Gastroesophageal reflux

Gastroesophageal reflux in cats is a condition in which stomach contents, including gastric acid, digestive enzymes, and occasionally bile, flow backward from the stomach into the esophagus. This retrograde movement of acidic material occurs when the lower esophageal sphincter, the muscular valve that normally prevents backflow, relaxes inappropriately or fails to maintain adequate pressure. Unlike the stomach, which has a protective mucus lining to withstand acidic conditions, the esophagus lacks this defense and is readily damaged by exposure to gastric contents. Gastroesophageal reflux can range from occasional mild episodes to chronic severe disease that causes significant esophageal damage and complications affecting the cat's ability to eat and maintain nutrition.

The causes of gastroesophageal reflux in cats are varied and include both transient factors and chronic conditions. Anesthesia is one of the most common triggers, as anesthetic agents relax the lower esophageal sphincter while the cat is positioned in ways that promote reflux. Other causes include hiatal hernias, delayed gastric emptying, chronic vomiting conditions, and increased abdominal pressure from obesity or pregnancy. Certain medications can reduce esophageal sphincter tone, and some cats may have primary motility disorders affecting normal esophageal function. Understanding the underlying cause is essential for developing an effective treatment and prevention plan.

The impact of gastroesophageal reflux on a cat's health depends on the frequency and severity of episodes and whether esophageal damage has occurred. Occasional mild reflux may cause only transient discomfort, while repeated or severe reflux can lead to esophagitis, the inflammation of the esophageal lining. Chronic esophagitis can progress to esophageal stricture, a narrowing of the esophagus due to scar tissue formation that significantly impairs swallowing. Aspiration of refluxed material into the airways can cause aspiration pneumonia, a serious and potentially life-threatening complication. Because cats may not show obvious signs of discomfort, reflux-related damage can progress silently before becoming clinically apparent.

Gastroesophageal reflux is generally treatable when identified and managed appropriately, with most cats responding well to medical management and dietary modifications. Treatment focuses on reducing gastric acid production, protecting the esophageal lining, and addressing underlying causes. Dietary changes including smaller, more frequent meals and appropriate food consistency can significantly reduce reflux episodes. With proper veterinary care, most cats with gastroesophageal reflux can achieve symptom control and maintain good quality of life. However, cases complicated by stricture formation may require more intensive intervention, emphasizing the importance of early recognition and treatment.

The primary causes of gastroesophageal reflux involve dysfunction of the mechanisms that normally prevent stomach contents from entering the esophagus. The lower esophageal sphincter is the key barrier against reflux, and any condition that reduces its tone or causes inappropriate relaxation can allow gastric contents to flow backward. General anesthesia is a well-documented cause of reflux in cats, as anesthetic agents relax smooth muscle including the esophageal sphincter while also eliminating the protective swallowing reflex. Improper positioning during anesthesia, particularly with the head lower than the stomach, increases reflux risk. Pre-anesthetic fasting that is too short allows stomach contents to be present during the procedure, while fasting that is excessively long may increase gastric acid concentration.

Anatomical abnormalities can predispose cats to chronic gastroesophageal reflux. Hiatal hernias, in which a portion of the stomach protrudes through the diaphragm into the chest cavity, disrupt normal esophageal sphincter function and create conditions favorable for reflux. Congenital abnormalities of the esophagus or stomach may affect normal anatomy and function. Esophageal strictures from previous injury or inflammation can alter motility patterns and promote reflux. Cats with megaesophagus, a condition of esophageal dilation and impaired motility, often experience concurrent reflux issues. These structural problems may require surgical correction in addition to medical management.

Environmental and lifestyle factors significantly influence the development and severity of reflux. Obesity increases intra-abdominal pressure, which can overcome esophageal sphincter resistance and promote reflux. Feeding large meals causes gastric distension that increases the likelihood of reflux events. Feeding immediately before physical activity or excitement can trigger episodes. Stress may alter gastrointestinal motility and contribute to reflux in susceptible cats. Certain sleeping positions or resting places that put pressure on the abdomen may exacerbate reflux. Cats that eat too quickly and swallow excessive air may experience increased gastric pressure.

