Megaoesophagus
What is Megaoesophagus
Achalasia
What Does This Mean For My Dog
 

THE PET HEALTH LIBRARY

By Wendy C. Brooks, DVM, DipABVP
Educational Director, VeterinaryPartner.com 
http://www.veterinarypartner.com

Megaoesophagus.


Vomiting versus Regurgitation
Most people do not realize that there is a difference between these two actions. Vomiting is an active process. There is gagging, heaving, and retching as the body actively expels stomach contents.  Regurgitation is passive. For whatever reason, food is swallowed from the mouth but never really goes anywhere beyond that point.  Food sits in the oesophagus until it simply falls back out the mouth at some point.  In the dog, megaesophagus is the most common cause of regurgitation.

What is Megaesophagus?
The oesophagus is the tube connecting the throat to the stomach.  When food is perceived in the oesophagus, neurologic reflex causing muscle contraction and relaxation lead to rapid transport of the food into the stomach, like an elevator going down. Other reflexes prevent breathing during this swallowing process to protect the lungs from aspiration.

When these reflexes are interrupted such as by disease in the oesophageal tissue or nerve disease, the oesophagus loses its ability to transport food.  Instead the oesophagus loses all tone and dilates.  Also, the reflex protecting the lung is disrupted and aspiration pneumonia commonly follows.

What Kind of Conditions Cause Megaesophagus?
Most cases involve young puppies (Great Danes, Irish setters, German Shepherds are genetically predisposed).  In these cases the condition is believed congenital though it often does not show up until the pup begins to try solid food. Congenital megaesophagus is believed to occur due to incomplete nerve development in the oesophagus. The good news is that nerve development may improve as the pet matures.  Prognosis is thus better for congenital megaesophagus than it is for megaesophagus acquired during adulthood.

Another congenital problem is the  “Vascular Ring Anomaly.” This is a band of tissue constricting the oesophagus. Such tissue bands are remnants of foetal blood vessels which are supposed to disappear before birth. They do not always do so.  Improvement is obtained when the band is surgically cut but in 60% of cases some residual regurgitation persists.

In adult dogs, diseases that cause nerve damage can lead to Megaesophagus. Myasthenia gravis would be a common cause and very important to rule in or out.  Myasthenia gravis  is a condition whereby the nerve/muscle junction is destroyed. Signals from the nervous system sent to coordinate oesophageal muscle contractions simply cannot be received by the muscle. Megaesophagus is one of its classical signs though general skeletal muscle weakness is frequently associated.  This condition is treatable  but special testing is needed to confirm it.  

Scarring in the oesophagus (as would occur after a foreign body episode or with damage to the oesophagus from protracted vomiting) may be sufficient to interrupt neurologic transmissions or even narrow the oesophagus so that food cannot pass through it.  (Such a narrowing is called a “stricture.”)  Technically, this is not a true megaesophagus as the muscles are working normally; there is simply an obstruction present. Special balloons can be inserted in the oesophagus to dilate the narrowed area but some residual regurgitation is likely to persist.  Tumours of the oesophagus may have similar effects in that they, too, can cause obstruction.

Hypothyroidism may be associated with megaesophagus. It is easy to rule thyroid disease in or out with blood testing and it is important to treat a thyroid hormone deficiency; however, megaesophagus usually does not correct with thyroid replacement therapy. Whether or not hypothyroidism can truly cause megaesophagus is still being debated.

Addison's disease (hypoadrenocorticism) has also been associated with megaesophagus though this would be a rare cause. This condition represents a deficiency of cortisone production by the adrenal gland. This deficiency alters the metabolism of oesophageal muscle. Diagnosis and treatment are not difficult.
External obstruction of the oesophagus could cause a similar syndrome by creating a blockage.  A mass in the chest could pinch the oesophagus closed.

Many of the above conditions are treatable and it is important to find a cause for megaesophagus if it is at all possible to do so. Unfortunately, most cases do not have a clear cause and must be managed as they are. This can be hard work.

The Diagnostic Plan
First, the megaesophagus must be diagnosed.  This is done radiographically.  If megaesophagus is not obvious on plain films, it is better not to use contrast (Barium) studies if possible. This is because megaesophagus patients have the tendency to inhale or "aspirate" food contents that back up in their throats.  This is dangerous enough when the material is simply food but if barium is present and becomes inhaled, the body has great difficulty removing it from the lungs. Still, sometimes this is the only way to see the megaesophagus.

