Difference between revisions of "Oesophagitis"

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==Introduction==  
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[[Image:Oesophagitis.jpg|thumb|right|250px|Endoscopic image showing marked inflammation of the oesophageal mucosa<br><small> Copyright David Walker 2007 RVC]]</small>
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Oesophagitis refers to [[Inflammation - Pathology|inflammation]] of the oesophagus.  This usually involves the '''mucosa''' but can involve the deeper layers of the submucosa and muscularis and it may follow an '''acute''' or '''chronic''' course.  The oesophagus is usually protected from physical or chemical damage by mucus (produced by simple tubuloacinar glands along its whole length in dogs and in the rostral portion in cats), by peristaltic waves and by the upper and lower oesophageal sphincters which together prevent ingesta or regurgitated material from remaining in contact with the oesophageal wall.  Oesophagitis is a serious condition and, if not treated, it may progress to ulceration, [[Rupture of the Oesophagus|rupture]], [[Oesophageal Stricture|stricture formation]] or derangement of normal motility ([[Megaoesophagus|megaoesophagus]]).  The most common causes are:
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==Description==  
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[[Image:Oesophagitis.jpg|thumb|right|250px|Oesophagitis - Copyright David Walker RVC]]
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Oesophagitis refers to [[Inflammation - Pathology|inflammation]] of the oesophagus.  This usually involves the '''mucosa''' but can involve the deeper layers of the submucosa and muscularis and it may follow an '''acute''' or '''chronic''' course.  The oesophagus is usually protected from physical or chemical damage by mucus (produced by simple tubuloacinar glands along its whole length in dogs and in the rostral portion in cats) and by peristaltic waves and the upper and lower oesophageal sphincters which prevent ingesta or regurgitated material from remaining in contact with the oesophageal wall.  Oesophagitis is a serious condition and, if not treated, it may progress to ulceration, rupture, stricture formation or derangement of normal motility (megaoesophagus).  The most common causes are:
 
*'''Physical Injury'''
 
*'''Physical Injury'''
 
**Ingestion of [[Oesophageal Foreign Body|'''foreign bodies''']] which lodge in the oesophagus.
 
**Ingestion of [[Oesophageal Foreign Body|'''foreign bodies''']] which lodge in the oesophagus.
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**'''Gastro-oesophageal reflux''', which may occur with '''general anaesthesia''' or [[Hiatal Hernia|'''hiatal hernias''']].
 
**'''Gastro-oesophageal reflux''', which may occur with '''general anaesthesia''' or [[Hiatal Hernia|'''hiatal hernias''']].
 
**'''Chronic vomiting'''
 
**'''Chronic vomiting'''
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**Ingestion of '''caustic''' or '''irritant substances''', including '''[[Tetracyclines|doxycycline]]''' in cats.
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**Ingestion of '''caustic''' or '''irritant substances''', including '''doxycycline''' in cats.
  
 
==Signalment==
 
==Signalment==
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Any age group can be affected and there is usually a history suggestive of a particular cause, such as a recent general anaesthetic or administration of doxycycline to a cat.
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Any age group can be affected and there is usually a history suggestive of a particular cause, such as a recent general anaesthetic or administration of doxycylcine to a cat.
  
 
==Diagnosis==
 
==Diagnosis==
 
===Clinical Signs===
 
===Clinical Signs===
 
Signs include:
 
Signs include:
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*'''Regurgitation''' and '''hypersalivation/ptyalism''' are the most common signs.  Regurgitation can be recognised if the animal shows no abdominal effort (as would occur with vomiting) and if the material produced still resembles the food that was eaten with little apparent digestion.  The material produced is often covered with white foam but bile should never be present.
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*'''Regurgitation''' and '''hypersalivation/ptyalism''' are the most common signs.  Regurgitation can be recognised if the animal shows no abdominal effort (as would occur with vomiting), if the material produced still resembles the food that was eaten.  The material produced is often covered with white foam but bile should never be present.
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*Animals may appear to have '''difficulty in swallowing''' and often appear to make '''multiple swallowing efforts''' and to '''extend their necks''' during swallowing.  
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*Animals show '''difficulty in swallowing''' and often appear to make '''multiple swallowing efforts''' and to '''extend their necks''' during swallowing.  
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*Animals may show signs of '''pain during swallowing''' (odynophagia) and may therefore become '''anorexic'''.
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*Animals may show signs of '''pain during swallowing''' (odynophagia) and may become '''anorexic'''.
 
*Like any animals which regurgitate repeatedly, those with oesophagitis may develop '''aspiration pneumonia''' and show signs of pyrexia, coughing, tachypnoea and dyspnoea.
 
*Like any animals which regurgitate repeatedly, those with oesophagitis may develop '''aspiration pneumonia''' and show signs of pyrexia, coughing, tachypnoea and dyspnoea.
  
