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Jolanta Spuzak, Krzysztof Kubiak, Marcin Jankowski, Jozef Nicpon, Kamila Glinska-Suchocka, Maciej Grzegory, Igor Maksymovych*©
Department of Internal Diseases and Clinical for Horses, Dogs and Cats, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, pl. Grunwaldzki 47, 50-366 Wroclaw, Poland *Department of Clinical Diagnostics, Lviv National University of Veterinary Medicine and Biotechnology, ul. Pekarska 50, 79010 Lviv, Ukraine
ENDOSCOPY IN DIAGNOSTICS OF GASTROESOPHAGEAL REFLUX AND DUODENOGASTRIC REFLUX IN DOGS AND CATS
Key words: gastroesophageal reflux, duodenogastric reflux, endoscopy, dogs, cats.
Introduction
Gastroesophageal reflux is a disturbance in which chyme moves back from the stomach to the esophagus. It occurs when the inferior sphincter of the esophagus is open. Consequently, it leads to an effect of acid gastric contents on the esophagus mucosa, which may cause the esophagus inflammation. In the case of duodenogastric reflux chyme moves back from the duodenum to the stomach, which occurs when the pyloric sphincter is open. The consequence is the effect of the duodenum contents on the gastric mucosa leading to the change of its properties and inflammation. The most frequent reflux signs include : vomit, false vomit, frequent swallowing, ptyalism and changeable appetite (1, 2, 3, 4). The aim of the study
The aim of the study was to evaluate usefulness of the endoscopic examination in diagnostics of gastroesophageal reflux and duodenogastric reflux in dogs and cats.
Materials and methods
The study was conducted on 60 dogs and 30 cats of different breed, size and sex, aged 1-10 years, referred to the Endoscopy Centre of the Department of Internal Diseases with Clinic for Horses, Dogs and Cats with the symptoms of chronic vomit. The endoscopic examination of the anterior segment of the digestive tract was performed in general anesthesia, after 24h fasting and a 6h break in administration of water. General anesthesia was carried out according to the following pattern : Dogs
- premedication : xylasine in a dose 1-2 mg/kg b.w. with atropine in a dose 0.05 mg/kg b.w.,
- main anesthesia : thiopentale in the initial dose 5mg/kg b.w. , and next according to the effect,
- local anesthesia of the throat area : 1% lignocaine. Cats
- xylasine in a dose 1-2 mg/kg b.w. with ketamine in a dose 10-20 mg/kg b.w.,
- local anesthesia of the throat area : 1% lignocaine.
© Jolanta Spuzak, Krzysztof Kubiak, Marcin Jankowski, Jozef Nicpon, Kamila Glinska-Suchocka, Maciej Grzegory, Igor Maksymovych, 2009
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The endoscopic examination was performed using a paediatric Olympus GIF XQ 20 fiberscope.
Results
The examinations conducted in the dogs revealed : esophagitis - in 10 cases, a foreign body in the esophagus - in 2 cases, the open inferior sphincter of the esophagus - in 18 cases, sliding hiatus hernia - in 3 cases, gastritis - in 52 cases, gastric ulcers - in 7 cases, a foreign body in the stomach - in 4 cases, the open pylorus - in 34 cases, proliferative changes in the stomach - in 1 case, hypertrophic pyloric stenosis - in 3 cases, duodenitis - in 9 cases, duodenal ulcers - in 2 cases. In 21 dogs gastroesophageal reflux was diagnosed. In 18 dogs it was caused by the open inferior sphincter of the esophagus, however in 3 dogs it resulted from sliding hiatus hernia. In 34 dogs duodenogastric reflux was diagnosed.
The examinations conducted in the cats revealed : esophagitis - in 6 cases, sliding hiatus hernia - in 2 case, the open inferior sphincter of the esophagus - in 12 cases, gastritis - in 26 cases, gastric ulcers - in 8 cases, proliferative changes in the stomach - in 2 case, the open pylorus - in 20 cases. In 14 cases gastroesophageal reflux was diagnosed on the basis of the endoscopic examination. In 2 case it was caused by sliding hiatus hernia and in 12 cases - by the open inferior sphincter of the esophagus. In 20 cases duodenogastric reflux was diagnosed.
The case reports
Case I concerns a male dog, Yorkshire Terrier, 2 years of age. Yellow vomit, sometimes containing blood, had been observed in the dog for a year. The endoscopic examination revealed : the open inferior sphincter of the esophagus, swollen, reddened and brittle gastric mucosa, yellow chyme, the open pyloric sphincter and visible duodenal contents entering the stomach. On the basis of the endoscopic examination gastroesophageal reflux and duodenogastric reflux were diagnosed. The specimens of the gastric mucosa were collected from the stomach for the histopathological examination. The histopathological examination showed chronic, active gastric mucosa inflammation of a moderate degree.
