Disorders of the Esophagus in Cats
Signs of problems with the esophagus include difficulty swallowing and regurgitation (return of food or fluid before it has reached the stomach). Congenital abnormalities of the esophagus are discussed elsewhere.
Inflammation of the esophagus (esophagitis) is usually caused by certain drugs (such as doxycycline), foreign objects, or acid reflux. Other causes include eating an irritating or caustic substance, cancer, and calicivirus infection. Acid reflux can be associated with anesthesia, certain drugs, vomiting, and feeding tubes. Signs of esophagitis include regurgitation, drooling, difficulty or repeated swallowing, pain, depression, loss of appetite, and extension of the head and neck. Mild inflammation may produce no visible signs and often requires no treatment. Esophagitis is diagnosed by using a special camera called an endoscope that allows a veterinarian to look inside the esophagus.
If your cat displays signs of esophagitis, your veterinarian will likely recommend treatment. If the problem is caused by acid reflux (a cause of heartburn in people), drugs may be prescribed to reduce stomach acid, to decrease reflux, to protect the esophagus, and to relieve pain. Your veterinarian may recommend feeding your pet a diet of soft food, low in fat and fiber, in small, frequent meals. If esophagitis is severe, a feeding tube may need to be surgically placed into the stomach, bypassing the esophagus to allow it to rest. Antibiotics are sometimes prescribed to prevent bacterial infection.
Esophageal dysmotility is an abnormal movement of the esophagus. Cats can be born with esophageal dysmotility, or it can develop because of certain neurologic disorders, tumors in the chest, or narrowing of the esophagus (esophageal stricture). Sometimes, the cause is unknown. Many cats can improve with the use of medications.
Cats are generally pickier eaters than dogs, but occasionally they will get foreign objects lodged in the esophagus. Bones are the most common, but other objects such as needles, string, thread, fishhooks, and wood may also become stuck. Signs include excessive drooling, gagging, regurgitation, and repeated attempts to swallow. If the object is stuck for a long time, decreased appetite, weight loss, and lethargy may be seen. The object can also perforate the esophagus and cause serious complications.
Many foreign objects can be seen on x-rays. If a foreign object is found in the esophagus, a veterinarian will need to remove it as soon as possible. Most of the time, the object can be removed with an endoscope, which is a small video camera within a flexible tube that can be placed into the esophagus. Surgery is necessary if the esophagus has been perforated or the foreign object cannot be removed using endoscopy. In these cases, most patients recover, but there is an increased risk for poor healing or narrowing of the esophagus (stricture).
Esophageal stricture is a narrowing of the esophagus. It may develop after trauma (for example, ingestion of a foreign object, caustic substance, or certain drugs), inflammation of the esophagus, gastroesophageal reflux (gastric acid flowing back into the esophagus), or tumor invasion. Signs include regurgitation, excessive drooling, difficulty swallowing, and pain. Examining the esophagus using fluoroscopy and endoscopy are the preferred methods for diagnosis. This enables the veterinarian to actually see the number, location, and types of strictures. Endoscopy may also allow the veterinarian to correct the stricture at the time of examination.
Treatment with a balloon catheter has been successful. The catheter is a tube that is placed in the esophagus and then advanced to where the stricture occurs. The tip of the catheter is then inflated like a balloon, which stretches the esophagus and relieves the stricture. Other methods, including surgery, have been less successful.
Diverticula are pouch-like expansions (dilations) of the esophageal wall. They can be inherited or acquired; however, they are rare in cats. There are 2 types of acquired diverticula: pulsion and traction. Pulsion diverticula are caused by an increase in pressure inside the esophagus or deep esophageal inflammation, which leads to a rupture (hernia) of the inner lining. Traction diverticula are caused by inflammation in the chest cavity close to the esophagus. Fibrous tissue is formed and then contracts, pulling the esophageal wall outward.
Small diverticula may cause no signs. Large diverticula can trap food in the pouch, causing the cat to have trouble breathing, vomit, or stop eating. Contrast x-rays can be used to diagnose the disorder. Endoscopy (using a tiny video camera in a flexible fiber optic tube) can allow the veterinarian to see the pouch and any ulceration or scarring that may be present.
Small diverticula can usually be treated with a bland, soft food diet. The animal should also eat in an upright position (having the forelegs raised higher than the rear legs, such as on a ramp or platform, and holding this position for a short period of time after eating). Large diverticula require surgery involving removal of the pouch and rebuilding of the esophageal wall. The outlook for recovery after surgery is fair to good.
Also see professional content regarding esophageal disorders.