Several risk factors increase a cat's susceptibility to gastroesophageal reflux. Young cats, particularly those undergoing spay or neuter surgery, are at increased risk for anesthesia-related reflux and subsequent esophageal damage. Brachycephalic breeds with shortened airways and altered upper gastrointestinal anatomy may be predisposed to reflux. Cats with chronic vomiting conditions experience repeated exposure to gastric acid moving through the esophagus. Those with delayed gastric emptying retain stomach contents longer, increasing reflux opportunities. Certain medications including some sedatives, calcium channel blockers, and nitrates can reduce esophageal sphincter pressure.

The mechanism of gastroesophageal reflux involves failure of the anti-reflux barrier combined with the presence of harmful gastric contents. Normally, the lower esophageal sphincter maintains high pressure that exceeds gastric pressure, preventing backflow. When this barrier fails, acidic gastric juice containing hydrochloric acid with a pH as low as 1-2 contacts the esophageal mucosa. Unlike gastric epithelium, esophageal epithelium lacks protective mucus and is rapidly damaged by acid exposure. Pepsin, the primary gastric enzyme, becomes activated in the acidic environment and begins digesting esophageal tissue. Bile refluxing from the duodenum adds additional caustic substances. The resulting inflammation can range from superficial erythema to deep ulceration and stricture formation.

Early warning signs of gastroesophageal reflux in cats can be subtle and easily overlooked. Initial indicators may include increased swallowing motions when the cat is not eating, suggesting discomfort in the throat or esophagus. Cats may display excessive lip-licking or drooling, which indicates nausea or esophageal irritation. Slight reluctance to eat or eating more slowly than usual may be observed before more obvious symptoms develop. Some cats may repeatedly approach their food bowl but then walk away after eating only a few bites. Changes in food preferences, particularly avoiding dry food in favor of wet food or vice versa, may indicate swallowing discomfort. These early signs often precede the development of more recognizable symptoms.

Regurgitation is a hallmark symptom of gastroesophageal reflux and esophageal disease, and it differs importantly from vomiting. Regurgitation is a passive process in which undigested food and fluid are expelled without the abdominal contractions and retching that accompany vomiting. The regurgitated material typically appears shortly after eating and consists of tubular-shaped undigested food covered in mucus. Some cats may regurgitate clear or frothy fluid without food content. The timing can vary from immediately after eating to several hours later if food has been retained in a dilated or damaged esophagus. Chronic reflux may cause occasional regurgitation rather than frequent episodes, making the pattern harder to recognize.

Behavioral changes associated with gastroesophageal reflux reflect the discomfort that cats experience during and after eating. Affected cats often become reluctant eaters, showing interest in food but eating hesitantly or stopping frequently during meals. Some cats may cry out or vocalize during or after eating, indicating pain. Extended neck postures or repeated swallowing motions during and after meals are common. Cats may seek unusual positions after eating, such as keeping the head elevated, which can reduce reflux symptoms. Decreased activity and lethargy may develop as nutritional intake declines. Some cats become withdrawn or irritable due to chronic discomfort.

Physical signs that owners may observe include weight loss, which can become significant if eating is substantially reduced. Excessive salivation or drooling, particularly during or after meals, indicates esophageal irritation. The coat may become dull and unkempt as nutritional status declines and grooming decreases. Bad breath may develop from esophageal inflammation or retained food in a damaged esophagus. Some cats develop a preference for certain textures that are easier to swallow. Coughing or gagging may occur, particularly if aspiration of refluxed material is happening. Extended periods of neck stretching or repeated swallowing are visible signs of esophageal discomfort.

Symptom progression in untreated gastroesophageal reflux typically follows a pattern of worsening as esophageal damage accumulates. Early-stage reflux may cause only occasional discomfort and subtle eating changes. As esophagitis develops, symptoms become more pronounced with increased regurgitation and eating reluctance. If stricture formation begins, progressive difficulty swallowing becomes apparent, with cats eventually having trouble getting even small amounts of food past the narrowed area. Weight loss accelerates as nutritional intake becomes increasingly compromised. The timeline of progression varies based on reflux severity and whether exposure to caustic gastric contents continues.

Emergency symptoms requiring immediate veterinary care include complete inability to swallow food or water, which may indicate severe stricture or esophageal obstruction. Respiratory distress with coughing, rapid breathing, and fever suggests aspiration pneumonia and requires urgent treatment. Severe dehydration with lethargy and collapse needs immediate fluid therapy. Vomiting blood or regurgitating material containing blood indicates significant esophageal damage. Sudden worsening of symptoms in a cat previously stable on treatment warrants urgent evaluation. Young cats showing any symptoms after recent anesthesia should be evaluated promptly, as post-anesthetic esophagitis is most treatable when addressed early.

