Regurgitation

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Introduction

Regurgitation describes the passive, retrograde movement of food and water from the mouth or the oesophagus.

It is important to differentiate regurgitation from vomiting as they represent very different disease aetiologies.

Regurgitation is the hallmark sign of oesophageal disorders.

Causes include:

Oesophageal obstruction:

Congenital vascular ring anomaly
Foreign body
Stricture
Neoplasia
Extraoesophageal compression: thyroid carcinoma, pulmonary alveolar cell carcinoma
Rare miscellaneous causes: cricopharyngeal achalasia, oesophageal diverticulum, oesophageal atresia

Oesophagitis:

Gastrooesophageal reflux
Persistent vomiting
Hiatal hernia
Caustic agents

Megaoesophagus:

Congenital megaoesophagus: idiopathic or myasthenia gravis
Acquired megaoesophagus
Neuropathy: polyradioculoneuropathy
Immune-mediated: polyneuritis, polymyositis, SLE, myasthenia gravis, dermatomyositis
Myopathy
Metabolic: hypothyroidism, hypoadrenocorticism
Lead toxicity
Canine distemper
Dysautonomia

Pharyngeal disorders:

Rabies
Foreign body
Other obstructions

Clinical Signs

Regurgitation Vomiting
Passive event Abdominal effort
No prodromal nausea Prodromal nausea
Undigested tubular food Usually digested food
Possibly painful No swallowing pain
Usually alkaline pH Alkaline or acidic pH

There may be additional signs such as coughing and dyspnoea secondary to aspiration pneumonia.

Weakness may be present due to a systemic disorder such as myasthenia gravis, Addison's disease, polymyositis.

Animals usually have a ravenous appetite.

Dysphagia may be present if the pharynx is involved.

Diagnosis

Diagnosis should take into account the signalment and history.

Physical examination may involve oesophageal palpation, lung auscultation to check for aspiration pneumonia, checking for underlying or concurrent diseases.

Plain radiography: may detect a radioopaque foreign body.

Contrast radiography: for radiolucent foreign bodies, obstructions, megaoesophagus.

Endoscopy may also be indicated to visualise the problem.

Treatment

The initiating cause should be treated, which may involve removal of a foreign body or resection of a persistent right aortic arch.

Minimising the chances of aspiration pneumonia is important, and includes: feeding solid large pieces of food from a height.

General medical management may include: sucralfate liquid to act as a chemical bandage for the oesophagus, ranitidine and omeprazole to inhibit gastric acid secretion which may contribute to oesophagitis.

Complications following oesophageal disease include: aspiration pneumonia which should be treated aggressively, oesophageal strictures, continued oesophagitis, perforation, fistula, diverticulum formation, motility disorders.

The prognosis is usually guarded.


Regurgitation Learning Resources
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Feline Medicine Q&A 07


References

Allenspach, K. (2009) Dysphagia and regurgitation in small animals RVC student notes

Pasquini, C. (1999) Tschauner's guide to small animal clinics Sudz Publishing




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