 
===Laboratory Tests===
 
===Laboratory Tests===
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The results of diagnostic tests are usually unremarkable but, as with any inflammatory process, there may be an overall '''leucocytosis''' caused by '''neutrophilia''' in the acute stage.
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Generally unremarkable but may show:
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*leucocytosis
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*neutrophilia
 
===Diagnostic Imaging===
 
===Diagnostic Imaging===
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'''Plain radiographs''' of the chest usually show little inidcation of disease but signs of aspiration pneumonia (an alveolar pattern) may be seen in cranio-ventral lung lobes.  
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'''Survey radiographs''': generally normal. Signs of aspiration pneumonia may be seen in ventral lung lobes. It can be better differentiated using barium-contrast studies which may show:
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'''Barium contrast studies''' could be performed and these may show an '''irregular mucosal surface''' and '''narrowing''' or '''dilation''' of the oesophagus due to stricture formation or megaoesophagus, respectively.  Barium should not be administered if an oesophageal rupture is suspected as it may escape into the mediastinum and initiate a foreign body reaction.
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*an irregular mucosal surface
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*narrowing
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'''Endoscopy''' is the gold standard technique for diagnosis of oeosphagitis but it requires a general anaesthetic (which may be the cause of the problem) and, if a large endoscope is used, there is the potential to cause further traumatic damage. Since medical management of oesophagitis is generally inexpensive, it is rarely advisable to perform this technique in an animal suspected of having active inflammation.  If it is performed, the oesophagus may be seen to have an oedematous mucosa that is hyperaemic, ulcerated and actively bleeding, whilst less severe cases may require several mucosal biopsies to diagnose the condition definitively.
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*a dilated oesophagus
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*oesophageal hypomotility
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'''Endoscopy''': To better diagnose oesophagitis, endoscopy with biopsies can be used. Severe oesophagitis will be seen with an oedematous mucosa that is hyperaemic, ulcerated and actively bleeding, whilst less severe cases may require several mucosal biopsies to diagnose the condition.
 
==Treatment==
 
==Treatment==
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Since oesophagitis can lead to serious sequelae, even mild inflammation should be treated aggressively.  Any animal which suffers gastro-oesophageal reflux under general anaesthesia should receive metaphylactic treatment as described below.  Components of medical management include:
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Mild oesophagitis:  
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*'''Withdrawal of oral food for 2-3 days''' as standard but, if the inflammation is severe or rupture has occurred, a '''gastrostomy tube''' may be required.
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*withdraw oral food for 2-3 days and manage as an outpatient.
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*'''Oral sucralfate suspension''' is thought to bind to the base of any ulcers, to stimulate epithelial repair and to neutralise any refluxed gastric juices.
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More severe oesophagitis:
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*'''Gastric acid secretory inhibitors''' (e.g. ranitidine, omeprazole) can be useful in cases of gastro-oesophageal reflux.
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*may need admitting to the hospital, Nil Per Os and animal may require enteral or parenteral nutritional support.
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*'''Metaclopramide''', a promotility drug that increases the tone of the lower oesophageal sphincter, may also be used to manage gastro-oesophageal reflux but not if oesophageal motility is thought to be impaired (i.e., if megaoesophagus is present).
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Drugs:
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*'''Broad spectrum intra-venous bactericidal antibiotics''' may be required in animals with severe oesophagitis or aspiration pneumonia.  Coupage and nebulisation may be useful adjunctive treatments for aspiration pneumonia and it may be necessary to provide oxygen to dyspnoeic animals.
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*oral sucralfate suspension
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*'''Analgesia''' should be provided to encourage animals to eat after 2-3 days.
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*gastric acid secretory inhibitors (e.g. ranitidine, omeprazole) can be useful in cases of gastro-oesophageal reflux
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*broad spectrum antibiotics in animals with sever oesophagitis or aspiration pneumonia
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*analgesics
 
==Prognosis==
 
==Prognosis==
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Mild oesophagitis has a good prognosis if treated aggressively but animals which develop ulceration, strictures or aspiration pneumonia have a much more guarded prognosis.  
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Mild oesophagitis has a good prognosis whereas ulcerative oesophagitis and animals suffering from aspiration pneumonia have a more guarded prognosis.
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==References==
  
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{{Learning
 
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|Vetstream = [https://www.vetstream.com/canis/Content/Disease/dis00997.asp, Oesophagitis]<br>[https://www.vetstream.com/canis/Content/Disease/dis00989.asp, Megaoesophagus]
 
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|literature search = [http://www.cabdirect.org/search.html?q=title%3A%28%22oesophagitis%22%29+OR+title%3A%28%22esophagitis%22%29 Oesophagitis publications]
 