The diagnostic process for gastroesophageal reflux begins with a detailed history and physical examination. The veterinarian will ask specific questions to distinguish regurgitation from vomiting, as this distinction is crucial for directing the diagnostic workup. Information about the timing of symptoms relative to eating, the appearance of expelled material, and whether abdominal contractions occur helps differentiate these processes. History of recent anesthesia, chronic vomiting, or medications that affect esophageal function is relevant. The physical examination includes careful observation of swallowing, palpation of the neck and esophagus for pain or abnormalities, and assessment of body condition and hydration status.

Laboratory testing provides baseline health information and helps rule out systemic causes of the symptoms. Complete blood count and chemistry panel evaluate for infection, anemia, electrolyte imbalances, and organ function. These tests may be normal in straightforward reflux cases but can reveal complications such as aspiration pneumonia or dehydration. In older cats, thyroid testing rules out hyperthyroidism as a contributing factor. Fecal examination eliminates parasites as a cause of gastrointestinal symptoms. If aspiration pneumonia is suspected, arterial blood gas analysis may assess respiratory function.

Imaging studies are essential for evaluating esophageal structure and function. Plain thoracic radiographs may reveal esophageal dilation, foreign bodies, or evidence of aspiration pneumonia. Contrast esophagography using barium or iodinated contrast provides detailed images of esophageal contour and motility, revealing strictures, diverticula, or masses. Fluoroscopic evaluation allows real-time observation of swallowing and can detect motility abnormalities and reflux events. Thoracic ultrasound may be useful for evaluating the esophageal wall in certain areas. Advanced imaging such as CT scanning provides detailed anatomical information in complex cases.

Endoscopy is the gold standard for diagnosing esophagitis and assessing esophageal damage from reflux. Direct visualization reveals inflammation, ulceration, or stricture formation that cannot be seen on radiographs. The severity and extent of esophagitis can be graded, helping guide treatment intensity. Biopsy samples obtained during endoscopy provide tissue for histopathology, which can distinguish reflux esophagitis from other conditions such as eosinophilic esophagitis or neoplasia. If strictures are present, endoscopy allows measurement of the narrowing and, in some cases, therapeutic intervention through balloon dilation. Esophageal pH monitoring, while not commonly performed in cats, can document acid reflux events if diagnosis remains uncertain.

Initial treatment for acute gastroesophageal reflux focuses on reducing gastric acid production and protecting the esophageal lining from further damage. Proton pump inhibitors such as omeprazole are the most effective medications for suppressing gastric acid and are typically administered once or twice daily. H2-receptor antagonists like famotidine provide an alternative or adjunctive approach to acid reduction. Sucralfate suspension provides a protective coating over damaged esophageal tissue, binding to the ulcerated areas and shielding them from acid exposure. Prokinetic medications such as metoclopramide may be prescribed to improve gastric emptying and reduce reflux episodes. Anti-nausea medications control discomfort and encourage eating.

Medical management of chronic gastroesophageal reflux requires long-term medication combined with dietary and lifestyle modifications. Acid suppression therapy may need to continue for weeks to months while the esophagus heals, and some cats require indefinite treatment. Sucralfate is typically given 30 minutes before meals and other medications to maximize its protective effect. The specific medication protocol is adjusted based on response, with some cats needing combination therapy for adequate symptom control. Regular monitoring assesses treatment effectiveness and allows for adjustments. Gradual medication tapering may be attempted once symptoms have been well controlled for an extended period.

Surgical intervention becomes necessary in specific circumstances including severe hiatal hernia, refractory strictures, and cases not responding to medical management. Hiatal hernia repair surgically restores normal anatomy and function of the esophageal-gastric junction. Esophageal stricture dilation using balloon catheter techniques can be performed endoscopically, often requiring multiple sessions for optimal results. In severe cases, surgical resection of strictured segments may be necessary. Anti-reflux surgical procedures such as fundoplication, while less commonly performed in cats than in humans, may be considered in refractory cases. Surgical treatment requires careful patient selection and carries risks that must be weighed against potential benefits.