The next step is to determine whether or not the animal has "aspiration pneumonia" from inhaling regurgitated food material.  Chest radiographs in combination with a history of cough, nasal discharge, and the presence of fever indicate pneumonia.   Usually the chest radiographs will show disease in the areas of the chest which are lowest in the standing animal as this is where gravity draws inhaled material. The presence of aspiration pneumonia makes the case much more serious as pneumonia can be a life threatening condition.

Endoscopy is an important diagnostic test for the megaesophagus patient and, if possible, should be done in all cases. In endoscopy a long skinny tube with a special camera on the end is passed down the oesophagus to the stomach. Ulcers on the oesophageal walls will be seen and any narrowing will be obvious. Biopsies can be taken if any suspicious lesions are present.

Blood testing to rule in or out treatable causes of megaesophagus should be performed.

Treatment
The first step is to determine if the dog does better with a liquid or solid diet. Every individual is different. One must train the dog to eat in an elevated position. Ideally, the pet should be kept in this position for 10-15 minutes after the meal.  Feeding tubes can be placed directly in the stomach for more convenient feeding. If the “cardiac sphincter” which separates the stomach from the oesophagus is weak, though, regurgitation may still occur. A medication called Metoclopramide (trade name: Reglan) may help increase the tone of this sphincter.

Medication for nausea may be helpful for patient comfort and strong antacids will help minimize acid related damage to the oesophagus when food is regurgitated from the stomach.

There is a motility modifier called "Cisapride" which is helpful to many cases. Theoretically this should not be so as the type of muscle in the dog's oesophagus is not of a type that should be affected by this medication. Nonetheless, many individuals experience fewer episodes of regurgitation while on cisapride. Given the difficulty in managing this condition, we recommend at least a one week trial for any megaesophagus patient. Cisapride also is able to increase cardiac sphincter tone. Cisapride is no longer commercially available in the U.S., but it can be made up by most “compounding pharmacies.”

Aspiration pneumonia is treated with fluids and antibiotics as is any other bacterial pneumonia, though these individuals may re-aspirate at any time and require treatment all over again. Hospitalization may be required.

The Feeding Tube
If elevated feeding is not providing adequate nutrition for the patient, there is an alternative: the gastric feeding tube. The tube allows food to be delivered directly into the stomach, skipping the diseased oesophagus. This does not end regurgitation, as the animal will still be swallowing saliva throughout the day and periodically regurgitating that saliva, but the food regurgitation should be controlled with tube feeding.

The special feeding tubes can be placed in the stomach either surgically, endoscopically, or using special stomach tube applicators. The tube exits the body from the side where it is comfortable for the pet. A protective bandage is used for daily wear and a clamp prevents leakage of stomach contents from the tube. The pet owner must be comfortable changing the dressings around the tube.

Food is administered as a blended slurry through the tube. A liquid diet can be purchased but usually a thicker food is made with a blender. With the tube food is administered cleanly with no spillage. Some water in a syringe is used to clear the tube before and after feeding.

Megaesophagus is a difficult condition to manage. Treatment requires dedication and commitment and still may produce poor results. Be sure your veterinarian has answered all your questions about this condition.
 Date Published: 1/1/2001
Copyright 1991 - 2007, Veterinary Information Network, Inc.
This work was originally published by Veterinary Information
Network, Inc. (VIN) and is republished with VIN's permission.

back to top
******************************
 ciddlogo

What is megaesophagus?
With this condition, there is dilation of the esophagus due to a loss of normal peristaltic function. Peristalsis is the process by which waves of muscular contraction move along the contents (food in this case) of tubular organs. Animals with megaesophagus regurgitate undigested food shortly after eating.

Dogs may be born with esophagus or they may develop it later in life. It is commonly seen with other disorders such as myasthenia gravis   and peripheral neuropathies

How is megaesophagus inherited?
This is an autosomal recessive trait in the wire-haired fox terrier, and autosomal dominant in the miniature schnauzer. The mode of inheritance has not been determined for other breeds that are predisposed to this condition.

What breeds are affected by megaesophagus?
Chinese shar pei, German shepherd, Great Dane, greyhound, Irish setter, miniature schnauzer, wire-haired fox terrier.

For many breeds and many disorders, the studies to determine the mode of inheritance or the frequency in the breed have not been carried out, or are inconclusive. We have listed breeds for which there is a consensus among those investigating in this field and among veterinary practitioners, that the condition is significant in this breed.

What does megaesophagus mean to your dog & you?
Although it may not be noticed until young adulthood, this disorder is usually first recognized in puppies around the time of weaning. Affected pups regurgitate food, fail to thrive, and may develop respiratory difficulties associated with aspiration pneumonia due to inhalation of food particles. Signs include laboured breathing, fever and lethargy, and nasal discharge.