Case II concerns a female cat, of the European breed, 13 years of age. Vomit, most frequently containing bile, had been observed in the cat for about 7 months. The endoscopic examination revealed : reddened mucosa of the esophagus, the open sphincter of the esophagus, swollen, reddened and brittle gastric mucosa, the open pyloric sphincter and visible duodenal contents entering the stomach.Gastroesophageal reflux and duodenogastric reflux were diagnosed on the basis of the endoscopic examination. The specimens of the gastric mucosa were collected from the stomach for the histopathological examination. The histopathological examination showed chronic gastric mucosa inflammation of high activity and intensity without neoplastic changes.
Case III concerns a male dog , French Bulldog, 1.5 years of age. Sporadic vomit had been observed in the dog since the puppy time. During the recent 5 months the intensity of vomit had intensified and it appeared 3-4 times daily in the previous month. The endoscopic examination showed the signs of the haemorrhagic esophagitis with clots and fresh blood in its thoracic segment, the widely open stomach cardia, transfer of the stomach wall to the esophagus synchronized with breathing movements and the signs of the chronic gastritis. The endoscopic
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examination allowed the diagnosis of sliding hiatus hernia responsible for gastroesophageal reflux.
Conclusions
Based on the above observations it was proved that the endoscopic examination of the esophagus is a highly useful technique in diagnosing gastroesophageal reflux and duodenogastric reflux in dogs and cats. It is often the only diagnostic method. The histopathological examination of the collected mucosa samples specifies the diagnosis, which chanels further treatment.
References
1. Jergens A. E.: Diseases of the Esophagus. In:Handbook of Small Animal Practice, Morgan R.V., 323-333.
2. Nieradka R., Depta A., Rychlik A., Kander M., Nowicki M., Chrz^stowska M., Sarti K.: Refluks dwunastniczo-zol^dkowy u psow. XIV Kongres PSLWMZ Kardiologiczno-Gastroenterologiczny, Wroclaw, 9-10.09.2006 r., 27-35.
3. Nieradka R., Depta A., Rychlik A., Kander M., Sarti K., Chrz^stowska M.: Choroby przelyku u psow i kotow. XIV Kongres PSLWMZ Kardiologiczno-Gastroenterologiczny, Wroclaw, 9-10.09.2006 r., 45-48.
4. Suter P. F.: Choroby ukladu pokarmowego. W: Praktyka kliniczna: psy. Niemand H. G., Suter P. F., 689-792.
Summary
The aim of the study was to evaluate usefulness of the endoscopic examination in diagnostics of gastroesophageal reflux and duodenogastric reflux in dogs and cats. The study was conducted on 60 dogs and 15 cats of different breed, size and sex, aged 1-10 years, referred to the Endoscopy Centre of the Department of Internal Diseases with Clinic for Horses, Dogs and Cats with the symptoms of chronic vomit. The examinations conducted in the dogs revealed: esophagitis - in 10 cases, a foreign body in the esophagus - in 2 cases, the open inferior sphincter of the esophagus - in 18 cases, sliding hiatus hernia - in 3 cases, gastritis - in 52 cases, gastric ulcers - in 7 cases, a foreign body in the stomach - in 4 cases, the open pylorus - in 34 cases, proliferative changes in the stomach - in 1 case, hypertrophic pyloric stenosis - in 3 cases, duodenitis - in 9 cases, duodenal ulcers - in 2 cases. In 21 dogs gastroesophageal reflux was diagnosed. In 18 dogs it was caused by the open inferior sphincter of the esophagus, however in 3 dogs it resulted from sliding hiatus hernia. In 34 dogs duodenogastric reflux was diagnosed.
The examinations conducted in the cats revealed : esophagitis - in 6 cases, sliding hiatus hernia - in 2 case, the open inferior sphincter of the esophagus - in 12 cases, gastritis - in 26 cases, gastric ulcers - in 8 cases, proliferative changes in the stomach - in 2 case, the open pylorus - in 20 cases. In 14 cases gastroesophageal reflux was diagnosed on the basis of the endoscopic examination. In 2 case it was caused by sliding hiatus hernia and in 12 cases - by the open inferior sphincter of the esophagus. In 20 cases duodenogastric reflux was diagnosed.
Стаття надшшла до редакцИ 25.09.2009
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