What is megaesophagus?

Megaesophagus occurs when the esophagus loses its muscular tone and becomes flaccid and dilated, making it unable to propel food to the stomach. Instead, food and fluid gather in the esophagus, leading to regurgitation and a high risk of aspiration pneumonia. The condition is more common in dogs than cats and may require lifelong management strategies. 🐶🥤

Diagnosing underlying causes

• Test for myasthenia gravis and Addison’s disease unless congenital.
• Consider rarer causes: lead poisoning, neuromuscular diseases, esophagitis, parasites.
• Consult with a specialist if condition doesn’t improve with standard care.

Managing Esophagitis & Acid Irritation

Chronic regurgitation leads to esophagitis—treat with:

• Sucralfate liquid as a soothing esophageal “bandage.”
• Combine with acid blockers: famotidine, omeprazole, or compounded cisapride.
• Pain control using gabapentin or tramadol.
• Anti-nausea meds: maropitant or ondansetron.

Other helpful medications

• Sildenafil/tadalafil relax lower esophageal sphincter.
• Pro-motility drugs: metoclopramide, cisapride, low-dose erythromycin.
• Bethanechol may help rare cases with residual neuromuscular tone.
• Antibiotics for aspiration pneumonia (4–6 weeks). Add mucolytics (e.g., acetylcysteine).

Managing regurgitation & hydration

Differentiate between regurgitation (no retching) vs vomiting. While some regurgitation may persist, frequent episodes warrant evaluation.

Offer water only while the dog is held upright for at least 5 minutes after drinking. Water can also be included in meals. Avoid free access to water bowls, puddles, or toilets.

Use homemade “Knox Blocks” to increase hydration: Recipe options:

1. Chicken broth + Knox gelatin + boiling water → refrigerate → cubed.
2. Boiling water + gelatin + broth → refrigerate → makes ~64 oz gelatin.

Exercise & feeding posture

Gentle walks before/after meals can support esophageal clearance. Always feed with the dog upright in a “begging” position using a Bailey Chair.

Food formats:

• Blended gruel/liquid.
• Meatball format, swallowed whole.
• Occasionally canned dog food. Dry food rarely tolerated.

Serve 3–6 small daily meals; keep food volume limited to lower regurgitation risk. Use low-fat, calorie-dense diets—not high-fiber. Dietitian consultation recommended for homemade diets.

Feeding tubes

If regurgitation prevents oral intake, consider PEG feeding tube placement under anesthesia to bypass esophagus and directly supply stomach nutrition. Delaying placement may worsen outcomes.

Aspiration Pneumonia (AP) Risks & Treatment

AP is a major risk—suspect it if lethargy or appetite drops. Chest X-rays (three views) are essential; signs may be delayed 1–2 days. Treat with antibiotics for 4–6 weeks, guided ideally by lung sampling. Additional care includes albuterol nebulization and percussion therapy.

Note: avoid nicotine users near nebulization. Daily nebulization may help for recurrent cases.

Sleeping arrangements

Elevate the dog’s head using a “neck balloon” collar or incline while sleeping. This can reduce night-time regurgitation into airways and help prevent micro-aspiration.

Anesthesia precautions

1. Pretreat with metoclopramide + maropitant to clear stomach.
2. Slightly elevate front of surgical table to prevent reflux.
3. Keep intubation tube in until swallowing returns.
4. Maintain upright posture during recovery to allow esophageal drainage.

Treats & Training

Avoid edible treats—these trigger saliva and regurgitation. Use verbal praise and petting as healthy rewards instead.

Prognosis & Resolution

Most cases are chronic; only ~15% of acquired adult cases resolve. Puppies (e.g., German Shepherds) occasionally outgrow the condition. With consistent management and pneumonia control, dogs can live a good long life. Example: a dog lived 13 normal years with asthma as cause but megaesophagus well-managed.