How should megaesophagus be managed?
With proper management, ME dogs can live long and healthy lives!
The most important management technique for ME is Vertical Feeding. Since the esophagus isn’t working correctly in an ME dog, gravity is needed to get food to the stomach.
# 1 Feed Your Dog Upright
You can use a “Bailey Chair,” a high chair, a laundry basket, ANYTHING that keeps your pup vertical! After each feeding, have your dog remain upright in the chair for at least 10 minutes. Some dogs may need more time upright than others — this part is trial and error.
# 2 Food Consistency
Yet another area that requires some trial and error. Some dogs do well with a slurry or milkshake consistency. Some dogs thrive on soaked kibble (water or broth overnight to make into a “mush”), and some dogs do better with food shaped into little meatballs (be sure that they are small enough so that your dog can swallow them–chewing negates the benefits of the meatball shape).
Many ME dogs do not do well with water, so water is added to their food (in addition to the softer easy-to-swallow consistency of softened food, it’s a great way to incorporate water into your pup’s diet). Dogs that eat meatballs can get their water with something called Knox Blocks — basically jigglers for your pup! *See Recipes under link on homepage* Other dogs may do well with a large hamster style bottle mounted high enough to keep the throat in an elevated position.
There are several recipes you can try to add nutrition and weight to your dog, like “satin balls,” or you can try adding coconut milk or “Ensure” to their food. Please continue to check the Recipes link for new concoctions!
What works for one dog may not work for another, so keep track of what you try so that you can find what works best!
More Great Tips About Hydration!
- Adding water to your blended food to make a slurry
- Making Gelatin Cubes (see recipe tab)
- Ice cubes
- Adding “Thick-It” to the water. You can find this in your local drug store. It’s is often times used with stroke victims that have trouble swallowing. See the video under the recipe tab. Sosa eating Thick-It!
- Some dogs do okay with straight water if they are in their chairs in an upright position.
- Subcutaneous Fluids. Ask your vet to show you how this is done. Please watch Carter’s Video. It’s not as scary as it looks and it can save your dogs life!
# 3 Smaller More Frequent Meals
Some dogs can eat twice a day while others may tolerate smaller, more frequent meals better. Say it with us, “this requires trial and error!”
Don’t get discouraged and don’t give up — you’ll find something that works!
# 4 Try a Pro Collar or “Neck Hug”
These devices help to elevate your dog’s head while reclining. Keeping your dog’s head elevated helps keep any food that’s still in the esophagus, or saliva (face it, that’s always there), from being regurged. Some dogs take a while to get used to this large fluffy collar — This elevates your dog’s head off the floor when they are laying down. You can find inflatable Pro Collars at Petsmart or Petco. The Neck Hug from Wag Tail Farms is a stuffed elizabethan collar.
Please check out the Wag Tail Farms website.
# 5 Try Medications
Antacids, like famotidine or omeprazole can to help to control stomach acid. Your vet may also prescribe a motility drug. One more time, “this requires trial and error!”
Listed here are some of the most commonly prescribed drugs associated with Canine Megaesophagus. Not all ME dogs take the medications listed below – trial and error (and the advice of your vet) will help you to find what works best.
Antacids – The sphincter between the esophagus and stomach in ME dogs does not work properly and often allows acidic stomach fluids to reflux (leak back) in the esophagus. Acid can cause burning and ulcers and lead to esophagitis. Here are some common antacids that your vet may prescribe:
- esomeprazole magnesium
- famotidine
- omeprazole
- cimetidine
- ranitidine
Antibiotics to treat AP (Aspiration Pneumonia) – It is very important to recognize the signs of AP and act on it right away. If your dog shows signs of being lethargic, coughing, wheezing, sneezing, increased respiration rate, fever, off of their food or water, incessant panting it’s best to get them in for x-rays. Many times a vet cannot tell just by listening on their stethoscope. Your vet may take two x-rays of the lungs – one with the dog on its stomach or back, and one with the dog lying on its side. Often, two antibiotics will be prescribed for 2-6 weeks, consisting of a broad -spectrum antibiotic, like Enrofloxacin, along with one other. If a dog has chronic or recurring AP, the drugs can be administered through a Nebulizer to avoid taking orally.
*Each of these meds has side effects that may or may not impact your pup. Clavamox, for example, can cause nausea, loss of appetite, or vomiting. You will need to monitor your pup while taking this medication for any complications.
- enroflaxacin
- Clavamox
- ecphalexin
- azithromycin
Sucralfate – is an anti-ulcer medication used in the treatment of ulcers of the esophagus, stomach , or small intestines. Give orally on an empty stomach (1 hour before or 2 hours after feeding or giving other medications). It is best to crush them and mix with water (can be given with a syringe), so the medication is better absorbed.
Maropitant – Severe Esophagitis can cause nausea. This is an anti-emetics drug that really works!
Neurontin – Esophagitis can be painful for your pup, causing him to avoid eating. This is a medication that helps manage your pup’s pain.
Slippery Elm – Slippery Elm is an herbal treatment prepared from the inner bark of the Slippery or Red Elm Tree. The term “slippery” refers to the remarkable sticky gel that is formed when the powdered bark comes in contact with water. It is a protector and lubricator for pets with gastrointestinal disease and esophageal diseases. It is very soothing to the esophagus.
Tramadol – Pain medication that is used often for pain management associated with many illnesses/injuries in dogs.
ondanestron – anti-emetics for nausea caused by severe Esophagitis
Pro-Motility Drugs – Pro-motility drugs help open up the sphincter between the stomach and small intestines, allowing stomach contents to more quickly enter the small intestines, so that it is less likely to reflux back up into the esophagus.
Propulsid – helps with reflux –give 15-30 minutes to an hour prior to eating
metoclopromide – helps empty the stomach – give 15-30 minutes to an hour prior to eating
Bethanechol– increases the speed of rhythmic contractions in esophageal muscle
Sildenafil – 2017 published study evaluated the efficacy of oral sildenafil in dogs with congenital idiopathic megaesophagus. The study suggest the drug reduces the LES tone and facilitates the emptying of the esophagus. See Full Study here
* Note: Again, some dogs do not require drugs to manage ME, though most are on some sort of antacid. Some have had success with the pro-motility drugs and others have not. Keep trying until you find what works for your pup! Any and all medications and dosages should be regulated by your veterinarian.