Prospective evaluation of surgical management of sliding hiatal hernia and gastroesophageal reflux in dogs

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Background Information regarding clinical signs, assessment, treatment, and outcome in cats with hiatal hernia (HH) is limited. Objectives To characterize the clinical presentation of HH and medical and surgical outcomes in a cohort of affected cats. Animals Thirty‐one client‐owned cats with HH. Methods Medical records of cats with HH were retrospectively reviewed for signalment, history, results of diagnostic tests, details of surgical and medical treatments, complications, and outcome. Long‐term follow‐up data were obtained by telephone communication. Relationships between clinical variables and outcome were evaluated by regression analysis. Results Type I HH was present in 85.7% (24/28) of cats, and 64.5% (20/31) were >3 years of age at diagnosis. Twenty‐one of 31 (67.7%) cats underwent surgical repair including phrenoplasty, esophagopexy, and left‐sided gastropexy, and 10 of 31 cats were treated medically without surgery. Concurrent illness was common, and 77.4% cats had comorbidities. All cats survived to discharge, and median time to death or follow‐up was 959 days (range, 3‐4015 days). Cats treated medically survived longer than cats treated surgically, with median time to death or follow‐up of 2559 and 771 days, respectively. Conclusions and Clinical Importance Type I HH is the most common type of HH in cats. A congenital etiology is possible, but many cats with HH were >3 years of age at diagnosis and suffered from comorbidities, including upper airway obstruction. Case selection and the presence of comorbidities likely influenced the outcome. Cats with HH may not be diagnosed until disease is advanced or concurrent illness draws attention to clinical signs.

Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%

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Clinical findings, diagnostic test results, and treatment outcome in cats with hiatal hernia: 31 cases (1995‐2018)

Phillips

Corrie

Engel

et al. 2019

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“…Gastroesophageal disease (ie, GER with signs such as heartburn and regurgitation) is common in humans and MA of GER has been detected in various respiratory diseases in humans, including IPF, cystic fibrosis, COPD, and asthma . GER occurs commonly in dogs under anesthesia and with various disease processes, and a recent study suggests that GER disease might be more common in dogs than previously suspected . In healthy dogs GER without MA has been shown to occur (Grobman et al Abstract, 27th ECVIM‐CA Congress, 2017).…”

Section: Discussionmentioning

confidence: 99%

Reflux aspiration in lungs of dogs with respiratory disease and in healthy West Highland White Terriers

Määttä

Laurila

Holopainen

et al. 2018

BackgroundGastroesophageal reflux and microaspiration (MA) of gastric juice are associated with various human respiratory diseases but not in dogs.ObjectiveTo detect the presence of bile acids in bronchoalveolar lavage fluid (BALF) of dogs with various respiratory diseases.AnimalsTwenty‐seven West Highland White Terriers (WHWTs) with canine idiopathic pulmonary fibrosis (CIPF), 11 dogs with bacterial pneumonia (BP), 13 with chronic bronchitis (CB), 9 with eosinophilic bronchopneumopathy (EBP), 19 with laryngeal dysfunction (LD), 8 Irish Wolfhounds (IWHs) with previous BPs, 13 healthy WHWTs, all privately owned dogs, and 6 healthy research colony BeaglesMethodsProspective cross‐sectional observational study with convenience sampling of dogs. Bile acids were measured by mass spectrometry in BALF samples. Total bile acid (TBA) concentration was calculated as a sum of 17 different bile acids.ResultsConcentrations of TBA were above the limit of quantification in 78% of CIPF, 45% of BP, 62% of CB, 44% of EBP, 68% of LD, and 13% of IWH dogs. In healthy dogs, bile acids were detected less commonly in Beagles (0/6) than in healthy WHWTs (10/13). Concentrations of TBA were significantly higher in CIPF (median 0.013 μM, range not quantifiable [n.q.]‐0.14 μM, P < .001), healthy WHWTs (0.0052 μM, n.q.‐1.2 μM, P = .003), LD (0.010 μM, n.q.‐2.3 μM, P = .015), and CB (0.0078 μM, n.q.‐0.073 μM, P = .018) groups compared to Beagles (0 μM, n.q.).Conclusion and Clinical ImportanceThese results suggest that MA occurs in various respiratory diseases of dogs and also in healthy WHWTs.

“…Surgical management of HH and GER in dogs using hiatal plication, esophagopexy, and gastropexy has been described, with variable outcomes and persistent GER and sliding HH postoperatively in some patients. 39 Airway surgery therefore could be more effective in resolving these conditions because it targets the cause rather than the clinical signs. Further exploration is warranted in a larger population of dogs with BOAS monitored postoperatively.…”

Section: Resultsmentioning

confidence: 99%

Retrospective analysis of esophageal imaging features in brachycephalic versus non‐brachycephalic dogs based on videofluoroscopic swallowing studies

Eivers

Rueda

Liuti

et al. 2019

Background Idiopathic esophageal dysmotility (ED) is increasingly recognized in young dogs of brachycephalic breeds. Few studies have objectively associated specific videofluoroscopic swallowing study (VFSS) features with brachycephaly, leading to under‐recognition of ED in brachycephalic breeds. Hypothesis/objectives To describe and compare VFSS in brachycephalic dogs versus non‐brachycephalic dogs presented for dysphagia or regurgitation, and to investigate associations between these imaging findings and patient signalment. Methods Retrospective analysis of VFSS of dogs presented for dysphagia or regurgitation (not megaesophagus) from 2006 to 2017. Cases were divided into brachycephalic and mesaticephalic breeds. The VFSS were reviewed using a standardized protocol by 2 examiners. Esophageal motility was assessed using specific criteria, and particular imaging features were noted and graded. Fisher's exact test was used to determine associations among signalment (including brachycephaly), final diagnosis, outcomes, and ED features. Results Thirty‐six dogs were included (n = 10 normal, n = 26 presumed ED). Twenty dogs (77%) with presumed ED were brachycephalic with a median age of 1 year (range, 0.2‐10.5 years). Most common were prolonged esophageal transit time (ETT; n = 21/26), decreased propagation of secondary peristaltic waves (n = 20/26), and gastroesophageal reflux (GER; n = 18/28). Eight dogs (all brachycephalic) had hiatal herniation (HH). Morphological esophageal variations were only observed in brachycephalic dogs. Brachycephaly was significantly associated with ED ( P = .005), prolonged ETT ( P = .41), GER ( P = .02), and HH ( P = .03). Conclusions and Clinical Importance The majority of dogs with presumed ED was young and brachycephalic and had specific abnormalities that were less frequent in mesaticephalic dogs with regurgitation or dysphagia.