By Christie Long
My kid just came down to my office to say goodnight to me, and upon seeing the word “megaesophagus" on my otherwise blank screen, asked me what it meant.
I gave him the literal translation of “having a big esophagus" and told him he’d have to read the rest in the paper next week. Exasperated, he replied, “Mom, what could possibly be so bad about having a big esophagus?" and headed up to bed.
To a food-loving 9-year-old, it’s not obvious, but it turns out, a lot. Megaesophagus occurs when the esophagus becomes dilated and lacks sufficient muscular tone (that’s right, it’s a long, hollow muscle) to effectively move food from the mouth into the stomach. Animals that have this condition typically show it by chronically regurgitating chewed food.
It goes without saying that it’s difficult for these animals to get proper nutrition. But the most life-threatening complication of megaesophagus is the near-constant threat of aspiration pneumonia, a severe lung infection that occurs when particles of the regurgitated food are breathed into the lungs. Megaesophagus patients frequently battle pneumonia caused by bacteria that have become resistant to most commonly-used antibiotics, creating substantial treatment challenges.
Animals can be born with megaesophagus, and several breeds of dogs can inherit the disease, including Great Danes and German shepherds. These dogs begin to regurgitate as soon as they eat solid food, so the disease is diagnosed very early in life. Animals can also acquire megaesophagus later in life due to many conditions including nerve and muscle diseases, endocrine disorders and toxins.
Sometimes, the cause of megaesophagus is never found. Unfortunately, uncovering and treating the primary condition causing megaesophagus doesn’t always resolve flaccid esophagus, and the regurgitation and aspiration pneumonia continue.
Although megaesophagus sounds like a dismal diagnosis, veterinarians and owners of animals with the disease have gotten better at managing it, and many of these pets are living relatively normal lives. Probably the single most important discovery has been that feeding these patients in an upright position, similar to the way humans eat, significantly increases the chance that food will actually make it to the stomach.
Furthermore, keeping the pet in a sitting position for 20 to 30 minutes after feeding seems to reduce the incidence of regurgitation, and subsequently aspiration pneumonia. Many different devices have been proposed to accomplish this because, as you might imagine, it’s not natural for an animal to eat its food in a seated and upright position.
Chances of success in managing megaesophagus also seem to improve when owners are trained to recognize early signs of pneumonia, such as fever, lethargy and reduced appetite. Finding a food consistency that works for a particular patient is important as well.
Some megaesophagus patients do better eating a gruel-like diet, while others seem to ingest their food better if it is shaped into meatballs. Because more and more owners are attempting to manage this disease, online communities have sprung up to spread news and advice regarding helping these patients have a good quality of life for as long as possible.
Christie Long is a veterinarian at the VCA Animal Hospital in Fort Collins, CO. Long left her job in software sales in 2000 to travel for 13 months. Along the way, she was touched by the plight of the animals she saw and somewhere in the Nepalese Himalayas she vowed to return to school to become a veterinarian. While she often finds end-of-life situations heart-wrenching, she considers herself blessed to be called upon as a trusted adviser to families during difficult times. Dr. Long’s family includes her husband and travel partner, Wiley, their 5-year-old son, Wiley IV, their dogs Pancake and Gizmo and cats Sneaky and Sidh.