Supportive care is essential for maintaining nutrition and hydration while the esophagus heals. Cats with significant esophagitis may need temporary feeding tube placement to bypass the damaged esophagus and provide adequate nutrition. Gastrostomy tubes placed directly into the stomach are preferred over esophageal tubes, which could worsen esophageal irritation. Fluid therapy corrects dehydration and maintains hydration during recovery. Pain management with appropriate analgesics improves comfort and may encourage eating. Creating a low-stress environment supports healing and reduces factors that might exacerbate reflux.

Dietary modifications play a crucial role in managing gastroesophageal reflux. Feeding smaller, more frequent meals reduces gastric distension and reflux pressure. Low-fat diets empty from the stomach more quickly, reducing reflux opportunity. The optimal food consistency varies between patients; some cats do better with soft food that moves easily through the esophagus, while others benefit from formed food that stimulates more coordinated swallowing. Elevated feeding positions using raised bowls help gravity promote food movement into the stomach. Avoiding feeding immediately before strenuous activity or sleep reduces reflux risk. Water should be offered in small amounts rather than allowing large volume drinking.

Treatment decisions are influenced by multiple factors including the severity of esophageal damage, underlying cause, and practical considerations. Mild reflux in otherwise healthy cats may respond to dietary management and short courses of medication. Severe esophagitis or established strictures require more intensive and prolonged treatment. The presence of complications such as aspiration pneumonia necessitates additional targeted therapy. Cost of treatment, need for ongoing medication, and owner ability to administer complex medication schedules all factor into treatment planning. The veterinarian works with owners to develop protocols that balance optimal medical care with realistic expectations and resources.

Recovery timeline for gastroesophageal reflux varies considerably based on the severity of esophageal damage and the underlying cause. Cats with mild esophagitis from a single reflux event, such as post-anesthetic reflux, may heal within one to two weeks with appropriate treatment. Moderate esophagitis typically requires four to eight weeks for mucosal healing. Severe esophagitis with deep ulceration may take several months to resolve completely. If stricture formation has occurred, the recovery process becomes more prolonged and may require repeated dilation procedures over months. Cats whose reflux is secondary to a hiatal hernia may show improvement only after surgical correction.

Post-treatment care focuses on gradual normalization of eating while preventing reflux recurrence. Medications should be continued as prescribed, even as symptoms improve, to ensure complete esophageal healing. The transition from frequent small meals back to a normal feeding schedule should be gradual, typically over several weeks. Dietary modifications that proved effective during acute treatment may need to continue long-term. Follow-up endoscopy may be recommended to confirm healing, particularly in cases with significant initial damage. Activity restrictions are generally not necessary once acute symptoms have resolved, though avoiding feeding before vigorous activity remains advisable.

Prognosis for gastroesophageal reflux depends on the extent of esophageal damage at the time of diagnosis and the success of treating any underlying causes. Cats with mild esophagitis that is identified and treated promptly generally have excellent prognoses with complete recovery expected. Those with moderate esophagitis usually respond well to treatment, though they may be at increased risk for future episodes. Severe esophagitis and established strictures carry more guarded prognoses; while many cats improve significantly with treatment, some develop recurrent strictures requiring ongoing management. Aspiration pneumonia as a complication significantly impacts prognosis and requires aggressive treatment.

Long-term outlook for cats recovered from gastroesophageal reflux is generally favorable when preventive measures are maintained. Future anesthetic procedures should include appropriate precautions to minimize reflux risk, including proper fasting protocols, positioning, and perioperative acid suppression. Cats with anatomical predispositions to reflux, such as hiatal hernia, may require ongoing management even after initial recovery. Maintaining appropriate body weight and following dietary recommendations reduces recurrence risk. Regular veterinary monitoring allows early detection of any recurrence. With appropriate ongoing care, most cats that recover from gastroesophageal reflux maintain normal eating function and quality of life long-term.

Primary prevention of gastroesophageal reflux centers on minimizing known risk factors and protecting the esophagus during vulnerable periods. Proper anesthetic protocols are essential since anesthesia-related reflux is a common and preventable cause of esophageal damage. Appropriate pre-anesthetic fasting, typically 8-12 hours for food and 2-4 hours for water, balances the need for an empty stomach against excessive gastric acid concentration. Pre-anesthetic antacid administration reduces acid production and reflux damage potential. Proper patient positioning during anesthesia, with the head slightly elevated when possible, promotes gastric emptying and reduces reflux. Monitoring for regurgitation during recovery and prompt treatment of any suspected reflux event prevents progression to severe esophagitis.

