Treat Canis Megaesophagus

ISSN 2398-2969

Megaesophagus

i canis

Contributor(s):

Ken Harkin

James Simpson

Laurent Garosi

Synonym(s): Megaoesophagus; ME

Introduction

Generalized and diffuse dilation of esophagus and loss of peristalsis preventing normal forward propulsion of ingesta.
Cause: primary congenital, secondary acquired.
Signs: regurgitation, repeated swallowing attempts, poor body condition + coughing/nasal discharge with secondary aspiration pneumonia.
Diagnosis: plain radiography.
Treatment: dependent on cause.
Prognosis: guarded.

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Pathogenesis

Etiology

Failure of sensory perception of a food bolus in esophagus, so no peristaltic contraction.
Primary:
- Congenital.
Acquired:
- Idiopathic.
- Esophageal foreign body Esophagus: foreign body.
- Esophageal stricture Esophagus: stricture.
- Esophageal or periesophageal neoplasia Esophagus: neoplasia (lymphoma, leiomyoma...).
- Right aortic arch Vascular ring anomalies.
Acquired systemic:
- Myasthenia gravis Myasthenia gravis.
- Myositis/myopathic disease Myopathies.
- Suspected hereditary generalized neuropathy in a number of breeds.
- Botulism Clostridium botulinum.
- Addison's disease Hypoadrenocorticism.
- Lead poisoning Lead toxicity.
- Organophosphate toxicity Organophosphorus poisoning.
- Hypothyroidism Hypothyroidism.

Specific

Neuromuscular disease, eg myasthenia gravis Myasthenia gravis, Addison's disease Hypoadrenocorticism, myositis or other myopathy Masticatory myopathies.
Secondary esophageal obstruction.

Pathophysiology

For both congenital and acquired idiopathic forms a selective vagal afferent dysfunction seems to play a major role.
Failure of sensory perception of food bolus in esophagus, therefore no peristaltic contraction.
Ingesta pools in esophagus.
Regurgitation of food follows.
Aspiration pneumonia common.

Diagnosis

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Treatment

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Outcomes

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Recent references from PubMed and VetMedResource.
Bell S M, Evans J M, Evans K M, Tsai K L, Noorai R E, Famula T R et al (2022) Congenital idiopathic megaesophagus in the German shepherd dog is a sex-differentiated trait and is associated with an intronic variable number tandem repeat in Melanin-Concentrating Hormone Receptor 2. PLoS Genet 18(3), e1010044 doi.org/10.1371/journal.pgen.1010044.
Mace S, Shelton G D, Eddlestone S (2012) Megaoesophagus. Compend Contin Educ Vet 34 (2), E1 PubMed.
Fracassi F, Tamborini A (2011) Reversible megaoesphagus associated with primary hypothyroidism. Vet Rec 168 (12), 329b PubMed.
McBrearty A R, Ramsey I K, Courcier E A, Mellor D J, Bell R (2011) Clinical factors associated with death before discharge and overall survival time in dogs with generalized megaoesophagus. JAVMA 238 (12), 1622-1628 PubMed.
Wray J D, Sparkes A H (2006) Use of radiographic measurements in distinguishing myasthenia gravis from other causes of canine megaoesphagus. JSAP 47 (5), 256-263 PubMed.
Gaynor A R, Shofer F S & Washabau R J (1997) Risk factors for acquired megaesophagus in dogs. JAVMA 211 (11), 1406-1412 PubMed.
Mears E A & Jenkins C C (1997) Canine and feline megaesophagus. Comp Cont Ed Prac Vet 19 (3), 313-326 VetMedResource.
Yam P S, Shelton G D and Simpson J W (1996) Megaesophagus secondary to acquired myasthesia gravis. JSAP 37 (4), 179-183 PubMed.
Simpson J W (1994 ) Management of megaesophagus in the dog. In Practice 16, 14-16 InPractice.

Other sources of information

Willard M D (1992) Dysphagia and swallowing disorders.In: Current Veterinary Therapy X. W B Saunders, Philadelphia. 572-580.
Guilford W G (1990) Megaesophagus in the dog and cat.Seminars in Vet Med and Surg5, 37-45.

Related Images

Esophagus: megaesophagus - radiograph DV

Esophagus: megaesophagus - radiograph lateral

Esophagus: stricture - barium

Esophagus: vascular ring anomaly 02 - barium

Thorax: megaesophagus radiograph lateral

ACTH stimulation test

Biopsy: muscle

Biopsy: nerve

Blood biochemistry: cortisol

Blood biochemistry: potassium

Botulism

Centronuclear myopathy

Chinese Shar Pei

Clostridium botulinum

Electromyography

Esophagitis

Esophagobronchial fistula

Esophagoscopy

Esophagus: diverticulum

Esophagus: foreign body

Esophagus: neoplasia

Esophagus: stricture

Fox Terrier - Wire

Gastrostomy: percutaneous tube 1 (endoscopic)

German Shepherd Dog

Great Dane

Hypoadrenocorticism

Hypokalemia

Hypothyroidism

Irish Red and White Setter

Irish Setter

Lead toxicity

Life stage: growth

Life stage: neonatal

Lung: aspiration pneumonia

Masticatory myopathies

Mediastinal disease

Myasthenia gravis

Myopathies

Newfoundland

Organophosphorus insecticide poisoning

Peripheral neuropathies

Primary ciliary dyskinesia

Radiography: thorax

Regurgitation

Salivary gland: necrotizing sialometaplasia

Schnauzer: miniature

Skin: familial dermatomyositis

Standard reasons for failure in a treatment

Stomach: pyloric stenosis

Therapeutics: antimicrobial drug

Thyroid: free T4 assay

Vascular ring anomalies

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Megaesophagus

Introduction