Regurgitation

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
Flashcards Test your knowledge using flashcard type questions	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