Esophagitis in Small Animals
Inflammation of the esophagus is usually caused by foreign bodies, gastroesophageal reflux, and occasionally certain drugs (eg, doxycycline). Gastroesophageal reflux is usually associated with anesthesia, drugs that decrease lower esophageal sphincter tone (eg, atropine, acepromazine), and acute or chronic vomiting. Other causes of esophagitis include ingestion of an irritating or caustic substance, neoplasia, and Spirocerca lupi infection (see Spirocerca lupi in Small Animals). Feeding tubes that traverse the gastroesophageal junction may result in gastroesophageal reflux. Calicivirus in cats may also cause esophagitis.
Regurgitation is the classic sign of esophagitis; others include ptyalism, repeated swallowing attempts, pain, depression, anorexia, dysphagia, and extension of the head and neck. Mild esophagitis may have no associated clinical signs.
Endoscopy is the diagnostic tool of choice. It allows visualization of any associated problems (eg, foreign body) and direct assessment of esophageal damage. Plain radiographs are of little or no benefit in the diagnosis of esophagitis. An esophagram under fluoroscopy demonstrates any associated esophageal motility defects secondary to the esophagitis and may demonstrate esophageal wall defects if severe.
Mild esophagitis may require no treatment. If clinical signs are present, medical therapy should be instituted. Esophagitis secondary to gastroesophageal reflux is treated by decreasing gastric acidity, increasing lower esophageal sphincter tone, increasing the rate of gastric emptying, and providing pain control. In most cases, H2-receptor antagonists (eg, ranitidine, famotidine) are sufficient to decrease gastric acid production; however, in severe cases of esophagitis, a proton pump inhibitor (eg, omeprazole) is preferred. Cisapride and metoclopramide increase lower esophageal tone and the rate of gastric emptying. Cisapride is more potent than metoclopramide. A sucralfate slurry may also be administered orally for esophageal cytoprotection. Soft food, low in fat and fiber, should be fed in small, frequent meals. Systemic analgesics may be used for pain relief.
If esophagitis is severe, a gastrostomy tube may be used to completely rest the esophagus. The administration of corticosteroids to prevent esophageal stricture formation is controversial. Broad-spectrum antibiotics should be used for concurrent aspiration pneumonia and may be useful in severe esophagitis as an attempt to prevent bacterial invasion and infection.