There can be a variety of co-existing conditions that can be associated w/ megaesophagus. This list is NOT based on anything that is published, but, has been created based on participating on the megae board for the last 5 years. a) the sphincter between the esophagus and stomach in megae dogs may be “lazy” and allow acidic stomach fluids to reflux (leak back) into the esophagus. Acid is NOT a friend to the esophagus, causing burns or ulcers. If the stomach fluids can be made LESS acidic, it is less likely to burn the inside of the esophagus (esophagitis). In general, most dogs need to be tried on one of a variety of “antacids.” The most successful seems to be Prilosec, Pepcid ADand Nexium. In people, these acid-meutralizers are recommended to be given once daily. Twice daily seems to work best in dogs. Chronic decreased acid, however, can cause a Vitamin b12 and/or folic acid deficiency, so supplementation w/ injectable b12 and/or b complex is suggested. Most owners are taught to administer the injections. b) Gastric motility may also be decreased. There is no known treatment for this; however, minimizing the amount of fat in the food, which stays in even a normal stomach, for a longer time, may be helpful. Ie. stay away from fatty foods, A/D, Maximum Calorie, etc. Metoclopromide, cisapride or low dose erythromycin may help the stomach empty more quickly. Bethenachol has also been used w/ some success. c) IBD – some of these dogs seem to have episodes of IBD (Inflammatory Bowel Disorder), or, perhaps H. pylori, which can only be diagnosed w/ endoscopy. However, treatment w/ amoxicillin or metronidazole (or, other antibiotic combos appropriate for these disorders) may be considered, without endoscopy. This “syndrome” should probably be called ANTIBIOTIC RESPONSIVE GASTRITIS/ ENTEROPATHY, as there is quite a bit of controversy about the true involvement of the bacteria Helicobacter pylori. – some of these dogs may also have dietary intolerances and may be best served by being fed a hypoallergenic diet. The most common ingredients (but, not the only ones for dogs to be “allergic/intolerant of” are eggs, milk, beef, chicken, soy, wheat and corn. There are few OTC dog food that is free of all of those. Most dogs require presciption diets; and, those are more balanced than homemade recipes. d) dysphagia/pharyngeal or cricopharyngeal achalasia – Can cause difficulty/impossible swallowing of food/ fluids. If the throat is affected, some of these dogs have a hard time swallowing fluids. Thickening agents such as “Thicks It,” or “Thick’n’Easy can be added to water, or liquid. e) GERD – GastroEsophageal Reflux Disease and/or hiatal hernia can be present. These dogs, in fact all megae dogs, probably benefit from sleeping or laying slanted w/ their heads above the bodies. A Pro-collar, which is sort of a like a human cervical collar, which will hold the pets head more elevated, which we believe minimizes the reflux of the acid into the back of the throat, can be helpful. f) Aspiration pneumonia – because of the potential for reflux of stomach contents back up into the esophagus, megae dogs can aspirate those fluids/acids into the trachea and down into the lungs, resulting in aspiration pneumonia (AP). The use of a nebulizer w/ albuterol and/or saline is helpful for AP. Some owners feel, for those dogs who are very prone to AP, or who have frequent attacks, that daily nebulizer w/ albuterol treatments seem to minimize attacks. This is not a “standard” use of nebulizer treatments, and many dvm’s, including specialists, seem to have a problem accepting this modality. Go to and view the “nebulizer” information sheet. g) esophageal stricture or esophagitis – Megaesophagus can occur after an anesthetic procedure. If the particular dog has GERD, a hiatal hernia, or an “opened” lower esophageal sphincter, when they are anesthetized, some of the acid can reflux back into the esophagus causing a sort of “burn.” If the inflammation is not recognized soon enough, a stricture can occur, which can then result in megaesophagus. Strictures may be treated w/ bougenage (stretching of the esophagus under anesthesia) and placement of a temporary or permanent feeding tube. Esophagitis is treated w/ carafate liquid and acid- inhibitors. h) dogs w/ Myasthenia Gravis (MG), Addison’s disease, or hypothyroidism can be predisposed to megae. A rare cause is lead toxicity. i) Laryngeal Paralysis (LP) – please see information on the main links page. Surgery for LP is usually not a good idea in dogs w/ megae, as it results in a permanently opened trachea, through which water and regurgitation/reflux can more easily pass into the lungs. Doxepin, an anti-anxiety drug, may help w/ some of the coughing in these dogs, per information presented on the Veterinary Information Network (VIN). j) Occasionally, we will receive a report that one of our megae dogs having suffered from Gastric Dilatation/Torsion. We don’t know if megaesophagus predisposes dogs to “bloat,” but, recognizing the symptoms is paramount. W/ bloat, the dogs usually vomit, rather than just regurgitate. They will retch, trying to “bring up” material, often just producing “slime” and/or foam. This is an emergency, as if it is not corrected, the dog will die. Gastric Dilatation/Torsion is most common in large, deep chested dogs like Danes, Dobes, GSD’s, etc., but, deep-chested small dogs, like dachsunds and Basset Hounds can also suffer from this disorder. k) Nausea and/or vomiting antibiotics is quite common in all dogs, not only those w/ megaesophagus. Administration of metoclopromide, if it is tolerated, one-half hour before the antibiotics are taken may minimize the nausea. Cerenia once daily for no more than 5 consecutive days, will usually also minimize the vomiting. If oral or injectable anti-emetics (anti-vomit) medications do not help, injectable antibiotics may be tried. l) Gastroesophageal intussuception occurs when the stomach “telescopes” into the esophagus through a weakened esophageal sphincter. Immediate surgical repair is needed. m) If a puppy is born with PRAA (Persistent Right Aortic Arch), a defect in which a blood vessel band “strangles” the esophagus, it may develop megaesopahgus. Rapid surgical correction (cutting the band) may result in resolution of the megaesophagus, but, not always. Dr. Kathy 6/09; revised 2-24-2011