Issue Description Bile and pancreatic juices enter the digestive
tract in the small intestine. They are kept out of the stomach by the
pylorus. Some dogs, for reasons that may include motility disorders,
chronic gastritis or loss of pyloric tone, have bile and digestive
juices flowing backwards into the stomach. As these juices were not
meant to be in the stomach, they cause gastritis and in some cases
ulceration, resulting in the clinical signs of vomiting, often early
in the morning, with the dog being normal the remainder of the time. Other Names Reflux Gastritis Syndrome, Bilious Vomiting Syndrome
Causes It is considered an idiopathic syndrome,
possibly a primary hypomotility disorder, although it has been
associated with giardiasis and inflammatory bowel disease.
Chronic intermittent vomiting of bile
associated with an empty stomach.
Signs generally occur late at night or early in the morning.
Signs may occur daily but are usually more intermittent. Between
episodes, the animal appears normal in all other respects.
Results of physical examination are usually unremarkable.
Any number of gastrointestinal and
nongastrointestinal disorders can cause chronic vomiting.
Giardia should be excluded since the signs of this disease may
mimic those of bilious vomiting.
Intestinal obstruction or partial obstruction should be ruled out.
CBC/Biochemistry/Urinalysis Results usually normal
Laboratory Tests Fecal examination to detect giardia or other
Imaging Liquid barium contrast study may reveal delayed
gastric emptying or depressed gastric contractions.
Other Diagnostic Procedures
Endoscopic findings are frequently normal.
Evidence of bile in the stomach or gastritis in the antral region seen
in some patients.
Endoscopy useful to rule out structural disease of the stomach and
inflammatory changes in the duodenum.
Treatment Many dogs will respond well to simply being fed
later at night, and giving at least two meals a day. Otherwise,
feeding of high fiber foods, the use of metoclopramide, antacids and
further feeding schedule manipulation will often produce good results
but will need to be maintained for life. These dogs may also benefit
for the feeding of a highly digestible diet.