Oesophageal Dysautonomia

Also known as Feline Key-Gaskell Syndrome and Feline Autonomic Polygangliopathy.

Part of a syndrome of generalised autonomic neuropathy. It has been observed throughout Western Europe and The United States.

Signalment

Historically reported most frequently in cats but now also in dogs.

Description

• Degenerative lesions of the autonomic ganglia, spinal cord intermediate grey columns and sympathetic axons
• Aetiology still largely idiopathic

Diagnosis

Clinical Signs

Those of a generalised autonomic dysfuntion of the gastrointestinal and urinary tracts. Those associated with the oesophagus include:

• Regurgitation
• Megaoesophagus
• Oesophageal hypotmotility

The most frequent clinical signs associated with the syndrome are depression, anorexia, constipation, regurgitation or vomiting and incontinence (faecal and urinary) less frequently.

Physical Examination

Findings associated with the GI system include:

• Dry mucous membranes
• Intestinal distension

Radiography

Plain Radiography

Oesophageal dilatation may be observed.

Contrast Radiography

Oesophageal hypomotility may be evident on barium contrast study.

Differential Diagnosis

There are few differentials on presentation of the many manifestations of the disease. However, early in the course of disease other causes of megaoesophagus need to be considered.

Treatment

Supportive

Including elevated feeding, gastrostomy tube feedings or total paranteral nutrition.

Parasympathomimetic Drugs

Some dogs may show minor improvement on initiation of for example, bethanechol, metoclopramide.

Prognosis

Guarded to poor. Recovery rates in the cat are reported as 20-40%, however this may take 2-12 months. In the dog recovery rates are lower. Despite recovery many are also left with residual impairment including intermittent regurgitation.