Some dogs appear to gradually outgrow this condition (by a year or so), while in others there is no improvement.

How is megaesophagus diagnosed?
Regurgitation of undigested food shortly after eating is the main sign with this disorder. Your veterinarian will take chest x-rays to determine if your dog has megaesophagus, and perform other laboratory tests since there are several conditions that may be associated with this disorder. 

For the veterinarian: Since megaesophagus may be associated with many different conditions,  the diagnostic work-up should include CBC, biochemical profile, urinalysis and survey thoracic radiographs in all cases.

How is megaesophagus treated?
If an underlying cause can be identified, treatment may improve esophageal function. There is no specific treatment for the megaesophagus itself, but it can usually be managed by feeding small, frequent, high-caloric meals from an elevated location so that gravity assists the passage of food. Different consistencies of foods can be tried to determine which causes the least regurgitation.

Some dogs appear to outgrow the problem, while in others there is no improvement and feeding management is required for life. Your veterinarian will discuss with you possible complications that you must watch out for, the most serious of which is aspiration pneumonia.

Breeding advice
Affected wire-haired fox terriers, their parents (carriers of the trait) and siblings (suspect carriers) should not be bred. Affected miniature schnauzers should not be bred.

In other breeds in which inheritance is unknown, it is safest to avoid breeding affected dogs, their parents and siblings.
FOR MORE INFORMATION ABOUT THIS DISORDER, PLEASE SEE YOUR VETERINARIAN.

Resources
Twedt, D.C. 1995. Diseases of the esophagus. In E.J. Ettinger and E.C. Feldman (eds.) Textbook of Veterinary Internal Medicine, pp.1124-1142. W.B. Saunders Co., Toronto.
Jenkins, C.C. and Mears, E.A. 1996. What's new in the diagnosis and management of megaesophagus. ACVIM-Proceedings of the 14th Annual Vet. Med. Forum, p. 585-586.
Copyright © 1998 Canine Inherited Disorders Database. All rights reserved.Revised: April 27, 2001.
This database is a joint initiative of the Sir James Dunn Animal Welfare Centre at the Atlantic Veterinary College, University of Prince Edward Island, and the Canadian Veterinary Medical Association. reprinted with kind permission from:-
 Alice Crook, DVM,Coordinator, Sir James Dunn Animal Welfare Centre, Atlantic Veterinary College,University of Prince Edward Island, 550 University Ave.Charlottetown, PEI C1A 4P3
http://www.upei.ca/cidd
back to top
*************************************

Achalasia

              (Megaesophagus) In the German Shepherd Dog
 DrGSDGenes@hotmail.com

What is Achalasia?
Achalasia is a common inherited disorder of the oesophagus seen in German Shepherd Dogs. It usually is first noticeable when a puppy begins to eat solid food.

Instead of the food going down the oesophagus and into the stomach, the oesophagus balloons out instead of contracting, and the pup regurgitates. He usually will immediately attempt to eat the food again and send it back down, only to have most of it come back up again. Affected puppies may develop inhalation pneumonia as a side effect of achalasia.

What Do I Do About It?
Unfortunately, there is no way to cure achalasia. Surgery does not work. Feeding liquids, feeding an affected dog by elevating his dish so he is standing while eating, are measures often suggested, but they do not relieve the problem. They may help temporarily. The best recommendation for achalasia is to euthanize the affected puppy and not to breed either parent to another known carrier of  achalasia again. Some people have tried to maintain affected animals, I know of none who were successful for very long.

Affected animals become more uncomfortable with the condition as they grow older. They are hungry, but cannot get enough to eat in a meal to satisfy that hunger. They generally lose weight and condition. They are hard to maintain as they vomit after every meal. If tiny amounts of food are given often, less vomiting may be seen, but the animal then has no regular digestive pattern, and is very hard to housebreak because of  it.

The best recommendation is for breeders to observe litters when first eating solids, take the above recommended measure of separating and observing a possibly affected pup, and confirming the diagnosis. Such a pup should not be sold, it should be euthanized. Nobody likes euthanizing puppies, but it is kinder in the long run than subjecting the unfortunate animal to living with the misery of the condition.

I have heard of one or two dogs who did not show symptoms of  achalasia until they were adults, but I don't have enough history to know if these dogs were affected with this condition or  another similar problem. Also, it is possible that an animal could be very mildly affected and not show symptoms. One might suspect this in a case where two dogs produced over 1/2 a litter of affected puppies, although this could have been just the genetic cookie crumbling with unlucky odds.
 