Environmental prevention strategies focus on factors that can promote reflux in daily life. Maintaining healthy body weight through appropriate feeding and activity reduces intra-abdominal pressure that can overcome esophageal sphincter resistance. Avoiding overfeeding and providing appropriately sized meals prevents excessive gastric distension. Elevated feeding positions help gravity promote food movement into the stomach and reduce reflux. Allowing time for digestion before vigorous activity or stress reduces reflux during these vulnerable periods. Managing stress and anxiety through environmental enrichment and consistent routines supports normal gastrointestinal function.

Dietary prevention involves feeding practices that support healthy esophageal function and minimize reflux risk. Feeding multiple small meals rather than one or two large meals reduces gastric distension and associated reflux pressure. Low-fat diets promote faster gastric emptying, reducing the time window for reflux to occur. Avoiding late-night feeding allows the stomach to empty before overnight sleep when reflux risk may be higher. Ensuring adequate hydration supports normal digestive function. For cats with known reflux tendency, continuing appropriate dietary modifications indefinitely provides ongoing protection. High-quality, easily digestible diets support overall gastrointestinal health.

Health maintenance through regular veterinary care enables early identification of conditions that may predispose to reflux. Routine wellness examinations can identify obesity, hiatal hernia, or other risk factors before they cause problems. Cats with chronic vomiting should be evaluated and treated to minimize repeated esophageal acid exposure. Regular dental care prevents oral conditions that might alter eating behavior. Medication reviews ensure that drugs known to reduce esophageal sphincter tone are used only when necessary and with appropriate gastroprotection. Senior cats benefit from increased monitoring as age-related changes may affect esophageal function.

Early intervention when symptoms first appear prevents progression to severe esophageal damage. Owners should be educated about early warning signs of reflux including changes in eating behavior, excessive swallowing, and regurgitation. Prompt veterinary consultation when these signs appear allows early treatment before significant esophagitis develops. Cats that experience an episode of reflux, particularly after anesthesia, should receive prophylactic acid suppression therapy. Working with your veterinarian to develop a risk assessment and prevention plan tailored to your cat's individual factors provides the best protection against this condition.

Daily management for cats with chronic or recurrent gastroesophageal reflux requires consistent attention to feeding practices and medication administration. Meals should be offered in smaller portions three to six times daily rather than one or two large meals. Medications, particularly proton pump inhibitors, work best when given on an empty stomach 30 minutes before meals. Sucralfate should be given separately from other medications to maximize its protective effect. Feeding positions should allow the head to be elevated, which can be achieved using raised bowls or feeding platforms. Establishing consistent feeding times helps maintain regular gastric function and makes medication scheduling easier.

Home environment modifications support esophageal health and minimize reflux triggers. Elevated resting spots that allow cats to sleep with their heads higher than their stomachs may reduce overnight reflux. Food and water bowls should be raised to comfortable heights, typically 4-6 inches off the ground for average-sized cats. Creating calm, stress-free feeding areas encourages relaxed eating that reduces air swallowing and promotes proper swallowing mechanics. Puzzle feeders that slow eating may benefit some cats by preventing rapid food intake, though others may find them frustrating. Access to fresh water at all times supports hydration and digestive function.

Maintaining quality of life for cats with reflux requires balancing necessary management with normal enrichment and activity. Most cats with well-controlled reflux can participate in normal play and activities. Timing of feeding relative to activity matters; allowing 30-60 minutes after eating before vigorous play reduces reflux risk. Interactive play sessions strengthen the bond between cat and owner while providing mental stimulation. Grooming sessions help maintain coat condition that may suffer during periods of reduced eating. Providing comfortable resting spots, sunny windows, and environmental enrichment keeps cats mentally engaged and happy.

Monitoring and ongoing care involve tracking symptoms and maintaining regular veterinary communication. Keeping a log of regurgitation episodes, eating patterns, and any changes in behavior helps identify trends and treatment effectiveness. Regular weigh-ins detect gradual weight changes before they become significant. Periodic follow-up appointments allow assessment of treatment response and medication adjustments. Owners should know which symptoms warrant routine follow-up versus urgent care. Some cats require periodic endoscopy to assess healing and check for stricture recurrence. Maintaining open communication with the veterinary team ensures problems are addressed promptly.

