Megaesophagus (ME) is a widespread and potentially fatal disease that affects German Shepherds of all ages, and seniors are no exception. The disease is caused by a genetic defect that interferes with the dog's ability to move food down its esophagus and into its stomach. Without treatment, the dog will slowly lose weight and eventually die of malnutrition, starvation, or aspiration pneumonia. There are several ways to treat megaesophagus, and most dogs can lead a relatively normal life with proper care and lots of dedication from their doggie parents.
If you suspect your older German Shepherd has megaesophagus, getting him diagnosed and treated as soon as possible is vital.
In this #LifeWithOldDogs® blog post and podcast, we talk with Donna Challender from the nonprofit organization The Upright Canine Brigade (UCB). The UCB started a decade ago as a grassroots effort to foster awareness of Megaesopahgus within the general pet community and as a learning tool for veterinarians on managing ME.
What is Megaesopahgus?
Megaesophagus (ME) is an enlargement of the esophagus, which is the tube that carries food and water to the stomach. In ME, the esophagus is flaccid and lacks the muscle motility to move food and water into the stomach.
There are two types of ME. One type is Congenital Idiopathic Megaesophagus (CIM), which means the dog is born with it. CIM is thought to result from incomplete nerve development in the esophagus, which may or may not improve as the dog matures. Similarly, another congenital problem is the vascular ring anomaly. This is where a band of tissue constricts the esophagus. As you can imagine, this would severely hinder the ability of food and water to make it past the area of constriction. In this case, surgery is the best chance of improving the dog's survival rate.
And the second type is known as Acquired ME, which is a secondary disease caused by other diseases such as myasthenia gravis, hypothyroidism, Addison Disease, and various neurological diseases. Furthermore, Acquired ME can present due to an obstruction, esophagitis, a stricture (a narrowing in the esophagus), or Persistent Right Aortic Arch (PRAA), also known as vascular compression of the esophagus.
What Are The Signs Of Megaesophagus?
*Regurgitation (not vomiting) of food and water
Weight loss
Not wanting to eat
Coughing/choking
Aspirating on food and water
Puppies have mom's milk coming out of their nose
How Is Megaesophagus Diagnosed?
It can be diagnosed with simple x-rays, but a barium swallow study may be needed to highlight the esophagus. It should be noted that a barium swallow may present its own issues due to the dog having difficulty swallowing the barium. Moreover, blood tests will be needed to look for diseases such as Hypothyroidism, Addison's, and Myasthenia Gravis. Additionally, a video Fluoroscopy, which is a real-time study of food going into the stomach and coming out again, highlights any problems that may exist along its paths, such as inflammation or strictures.
Treatment for Megaesopahgus:
First, If megaesophagus is presenting due to an underlying disease, then that disease must be treated to reduce and hopefully eliminate ME symptoms. But if it's Congenital Idiopathic Megaesophagus (CIM), then the focus is on managing the symptoms and supportive care. Treatment would look like this:
Using a special device called a Bailey Chair, similar to a high chair for dogs that keeps them upright during meals, allows gravity to do its thing and move the food down the esophagus and into the stomach.
It should be noted that an ME dog should sit in the Bailey Chair for at least 15 minutes or longer after a meal to ensure that the food has left the esophagus and landed in the stomach.
Smaller frequent meals are ideal for ME dogs. Instead of feeding once or twice a day, three or four smaller feedings may be necessary during the initial management of ME.
Thickening the food and water to make the consistency a bit more "doable" is recommended. Preferred consistency would be a slurry (canned and kibble or wet and kibble mixed), oatmeal consistency, and even a meatball-like consistency. Kibble alone is not recommended due to choking hazards.
Water can be a challenge for DM dogs, so it may need to be thickened with a product called "Thick-It," which does just as it says....make the water thicker, so the chances of choking are reduced. However, for some dogs with ME, water can be consumed when he is sitting upright before or after each meal.
Medications may be incorporated into the treatment plan as well. For instance, Promotility is a medication that stimulates smooth muscle contractions for the gastric system, small intestine, and large bowels to transit food more quickly. Another medication that may be utilized is Sildenafil, which relaxes the lower esophageal sphincter to allow food to enter the stomach.
Antacids also help prevent acid reflux and irritation of the esophagus.
Prognosis For Older German Shepherds With Megaesophagus
Let's start with the good. The prognosis can be good in the case of a primary disease-causing ME. For instance, dogs with Myasthenia Gravis (MG) have been known to go into remission once treated as early as four months.
With that said, there is no quick fix. This is a lifelong commitment, and there is a significant risk for potential complications, such as malnutrition, starvation, and aspiration pneumonia, so it's critical to get a precise diagnosis as early as possible to give your dog with ME the best possible chance of living life to the fullest while managing ME.
Donna and the folks at The Upright Canine Brigade are here to offer their assistance by sharing their knowledge and support in all things Megaesophagus. For more information and support, please listen to Donna in the coinciding episode of the #Lifewitholddogs® at:
And be sure to check out their website and Facebook group at:
* Regurgitation is not the same as vomiting. Vomiting is a forceful ejection of the stomach's contents, which can be dramatic and loud. On the contrary, regurgitation is the "passive" elimination of the contents in the esophagus, as if the contents were "spilling" back out.
***** Disclaimer: Throughout the "20 Most Common Health Issues in Senior German Shepherds" series, each blog post is expressed explicitly from our point of view and is not to be substituted for the professional medical expertise of your trusted veterinarian.