunchy Bites. Many dogs enjoy frozen treats
in hot weather, but
very cold food can cause an oesophageal spasm resulting in regurgitation, so
icy edibles are best excluded from the menu of a dog
with reflux. Conversely,
very hot food can damage the oesophageal sphincter, so meals and treats should
not be fed at heats that exceed body
temperature.
- Address obesity – Being overweight can exacerbate reflux because fat can push the stomach forward and pressurise it.
- Assess the potential for adverse food reactions – Allergies and intolerance to particular ingredients may be significant. If your vet suspects that the
- Address obesity – Being overweight can exacerbate reflux because fat can push the stomach forward and pressurise it.
- Assess the potential for adverse food reactions – Allergies and intolerance to particular ingredients may be significant. If your vet suspects that the
current diet is causing or exacerbating acid reflux, a product with a novel
carbohydrate and protein source (i.e. ones your dog has not eaten before) may
be recommended.
As a
responsible and ethical company, Arden Grange fully appreciates the caution
that must be taken when discussing the potential benefits of nutritional
supplements. It is against the law to make medical claims. Whilst these
ingredients are safe and natural, and may be beneficial to some of the cats and
dogs fed on Arden Grange, we must highlight that their inclusion is not a
substitute for veterinary intervention in the case of a sick animal.