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}}
 
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==References==
 
 
Hall, E.J, Simpson, J.W. and Williams, D.A. (2005) '''BSAVA Manual of Canine and Feline Gastroenterology (2nd Edition)''' ''BSAVA''
 
Hall, E.J, Simpson, J.W. and Williams, D.A. (2005) '''BSAVA Manual of Canine and Feline Gastroenterology (2nd Edition)''' ''BSAVA''
  
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Ettinger, S.J, Feldman, E.C. (2005) '''Textbook of Veterinary Internal Medicine (6th edition, volume 2)''' ''Elsevier Saunders''
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Merck & Co (2008) '''The Merck Veterinary Manual'''
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Merck & Co (2008) '''The Merck Veterinary Manual'''''Merial''
 
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{{review}}
 
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{{OpenPages}}
 
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[[Category:Oesophagus_-_Pathology]]
 
[[Category:Oesophagus_-_Pathology]]
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[[Category:Oesophageal Diseases - Cat]][[Category:Oesophageal Diseases - Dog]][[Category:Expert Review - Small Animal]][[Category:Expert Review - Horse]]
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[[Category:To_Do_-_James]]
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[[Category:Oesophageal Diseases - Horse]]
 

Revision as of 10:07, 7 July 2010


 This article is still under construction.



Description

Oesophagitis - Copyright David Walker RVC

Oesophagitis refers to inflammation of the oesophagus. This usually involves the mucosa but can involve the deeper layers of the submucosa and muscularis and it may follow an acute or chronic course. The oesophagus is usually protected from physical or chemical damage by mucus (produced by simple tubuloacinar glands along its whole length in dogs and in the rostral portion in cats) and by peristaltic waves and the upper and lower oesophageal sphincters which prevent ingesta or regurgitated material from remaining in contact with the oesophageal wall. Oesophagitis is a serious condition and, if not treated, it may progress to ulceration, rupture, stricture formation or derangement of normal motility (megaoesophagus). The most common causes are:

  • Physical Injury
    • Ingestion of foreign bodies which lodge in the oesophagus.
    • Passage of nasogastric or pharyngostomy feeding tubes or of large endoscopes.
  • Chemical Injury
    • Gastro-oesophageal reflux, which may occur with general anaesthesia or hiatal hernias.
    • Chronic vomiting
    • Ingestion of caustic or irritant substances, including doxycycline in cats.

Signalment

Any age group can be affected and there is usually a history suggestive of a particular cause, such as a recent general anaesthetic or administration of doxycylcine to a cat.

Diagnosis

Clinical Signs

Signs include:

  • Regurgitation and hypersalivation/ptyalism are the most common signs. Regurgitation can be recognised if the animal shows no abdominal effort (as would occur with vomiting), if the material produced still resembles the food that was eaten. The material produced is often covered with white foam but bile should never be present.
  • Animals show difficulty in swallowing and often appear to make multiple swallowing efforts and to extend their necks during swallowing.
  • Animals may show signs of pain during swallowing (odynophagia) and may become anorexic.
  • Like any animals which regurgitate repeatedly, those with oesophagitis may develop aspiration pneumonia and show signs of pyrexia, coughing, tachypnoea and dyspnoea.

Laboratory Tests

Generally unremarkable but may show:

  • leucocytosis
  • neutrophilia

Diagnostic Imaging

Survey radiographs: generally normal. Signs of aspiration pneumonia may be seen in ventral lung lobes. It can be better differentiated using barium-contrast studies which may show:

  • an irregular mucosal surface
  • narrowing
  • a dilated oesophagus
  • oesophageal hypomotility

Endoscopy: To better diagnose oesophagitis, endoscopy with biopsies can be used. Severe oesophagitis will be seen with an oedematous mucosa that is hyperaemic, ulcerated and actively bleeding, whilst less severe cases may require several mucosal biopsies to diagnose the condition.

Treatment

Mild oesophagitis:

  • withdraw oral food for 2-3 days and manage as an outpatient.

More severe oesophagitis:

  • may need admitting to the hospital, Nil Per Os and animal may require enteral or parenteral nutritional support.

Drugs:

  • oral sucralfate suspension
  • gastric acid secretory inhibitors (e.g. ranitidine, omeprazole) can be useful in cases of gastro-oesophageal reflux
  • broad spectrum antibiotics in animals with sever oesophagitis or aspiration pneumonia
  • analgesics

Prognosis

Mild oesophagitis has a good prognosis whereas ulcerative oesophagitis and animals suffering from aspiration pneumonia have a more guarded prognosis.

References

Hall, E.J, Simpson, J.W. and Williams, D.A. (2005) BSAVA Manual of Canine and Feline Gastroenterology (2nd Edition) BSAVA

Merck & Co (2008) The Merck Veterinary Manual

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