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==Introduction==  

 

[[Image:Oesophagitis.jpg|thumb|right|250px|Endoscopic image showing marked inflammation of the oesophageal mucosa<br><small> Copyright David Walker 2007 RVC]]</small>

==Description==  

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:

[[Image:Oesophagitis.jpg|thumb|right|250px|Oesophagitis - Copyright David Walker RVC]]

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, [[Oesophageal Stricture|stricture formation]] or derangement of normal motility ([[Megaoesophagus|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.

**'''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'''

**Ingestion of '''caustic''' or '''irritant substances''', including '''doxycycline''' in cats.

**Ingestion of '''caustic''' or '''irritant substances''', including '''[[Tetracyclines|doxycycline]]''' in cats.

==Signalment==

==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.

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.

==Diagnosis==

==Diagnosis==

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.

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.

===Diagnostic Imaging===

===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:

'''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.  

*an irregular mucosal surface

'''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.

*narrowing

 

*a dilated oesophagus

'''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.

 

'''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==

Mild oesophagitis:  

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:

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

*'''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.

*'''Oral sucralfate suspension''' is thought to bind to the base of any ulcers, to stimulate epithelial repair and to neutralise any refluxed gastric juices.

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

*'''Gastric acid secretory inhibitors''' (e.g. ranitidine, omeprazole) can be useful in cases of gastro-oesophageal reflux.

*'''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.

*gastric acid secretory inhibitors (e.g. ranitidine, omeprazole) can be useful in cases of gastro-oesophageal reflux

*'''Analgesia''' should be provided to encourage animals to eat after 2-3 days.

*broad spectrum antibiotics in animals with sever oesophagitis or aspiration pneumonia

 

*analgesics

==Prognosis==

==Prognosis==

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

Mild oesophagitis has a good prognosis if treated aggressively but animals which develop ulceration, strictures or aspiration pneumonia have a much more guarded prognosis.  

 

 

==References==

==References==

 

[[Category:Oesophagus_-_Pathology]]

[[Category:Oesophagus_-_Pathology]]

[[Category:To_Do_-_James]]

[[Category:Oesophageal Diseases - Cat]][[Category:Oesophageal Diseases - Dog]][[Category:Expert Review - Small Animal]][[Category:Expert Review - Horse]]

[[Category:Oesophageal Diseases - Horse]]