Evaluation of aerodigestive disease and diagnosis of sliding hiatal hernia in brachycephalic and nonbrachycephalic dogs

Abstract

Background Aerodigestive diseases (AeroD), hybrid disorders between the respiratory and gastrointestinal (GI) tracts, may present without GI signs. Sliding hiatal hernia (sHH) is an important AeroD in brachycephalic dogs linked to respiratory pathology. The spectrum of other AeroD and respiratory clinical signs (CS) in brachycephalic and nonbrachycephalic dogs with sHH is unknown. Objectives Characterize CS of AeroD in dogs with sHH, compare CS between brachycephalic and nonbrachycephalic dogs, and compare thoracic radiographs and videofluoroscopic swallow study (VFSS) for diagnosing sHH. Animals Sixty‐seven client‐owned dogs with sHH. Methods Medical records of dogs with sHH presented to the veterinary teaching hospitals at Auburn University and the University of Missouri between 1 January 2009 and 31 December 2020 were retrospectively reviewed. Between group, comparisons were made using Mann‐Whitney test, Chi‐square analysis, and Spearman correlation ( P < .05). Results Dogs with sHH presented with exclusively GI signs (28/67), mixed respiratory and GI signs (22/67), or with exclusively respiratory signs (17/67). Wheras brachycephalic dogs were not significantly more likely to present with respiratory CS ( P = .145), they were younger ( P < .001), and more likely to present in respiratory distress ( P = .02), and with radiographic evidence of aspiration pneumonia ( P < .001) compared to nonbrachycephalic dogs. Six of 12 dogs with normal thoracic radiographs having sHH presented with respiratory CS. For detection of sHH, VFSS was superior to radiographs ( P < .001). Conclusions and Clinical Importance Dogs with sHH may present with exclusively respiratory signs. Respiratory signs may be more severe in brachycephalic compared to nonbrachycephalic dogs. Videofluoroscopic swallow study was superior to thoracic radiographs for detection of sHH in dogs.

A One Health review of aerodigestive disease in dogs

“…2,15,[121][122][123][124][125] This is supported by recent studies in dogs with respiratory clinical signs with AeroD documented using videofluoroscopic swallow studies (VFSS) that had normal thoracic radiographs. 2,15,119 Laryngeal and pharyngeal stimulation, reflux, and occult aspiration triggering cough might be missed by thoracic radiography. 14,126 Further, thoracic radiographs might miss or underestimate the severity of pulmonary pathology.…”

“…Upper airway disorders (pharynx and larynx) Brachycephalic obstructive airway syndrome (BOAS) [11][12][13] Nasal/nasopharyngeal disease Rhinitis 14 Nasal masses 15 Nasopharyngeal stenosis 16 Nasopharyngeal foreign bodies 16 (Figure 1)…”

“…Laryngeal paresis and paralysis 17,18 Laryngeal collapse (nonbrachycephalic) 15,18,19 Pharyngeal collapse 2 Sleep disordered breathing [20][21][22] Lower airways and pulmonary parenchyma Large airway obstruction 23 Tracheitis 2,23 Chronic bronchitis 2,23,24 Bronchiectasis 23,25 Diffuse aspiration bronchiolitis 23,26 Aspiration pneumonia/pneumonitis 27 Interstitial lung disease 24 Idiopathic cough 28,29 Upper digestive tract and esophageal gastric junction (EGJ) Pharyngeal weakness (see Table 2) Pharyngeal masses 46,47 Cricopharyngeal achalasia and dyssynchrony 44,48 Esophageal dysmotility 49 Megaesophagus (see Table 3) Esophagitis 74 Lower esophageal sphincter achalasia-like syndrome (LES-AS) 52,75 Reflux diseases Gastroesophageal reflux disease (GERD) 2,15 Extraesophageal reflux disease (EERD) 2,15 Nasopharyngeal reflux disease (NPRD) 2,15 Esophago-pharyngeal reflux disease (EORD) 2 Sliding hiatal hernia (sHH) 15 Structural disorders of the esophagus Strictures 50 Persistent right aortic arch 50 Esophageal divert...…”

“…40,230 Several studies have also documented esophageal dysmotility alone or in combination with GERD and sHH in brachycephalic dogs of multiple breeds. 15,231 Mild esophageal dysmotility attributable to maturation of the neuromuscular system might be detected in juvenile dogs that might improve up to 1 year of age. 229 Defects in motility and esophageal clearance represent failures in airway protection.…”

“…2,13,231 VFSS is superior to thoracic radiographs for detecting sHH in dogs. 15,231 5.14 | Structural diseases of the esophagus: strictures, persistent right aortic arch, diverticula…”