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Duodenal-Gastric Reflux

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.

Symptoms
  • 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.


  • Diagnosis
  • 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 parasites

    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.

    Dogs
    Horse Herd