A CLINICAL STUDY ON THE DISEASES OF ESOPHAGUS AND STOMACH WITH SPECIAL REFERENCE TO ENDOSCOPY IN DOGS
Loading...
Files
Date
2010-07
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
SRI VENKATESWARA VETERINARY UNIVERSITY TIRUPATI - 517 502. (A.P.) INDIA
Abstract
ABSTRACT:
The present study was undertaken in 42 cases out of the 120 clinical cases of dogs presented with diseases of esophagus and stomach with the history of persistent vomiting or regurgitation. A total of 120 dogs were presented with the chief complaint of recurrent vomiting or regurgitation. Out of the total of 120 cases selected for closer examination, 78 dogs (65%) responded to routine medical treatment with antiemetics, antibiotics and fluid therapy and hence, they were excluded from the purview of the present clinical study. The remaining 42 dogs (35%), which continued to vomit or regurgitate for more than one week and showed signs consistent with the primary diseases of the esophagus and stomach formed the patient material for the present clinical study. All the 42 clinical cases of dogs underwent routine physical, clinical, haematological and biochemical examinations as well as plain and contrast radiographic, Ultrasonographic and endoscopic assessment to rule out the concurrent diseases prior to the consideration in the present study. The results of the present study revealed that out of the total 42 cases selected for the present study, 31dogs (73.81%) had diseases of the esophagus while the rest (11dogs; 26.19%) had diseases of the stomach. During the present study, megaesophagus was diagnosed in 18 (42.86%) dogs, reflux esophagitis in 2 dogs (4.76%), vascular ring anomalies in 2 dogs (4.76%), esophageal diverticula and esophageal nodule in one dog each (2.38% each), esophageal foreign bodies in 5 dogs (11.90%), esophageal erosion or ulcers in 2 dogs (4.76%), chronic gastritis in 3 dogs (7.14%), gastric foreign bodies in 4 dogs (9.52% ), gastric erosion/ ulcer in 2 dogs (4.76%) and gastric dilatation and Volvulus in 2 dogs (4.76%). The results also showed that the occurrences of these diseases were seen in dogs ranging from two and a half months to thirteen years of age. No sex wise occurrence of the esophageal or stomach diseases was reported. All the dogs afflicted with the various diseases exhibited similar symptoms like emaciation, shrunken abdomen, chronic weight loss, prominent rib cage, regurgitation, vomiting or both. In the present clinical study, 18 clinical cases of megaesophagus were recorded. The disease was encountered in Labrador (2 dogs), Golden Retriever (2 Dogs), German Shepherd (5 Dogs), Doberman (2 Dogs), Mongrel (3 Dogs), Pomeranian (2 Dogs), Cocker Spaniel (1 Dog) and Boxer (1 Dog) breeds of dogs. The mean age of occurrence was found to be 6.25 ± 0.88 years. Out of these 18 dogs, 11were found to be males (61.12 %) and the rest were females (7 dogs; 38.88%). All these 18 dogs showed the signs of regurgitation of the food soon after food consumption. The haematological and biochemical studies showed that all the parameters studied were with in the normal range, except for haemoglobin. Ultrasonography did not reveal any sort of esophageal pathology. Radiographic features of megaesophagus in the seven dogs were air filled dilated esophagus and tracheoesophageal stripe sign. Esophagography clearly revealed generalized distention of esophagus in all the 18 dogs. While endoscopy revealed markedly dilated, flaccid esophagus and pooling of retained fluid, in the most dependent segment of the esophagus. The results of the present study indicated that among the three treatment regimens tested, Metoclopramide combined with feeding the dogs in an upright position from an elevated platform improved the esophageal function to the maximum extent. Post mortem examination of the seven dogs died or euthanized showed severe dilatation and thinning of the esophageal wall, while histopathological examination showed scanty muscle bundles, infiltration of polymorphonuclear cells with submucosal congestion and enlargement of submucosal glandular pattern with epithelial irregularity. Scanning electron microscopy revealed destruction of blood vessels, loss of normal architecture and direction of inner circular as well as outer longitudinal muscle fibers while, transmission electron microscopic examination showed complete loss of cellular architecture, mitochondrial destruction and complete loss of architecture of myoneuronal plate at the neuromuscular junction suggestive of neuromuscular disorder. Two clinical cases of dogs were tentatively diagnosed to be suffering from reflux esophagitis. Endoscopic examination characterized by mucosal erythema, haemorrhage, mucosal irregularity, erosion with thickened mucosal folds especially at the lower esophageal area confirmed reflux esophagitis. Endoscopic examination showed the evidence of reflux esophagitis in these two dogs. Both the dogs recovered uneventfully following the treatment adopted. Esophagoscopy of a nine year old male Pomeranian dog with sings of recurrent cough and retching revealed a lemon sized nodular growth appearing as broad based protuberance with nipple like orifice located just caudal to the base of the heart suggestive of Spirocerca lupi infestation. No surgical exploration was conducted as the dog was not available for further investigation. Plain radiography of five cases out of 42 cases (11.90%) revealed osseous foreign bodies in the esophagus of four dogs and radiolucent foreign bodies (socks) in an other dog. In three dogs, osseous foreign bodies located in the