Oesophageal stricture is a rare but important problem for both dogs and cats. It happens when a narrowing forms in the tube that connects the mouth to the stomach. This creates a partial blockage for food and water.
Signs Of Oesophageal Stricture
Affected dogs and cats show the characteristic sign of being interested in food, but unable to keep it down. Critically, this is due to regurgitation.
Recognising the difference between regurgitation and vomiting is very important for a quick diagnosis:
- Regurgitation is a passive flow of food or water without obvious effort. There can be a lot of white foam and it almost never contains yellow bile.
- Vomiting involves repeated abdominal muscle contractions, and usually takes longer. Bile or a strong acid smell is often present.
Other signs of oesophageal stricture can be:
- Excessive salivation
- Difficulty eating or swallowing
- Weight loss
What Causes Oesophageal Stricture?
The table shows a summary of 111 affected dogs and cats where the cause was reported.
Any injury to the oesophageal wall can lead to scarring and narrowing of its internal diameter. The most important of these is gastro-oesophageal reflux. Under anaesthesia, stomach acids sometimes enter the oesophagus where they may cause severe burns. This can also happen during severe vomiting episodes.
Other injuries leading to stricture can be caused by foreign bodies (especially inappropriately fed bones), severe road trauma and caustic drugs. Doxycycline and clindamycin in particular are two commonly used tablets that must never be given without food.
After the damage occurs, regurgitation can develop anytime within 3 weeks (typically 7 days). It’s essential to stress that while anaesthesia can cause it, oesophageal stricture is an extremely rare consequence (I have only seen it once, after an emergency surgery).
Treatment Of Oesophageal Stricture
The goal of treatment is to allow a dog or cat to eat and drink without requiring special care. Complete cure, defined as the ability to ingest food of any consistency, is only seen in 12%‐23% of cases but is not necessary for a good quality of life.
Once a stricture is diagnosed, immediate supportive treatment may be:
- Drug therapy to reduce ongoing oesophagitis
- Nutrition and hydration via placement of a feeding tube in cases of severe narrowing
If the patient is stable, attempts are made to widen the narrowing via mechanical dilation. There are currently two established methods:
- Bougienage is the passing of solid tubes of increasing diameter to slowly stretch the stricture
- Balloon dilation is the same approach using inflatable tubes of gradually increasing size
Whichever is chosen (mostly balloon these days), process is slow to avoid tearing the oesophageal wall, which can be fatal. Dogs and cats require an average of three treatments, but a positive outcome is not always achieved.
Success Rates Of Dilation
The following table gives a quick summary of all the major studies in the past 25 years.
|Study Type||Success rate*||Mortality rate**|
|Balloon dilation1||14/20 (70.0%)||1/20 (5%)|
|Bougienage2||20/28 (71.4%)||0/28 (0%)|
|Balloon dilation3||10/13 (76.9%)||1/13 (7.7%)|
|Balloon dilation4||16/25 (64.0%)||1/25 (4%)|
|Balloon dilation5||14/23 (60.9%)||3/23 (13%)|
|Indwelling balloon dilation6||11/12 (91.7%)||0/12 (0%)|
As you can see, death rates are low but success only occurs in around 2 in 3 cases. Study 6 remains an experimental approach which (in my opinion) will end up with similar success and mortality rates if and when it becomes more widely used.
Management after dilation generally includes administration of various drugs to reduce gastric acidity, increase forward movement of the gut, and reduce scarring during healing.
Failure of dilation has in the past been sometimes followed by further surgical procedures, especially stenting and resection. Neither have sufficient success to be routinely recommended.
Do All Cases Need Treatment?
If you have a dog or cat with an oesophageal stricture, I hope that this information will allow you to make an informed decision. Whether to have dilation performed will come down to four things:
- How well your best mate is coping,
- The potential risk of aspiration pneumonia or megaoesophagus in your case,
- How much special care will be needed over life if you don’t,
- Sadly, also costs
Specialist veterinary care is unquestionably expensive, and I would prepare for around $5000. Costs will vary depending on how many dilations are needed. It might help to know that several papers observed that a favourable outcome was often associated with good results from the outset.
Most referral centres are quite willing to talk about their fees, especially to us vets, so it’s your right to ask. Good luck.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. These blogs are from a series regularly posted on email and Twitter. Subscribe via email here to never miss a story!
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- Adamama-Moraitou, K. K., Rallis, T. S., Prassinos, N. N., & Galatos, A. D. (2002). Benign esophageal stricture in the dog and cat: a retrospective study of 20 cases. Canadian Journal of Veterinary Research, 66(1), 55
- Bissett, S. A., Davis, J., Subler, K., & Degernes, L. A. (2009). Risk factors and outcome of bougienage for treatment of benign esophageal strictures in dogs and cats: 28 cases (1995–2004). Journal of the American Veterinary Medical Association, 235(7), 844-850
- Harai, B. H., Johnson, S. E., & Sherding, R. G. (1995). Endoscopically guided balloon dilatation of benign esophageal strictures in 6 cats and 7 dogs. Journal of Veterinary Internal Medicine, 9(5), 332-335
- Leib, M. S., Dinnel, H., Ward, D. L., Reimer, M. E., Towell, T. L., & Monroe, W. E. (2001). Endoscopic balloon dilation of benign esophageal strictures in dogs and cats. Journal of Veterinary Internal Medicine, 15(6), 547-552
- Melendez, L. D., Twedt, D. C., Weyrauch, E. A., & Willard, M. D. (1998). Conservative therapy using balloon dilation for intramural, inflammatory esophageal strictures in dogs and cats: a retrospective study of 23 cases (1987–1997). Eur J Comp Gastroenterol, 3(1), 31-36
- Tan, D. K., Weisse, C., Berent, A., & Lamb, K. E. (2018). Prospective evaluation of an indwelling esophageal balloon dilatation feeding tube for treatment of benign esophageal strictures in dogs and cats. Journal of veterinary internal medicine, 32(2), 693-700