Visiting Veterinarian - Chronic bloat

By Michelle Gerhard Jasny V.M.D. - March 27, 2008

When Artemis, the black lab, was young, she occasionally vomited after eating. This is not uncommon. Sometimes dogs eat too fast, or eat stuff that isn't edible, or have worms. I advised small, multiple meals and a fecal test for parasites. The vomiting resolved. Artemis grew to be a beautiful dog, but every now and then she seemed uncomfortable after eating, like she had indigestion. By the time Arty was an adult, the episodes became increasingly frequent. "Is she wolfing her meals quickly?" I asked her mom. No. "Getting into something outside? Compost? Manure? Garbage?" I continued. No. "Maybe she has a food intolerance," I suggested. Her owner tried different brands of foods, but nothing helped significantly.

As years passed, things gradually worsened. Artemis was exhibiting excessive borborygmus and flatulence. In other words, her stomach gurgled loudly and she farted a lot. I wasn't too concerned. Every time I examined her, she was the picture of health. Dogs fart. That's just how it is. We checked repeatedly for gastrointestinal parasites. I suggested premium brand foods, Bean-O (an over-the-counter treatment for flatulence in people), and Pepto Bismol. "Put a big ball in her food dish," I said. "That will slow her eating down so she doesn't gulp air during dinner." She continued to gurgle and fart. "Try Hill's Prescription diets I/D," I said. "It's for chronic gastrointestinal disease. If that doesn't work, we'll try Z/D. It's hypoallergenic." Nothing helped. "It's happening after every meal now," her mother told me over the phone. "She licks her lips. Sometimes she drools and belches. Sometimes her stomach looks bloated." That was the magic word. Bloat.

Technically called gastric dilatation, bloat is a condition in which a huge amount of gas accumulates and is retained in the stomach. Bloat is uncomfortable, but the reason it puts fear into the hearts of veterinarians is the danger that the stomach may suddenly twist. This life-threatening situation is termed Gastric Dilatation and Volvulus (GDV). Us old-timers call it Gastric Torsion. The blood supply to the stomach is cut off by the twist. Tissue may begin to die. There is no way for the gas to escape. The stomach swells larger and larger, putting pressure on the aorta and compromising normal venous return to the heart. The spleen may also twist.

Gastric dilatation, sans volvulus, is treated by releasing the gas via a stomach tube, but if the stomach is twisted, the tube won't pass. Emergency surgery to de-rotate the stomach is the only hope. Once the organs are returned to normal position, the surgeon must assess whether the tissue is still viable. If the blood supply has been cut off long enough, the damage may be permanent, requiring resection of devitalized tissue. If the damage is too extensive, euthanasia may be the only humane choice. For animals that survive the initial portion of surgery, the surgeon has one more essential task. A gastropexy. Permanently fixing the stomach in place so it cannot twist again. Without a gastropexy, up to 80 percent of cases will have recurrences at a later date.

No one knows for sure what causes GDV. It is most common in German shepherds, Great Danes, Saint Bernards, Rottweilers, Labrador retrievers and other large, deep-chested dogs. This is thought to be due to conformation rather than inheritability. Theories abound as to prevention: feed only canned food, feed small multiple meals, avoid exercise right after eating. But the only surefire prevention is a gastropexy. Some veterinarians even advise gastropexy during spaying in females of susceptible breeds. (This is not suggested in male dogs, since castration does not involve opening the abdominal cavity like a spay does.)

When Arty's mom said "bloat," she really got my attention, but in my 25 years of experience, bloat had always occurred as one big, bad, crisis (usually in the middle of the night), not as a mild, recurrent, after-dinner discomfiture. Still.... "If you really think she's bloated, we should see her immediately," I advised. "Well, she seems fine now," her owner replied. "I'll bring her in next week." When Artemis came in, days later, she was perfectly fine. We took radiographs. Her stomach looked normal. No bloat. We checked yet again for intestinal worms and protozoal parasites like Giardia. All clear. We ran blood work. "Everything's hunky-dory" I said, sending her home with a differential diagnosis of food intolerance, food allergy, inflammatory bowel disease, or a motility disorder, and a plan to do a trial on a strict hypoallergenic diet of home-cooked venison and rice. We tried different medications. Sometimes her owner thought things were better, sometimes not. I suggested referral to a specialist who could look down her gut with an endoscope and take biopsies, but her owner didn't feel her symptoms were severe enough to warrant such measures. And so things went along, year after year. Then this February, she called again. "Arty is really uncomfortable," she said. "Can I bring her down right now?" Having never examined Artemis while she was actually having one of these postprandial episodes, I jumped at the opportunity.

Arty arrived quickly. She was a bit subdued and licking her lips. "She doesn't feel bloated," I ventured, palpating her abdomen. Most cases of bloat exhibit significant distress, their sides tense and visibly distended. Arty's abdomen was soft and pliable. She did not complain when I pressed on it. "Let's get an X-ray," I sighed, doubting it would help make a diagnosis. "Just to be sure." When the film was done, I looked in amazement. Even though I couldn't see anything externally or feel it on exam, the radiograph showed her stomach was markedly distended with gas. All these years that I was focused on indigestion, inflammatory bowel disease, or food allergies, I had just never taken an X-ray at the right moment. Arty was having chronic, recurrent bloat, a condition I didn't even know existed until that day. We immediately started her on anti-gas medications and antacids. Our biggest concern was that, at any time, one of these bloating episodes could suddenly become a life-threatening GDV. "You should have a surgeon do a gastropexy as soon as possible, so even if we can't stop the bloating, we won't have to worry about her stomach twisting, " I advised. "They can take biopsies at the same time."

After weighing the pros and cons of elective surgery, her mom took Artemis to the specialists. Arty has recovered uneventfully from her gastropexy procedure. The biopsies were all normal, and, much to everyone's delight, the surgery alone seems to have resolved her chronic bloat. She still takes a daily antacid and eats a hypoallergenic diet just to be on the safe side. As for me, I will never again dismiss recurrent discomfort after meals as mere indigestion, but will insist on doing a radiograph during an actual episode to rule out chronic bloat. Hmmm... maybe you can teach an old dog a new trick.

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