thoracic esophagus were pushed in to the stomach successfully by endoscope itself. In dog, osseous foreign bodies located in the post pharyngeal was retrieved by cheatle forceps under the endoscopic illumination. The dog with socks in the cervical esophagus vomited the socks out due to emetic effects of xylazine prior to endoscopic manoeuvre. All dogs recovered uneventfully. Barium swallow of the dogs revealed stricture of esophagus over the base of heart and cranial distention of esophagus suggestive of vascular ring anomalies. Despite of giving supportive therapy, both the dogs died. Necropsy revealed distention of esophagus cranial to the constructive vascular band confirmed vascular ring anomalies. Histopathological examination further confirmed presence of concurrent gastritis. Plain radiography of three year old female German shepherd dog with post prandial regurgitation, revealed saclike out pouching of cranial thoracic esophageal wall that rested on floor of sternum which was further confirmed by endoscopy. No treatment was initiated in this case on the owner was reluctant for surgery. The two dogs with vomiting of about three weeks duration that did not respond to routine medication were diagnosed to be suffering from esophageal erosions/ulcers, both by endoscopy and by positive contrast radiography. The dogs responded well to the treatment adopted. Gastroscopy of all three dogs revealed generalized congestion as well as petechial hemorrhagic spots on gastric mucosa with minor areas of mucosal erosions suggestive of chronic gastritis. Cytological examination of stomach fluid collected during endoscopy further confirmed chronic gastritis. No Helicobacter Like Organisms (HLO) was encountered. These three dogs responded well to the treatment protocol adopted i.e. combination of amoxicillin, clarithromycin, Metronidazole and ranitidine. In the present study, gastroscopy of two dogs revealed gastric ulcerative patches with marked thickening and irregular edges confirmed gastric erosion or ulcers. Both the dogs treated with sucralfate and omperazole responded well to complete recovery. In present clinical study, four dogs were diagnosed to be affected with gastric foreign bodies. Out of four cases, two dogs that underwent plain radiographic examination revealed presence of sewing needle in the stomach of one dog and a pair of metal caps of cool drink bottle and a safety pin in another dog. The metallic foreign bodies whose removal was considered to be too risky by endoscope were removed by standard gastrotomy. In the remaining two dogs that swallowed dog nylon belt, plain radiograph did not confirm their presence. Endoscopic examination revealed presence of dog collar made up of nylon in the stomach. Endoscopic retrieval of the nylon belt in the stomach of one dog was successfully done while, in the second case, the radiolucent foreign body (another nylon belt), which turned out later on to be a linear foreign body, was removed successfully by standard gastrotomy and enterotomy operation. All the dogs recovered uneventfully. In the two dogs with gastric dilatation and volvulus (GD-V) in the present study, the clinical and radiographic signs helped in confirmation of the disease and the clinical out come of their treatment with surgical derotation and gastropexy was uneventful. From the results of the present clinical study, it was concluded that about 35% of dogs (42 out of 120 dogs) that were refractory to general medical treatment for vomiting or regurgitation were appeared to be affected with primary diseases of esophagus and stomach. The most common malady affecting the esophagus in dogs was found to be megaesophagus (18), and this can be reasonably well managed by using metoclopramide and feeding the dogs in an upright position from an elevated platform. The disease is considered to be a neuromuscular disease as seen during scanning and transmission electron microscopy. The neuromuscular junctions as seen by transmission electron microscopy appeared to be destroyed in cases of megaesophagus. Esophagography was found to be more useful procedure in confirming the cases of megaesophagus than endoscopy. This is because it is sometimes difficult in mild cases to be sure whether the esophagus was really dilated or it appeared so due to insufflation during endoscopy. On endoscopy examination, a large cavernous lumen extending the length of the esophagus is vividly suggestive of megaesophagus. But a normal esophagus can also appear flaccid and distended under anaesthesia. The other diseases encountered in the present study in their order frequency of occurrence are esophageal foreign bodies (5), gastric foreign bodies (4), chronic gastritis (3), reflux esophagitis (2), esophageal erosion/ulcer (2), gastric erosion/ ulcer (2), vascular ring anomalies (2), gastric dilatation and volvulus (2), esophageal nodule (1) and esophageal diverticulum (1). Endoscopy is not always useful in treatment of esophageal or gastric foreign bodies in dogs for the shape and size of foreign body, duration of obstruction and nature and location of foreign body in the esophagus and stomach determine the use and success of endoscopy for therapeutic purpose. Endoscopy proved to be a valuable and useful aid in the diagnosis of esophageal and gastric ulcers/ erosions, esophageal nodule and esophageal diverticulum. Albeit veterinarians are still in the early phase of adoption of minimally invasive procedures, endoscopy proves to be vital diagnostic and therapeutic tool of the future veterinarians armamentarium.
Description
THESES
Keywords
null