 HEREDITY & Bloodlines
The condition is considered recessively inherited, and may vary from mild to severe.
 Breeders should not be criticized because their dogs produced an affected pup. The best protocol is not to KNOWINGLY breed two carriers together. So many top lines of the breed carry the gene that too much else would be lost if carriers were eliminated. Also, a recessive gene can pass hidden through many generations  undetected until two carriers are bred together.

back to top
***********************

Megaesophagus:

What does this mean for my dog?
Janeen Klinkenborg

You have just been told your dog has mega esophagus (which you have never heard of), and you are probably feeling overwhelmed and scared. Your veterinarian explained what mega esophagus is, but where to go from here and how to help your dog maintain a good quality of life seems uncertain. Be assured that mega esophagus is not a death sentence and that your dog can lead a normal life with a few adaptations.  Many others have been in the same place you are now. In fact there is a group of dog owners dealing with the same condition in their dogs and its members are available to assist you online. This group has knowledge about and experience with the follow-up care/daily management of dogs with mega esophagus. The purpose of this brochure is to share with you the valuable information that our group has learned through collective experience, helping you to provide the best daily care for your dog with mega esophagus.
 
We cannot stress enough the importance of partnering with your veterinarian and always discussing any changes to your dog’s care with him/her. After all, our veterinarians have medical knowledge that we do not and are familiar with our individual dogs and their unique needs.  Below you will find answers to some of your initial questions about mega esophagus, and basic management recommendations from the group. We also encourage you to join the group where you can receive more individualized support and suggestions.  By sharing what we have all learned through experience with our dogs, we hope to spread awareness and give peace of mind and hope to those who have just been told, “your dog has mega esophagus.”
 
What is Mega esophagus in simplified terms?
Mega esophagus is basically an enlarged or stretched esophagus (tube that carries food from the mouth to the stomach). The muscles in the esophagus that are responsible for pushing food along do not work properly because the nerves that control them are partially or completely paralyzed. A dog’s esophagus runs parallel to the floor.  Because the esophagus muscles are weak or non-functioning, whatever the dog eats or drinks can pool in the esophagus stretching the esophagus further and potentially creating pouches or pockets. These pockets collect food and water, where they will remain until the dog regurgitates them.

What is regurgitation? How is it different from vomiting?
Regurgitation is a passive occurrence. In other words, it tends to be a bit unexpected and often there is no warning that something is about to come out of the mouth. The dog may bark, and you’ll hear the ‘splat’ of something coming out. The dog may burp and something will come up. Sometimes a dog will exhibit signs before regurgitation such as: turning in a circle, getting a zoned-out look, hunching the back, looking uncomfortable or confused - like it is trying to work something out or its throat area may appear to contract. What comes out of the dog is often undigested food or water. Regurgitation is the body’s way of rejecting whatever did not make it to the stomach. This may be one or two pieces of food or a large quantity that has been sitting in the esophagus and may be accompanied by a fair amount of mucus (this is because the esophagus creates mucus as protection for itself).
 
Vomiting is an active occurrence. In other words, there is some forewarning that vomiting is about to occur. Dogs generally know this is about to happen and may even run to the door to go outside or to another room. Drooling sometimes precedes vomiting, which is usually an indication of nausea. The dog’s abdomen may quickly contract several times and you will hear the dog retch and gag. Then the entire contents of the stomach will be vomited. What comes out of the dog’s stomach may be either partially digested material, or bile (a yellowish substance). If your dog is vomiting there may well be a different or additional problem to consider.
 
Sometimes it is difficult to tell the difference between the two. But with time and careful observation of how your dog acts just beforehand, you can often tell which is happening. The difference may seem minor, but it is important to know which is happening.  Regurgitation is a symptom of mega esophagus, vomiting is not (although dogs with mega esophagus can vomit).

Why is regurgitation a problem?
The pooling of materials in the esophagus may further damage the esophagus, and may even result in painful ulcers or esophagitis.  It is important that whatever goes into the dog’s mouth gets to the stomach or it will sit in the esophagus until it comes back out (regurgitation).  A dog cannot thrive unless food reaches its stomach to deliver nutrients.  When regurgitation occurs there is also an increased risk that the dog will aspirate/inhale materials into the lungs (food, water, stomach acid, saliva, etc.). Aspirating anything into the lungs can cause life-threatening aspiration pneumonia (AP).  Though your dog may never develop AP, it is a potential danger for every dog with mega esophagus, and one for which you must be vigilant. Each time a dog has AP, scar tissue may form in the lungs. With recurring bouts of AP, the space available for air may become more limited, making breathing more difficult. Preventing AP is very important; adapting your dog’s daily routine is crucial to prevention. If you suspect your dog has aspirated, immediate medical attention is recommended. Antibiotic administration is strongly encouraged if your dog is showing symptoms of AP because physical symptoms may precede x-ray abnormalities by 48 hours. Recognizing AP early, before the lung/s are weakened, is critical in dogs with mega esophagus.  Loss of appetite or lethargy may be the first noticeable symptom.

