Achalasia‐Like Disease with Esophageal Pressurization in a Myasthenic Dog

Kempf, Jennifer; Beckmann, Katrin; Kook, Peter H

doi:10.1111/jvim.12329

Cited by 11 publications

(12 citation statements)

References 23 publications

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“…Although sporadic cases of functional LES obstruction have been suspected in dogs, comparable etiologic information is lacking. Functional LES disorders in dogs rarely are diagnosed because of limitations in currently available testing used in dysphagia evaluation . However, functional LES disorders may represent an important, yet undetected, subpopulation of dogs with ME, perhaps responsive to targeted intervention and with a different long‐term prognosis.…”

Section: Introductionmentioning

confidence: 99%

Videofluoroscopic swallow study features of lower esophageal sphincter achalasia‐like syndrome in dogs

Grobman

Schachtel²,

Gyawali

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) disorders causing functional obstruction are rare causes of ME that may respond to targeted treatment. Functional LES disorders are reported rarely in dogs because of challenges in diagnostic methodologies. Hypothesis/Objectives To identify dogs with videofluoroscopic swallow study (VFSS) features of LES achalasia‐like syndrome (LES‐AS). We hypothesized that dogs with LES‐AS could be distinguished from normal dogs using standardized VFSS criteria. Animals Dogs with LES‐AS by VFSS (n = 19), healthy normal dogs (n = 20). Methods Retrospective study. One‐hundred thirty dogs presented to the University of Missouri Veterinary Health Center (MU‐VHC) between April 2015 and December 2017 for a free‐feeding VFSS; 20 healthy dogs were included as controls. Swallow studies were evaluated for failure of the LES to relax during pharyngeal swallow (LES‐AS). Affected dogs subsequently were evaluated using standardized criteria to identify metrics important for identifying and characterizing dogs with LES‐AS. Results Nineteen dogs with LES‐AS were identified out of 130 VFSS. Megaesophagus was present in 14 of 19 (73.7%) dogs with LES‐AS. A baseline esophageal fluid‐line and “bird beak” were present in 68.4% (95% confidence interval [CI], 47.5%‐89.3%) and 63.2% (95% CI, 41.5%‐84.8%) of affected dogs, respectively. The esophagus was graded as acontractile (8/19), hypomotile (8/19), or hypermotile (3/19). Conclusions and Clinical Importance Dogs with LES‐AS may successfully be identified by VFSS using a free‐feeding protocol. These data are of critical clinical importance because a subpopulation of dogs with functional LES obstruction may be candidates for targeted intervention.

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Section: Introductionmentioning

confidence: 99%

Videofluoroscopic swallow study features of lower esophageal sphincter achalasia‐like syndrome in dogs

Grobman

Schachtel²,

Gyawali

et al. 2019

Veterinary Internal Medicne

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“…It represents a rare cause of ME that responds to targeted intervention and is considered distinct from conditions that cause esophageal hypomotility without functional LES obstruction. This condition has been suspected in dogs, with a few case reports over the last 4 decades and most presumptive diagnoses being made without manometry or dynamic imaging studies . The lack of recognition of this syndrome in dogs may in part be a consequence of limitations in available diagnostic tests.…”

Section: Discussionmentioning

confidence: 99%

“…High‐resolution manometry is considered the gold standard for diagnosis of LES achalasia in people. Unfortunately, this modality is not routinely performed in veterinary medicine because of limited availability, high cost, need for operator expertise, and patient compliance . However, before the adoption of the HRM in people, contrast swallow studies were used to diagnose LES achalasia and, although only moderately sensitive, were considered highly specific for this condition .…”

Section: Discussionmentioning

confidence: 99%

“…This condition has been suspected in dogs, with a few case reports over the last 4 decades and most presumptive diagnoses being made without manometry or dynamic imaging studies. 22,[25][26][27][28][29][30] The lack of recognition of this syndrome in dogs may in part be a consequence of limitations in available diagnostic tests. High-resolution manometry is considered the gold standard for diagnosis of LES achalasia in people.…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, this modality is not routinely performed in veterinary medicine because of limited availability, high cost, need for operator expertise, and patient compliance. 29,31 However, before the adoption of the HRM in people, contrast swallow studies were used to diagnose LES achalasia and, although only moderately sensitive, were considered highly specific for this condition. 7,16,32 Only a few manometric studies in dogs with ME have been performed, and these did not identify LES achalasia to the extent documented in our study.…”

Section: Discussionmentioning

confidence: 99%

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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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Mega‐Esophagus and Esophageal Dysmotility

Köster¹

2017

Chronic Disease Management for Small Animals

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Achalasia‐Like Disease with Esophageal Pressurization in a Myasthenic Dog

Cited by 11 publications

References 23 publications

Videofluoroscopic swallow study features of lower esophageal sphincter achalasia‐like syndrome in dogs

Videofluoroscopic swallow study features of lower esophageal sphincter achalasia‐like syndrome in dogs

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

Mega‐Esophagus and Esophageal Dysmotility

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