Caregiver support helps owners manage the demands of caring for cats with chronic digestive conditions. Understanding that flare-ups can occur despite best management reduces guilt and frustration. Online communities connect owners facing similar challenges and provide practical tips and emotional support. Pet insurance obtained before diagnosis helps manage costs for conditions requiring ongoing treatment. Financial assistance programs may be available through veterinary schools or charitable organizations. Taking time for self-care and accepting that perfect management is not always possible helps prevent caregiver burnout. Remember that providing consistent care day after day is a significant accomplishment that meaningfully improves your cat's quality of life.

Brachycephalic cat breeds, including Persians, Himalayans, Exotic Shorthairs, and Burmese, may face elevated risk for gastroesophageal reflux due to their altered upper airway and gastrointestinal anatomy. The shortened skull and facial structure that characterize these breeds can affect the configuration of the esophagus and lower esophageal sphincter region. Breathing difficulties common in brachycephalic cats may increase thoracic pressure changes that promote reflux. These breeds may also be more prone to hiatal hernias, which directly contribute to reflux by disrupting normal esophageal-gastric junction anatomy. Owners of brachycephalic cats should be particularly vigilant for signs of reflux and discuss prevention strategies with their veterinarians.

Siamese cats and related Oriental breeds have been reported to have higher rates of certain esophageal disorders, including megaesophagus, which can be associated with secondary reflux issues. The predisposition in these breeds appears to involve both structural and functional abnormalities of the esophagus. While not all Siamese cats will experience reflux, those with family history of esophageal problems may warrant increased monitoring. Mixed breed cats can also develop reflux, and breed is only one of many factors influencing individual risk. Cats of any breed that are obese, have chronic vomiting conditions, or require frequent anesthesia face elevated reflux risk regardless of their genetic background.

Screening recommendations for breeds at increased reflux risk focus on early identification of predisposing conditions. Brachycephalic cats should be evaluated for hiatal hernia if they show any signs of reflux or regurgitation. Pre-anesthetic assessment should include discussion of reflux risk and appropriate preventive measures. Siamese and Oriental cats with any swallowing abnormalities should undergo esophageal function evaluation. All cats undergoing anesthesia should have appropriate fasting protocols and positioning, with high-risk breeds potentially benefiting from additional precautions such as pre-operative acid suppression. Maintaining ideal body weight is particularly important for breeds with anatomical predispositions to reflux.

Several conditions commonly co-occur with gastroesophageal reflux or develop as complications of chronic acid exposure to the esophagus. Esophagitis, the inflammation of the esophageal lining, is the direct result of reflux and ranges from mild superficial irritation to severe ulcerative disease. Esophageal stricture develops when chronic inflammation and ulceration heal with scar tissue formation, progressively narrowing the esophageal lumen. Hiatal hernia can be both a cause and a complication of reflux, as chronic inflammation and scarring may alter the anatomy of the esophageal-gastric junction. Aspiration pneumonia occurs when refluxed material is inhaled into the lungs, causing bacterial infection and respiratory distress.

Conditions with similar symptoms to gastroesophageal reflux must be distinguished through appropriate diagnostic testing to ensure correct treatment. Megaesophagus causes regurgitation similar to reflux but involves primary esophageal dilation and motility failure rather than acid damage. Esophageal foreign bodies cause acute regurgitation and distress that may mimic severe reflux. Gastritis and gastric ulcers cause vomiting rather than regurgitation but may be confused with reflux by owners unfamiliar with the distinction. Inflammatory bowel disease affecting the upper gastrointestinal tract can cause symptoms overlapping with reflux. Gastrointestinal neoplasia, including esophageal or gastric tumors, must be ruled out in chronic cases.

Potential complications of gastroesophageal reflux represent serious health threats requiring vigilant monitoring and prompt intervention. Progressive stricture formation can eventually prevent adequate oral nutrition, requiring feeding tube placement or surgical intervention. Repeated aspiration events can cause chronic respiratory disease and lung damage. Severe esophagitis with deep ulceration can occasionally cause esophageal perforation, a life-threatening emergency. Chronic nutritional deficiency from inadequate food intake leads to muscle wasting and immune dysfunction. Barrett's esophagus, a precancerous change seen in humans with chronic reflux, has not been well-documented in cats but remains a theoretical concern. Early recognition and treatment of reflux prevents these serious complications from developing.