How did my dog get this? Will it ever go away or be cured?
Those are the million dollar questions. Mega esophagus can affect any breed and size of dog.  Mega esophagus may be congenital (inherited, possibly present at birth), or idiopathic (cause unknown). It may also be secondary to another condition. There are a variety of specific health disorders that may cause mega esophagus. Two of the more commonly seen conditions are myasthenia gravis (MG) and hypothyroidism.  Having tests to rule underlying conditions in or out is recommended because many can be treated, and with treatment the esophagus may improve (or reverse). Your veterinarian will be able to help evaluate any other symptoms your dog is exhibiting and may suggest other tests as well. While the hope exists that your dog may be one of the lucky ones whose esophagus reverses completely, many dogs that have mega esophagus will have it for the remainder of their lives. Some puppies that are born with mega esophagus or develop it very early in life do outgrow it, but there are no guarantees.

 
What can I do for my dog?
A few changes to your dog’s routine will help compensate for the inability of the esophagus to move food and water to the stomach.

1) Feed (and water) your dog vertically. This means the spine should be straight up and down, with the dog seated in the “beg position” every time the dog receives anything by mouth (food, water, medication, treats). Feeding your dog elevated is not enough because the esophagus is still at an angle and food can still accumulate in pouches and pockets. There are a variety of ways to feed vertically. There is a specially designed chair called the Bailey Chair, which you can build for your dog. This is highly recommended and with the proper fit assures your dog is correctly positioned and supported (see the attached pictures and the link at the end of this document). You may also have your dog sit on a pillow in a corner, facing outward, with his/her front feet on your lap (while you are sitting in a chair in front of him/her). Smaller dogs can be held or even supported vertically in a bucket, mailbox or baby pack. Whatever you do, be sure your dog has the proper support for its spine. Use pillows, towels, whatever works to accomplish this. It is also important to feed your dog slowly and not allow gulping. The same vertical position is necessary for water. Allowing your dog to drink from a bowl on the floor is usually a problem. Many people add enough water to their dog’s food to avoid this potential problem. A dog generally needs 1 ounce of water per pound of body weight per day, more if it is very active. Some people use unflavored gelatin to make water cubes to help hydrate their dog if liquid alone causes problems.

2) Keep your dog vertical for a minimum of 15-20 minutes after each meal. Yes, this sounds like a hassle, but the difference it makes in your dog’s health and quality of life will be well worth it.  The time spent vertical will allow gravity to empty anything in the esophagus into the stomach, which will in turn help minimize regurgitation. You will need to see what amount of time works best for your dog. In some cases 15 minutes is not long enough, and the time spent vertical must be increased. If your dog has orthopedic issues or other limitations that may make sitting in this position difficult, do the best you can to get as close to vertical as possible and discuss alternatives with your veterinarian.

3) Find the right food and consistency. Specialists recommend that dogs with mega esophagus eat a diet that is lower in proteins and fat, and higher in carbohydrates.  Proteins and fat require more stomach acid for digestion.  The increase in acid production can lead to acid reflux which can result in erosions or burns in the esophagus.  Carbohydrates are milder on the system and also add calories, which will help your dog gain weight.  Some dogs can only tolerate a very liquid consistency for their food, while others do best with rolled balls of food that are swallowed whole. There are also many dogs that fall somewhere in between. You will have to find what works best for your dog through trial and error. Generally you can start off with a milkshake consistency and then adjust from there. If the food is too sticky or is dry it can stick to the esophagus walls and cause problems. That doesn’t mean you can’t use kibble, but you will most likely have to grind, soak, mash, or blend it to get the right consistency.

4) Feed smaller, more frequent meals. Try to space your dog’s daily intake of food out into 3-4 feedings (or even more) throughout the day rather than 1-2. During your dog’s vertical time gravity is moving the food from the mouth to the stomach rather than the esophageal muscles, so things are moving at a much slower pace. Feeding smaller amounts of food and waiting two to three hours between meals will minimize pooling of materials in your dog’s esophagus and allow the body time for digestion.

5) Discuss medications with your veterinarian. While there is no drug that cures mega esophagus, many dogs do take some sort of medication. Your veterinarian may suggest a drug called Carafate/Sucralfate to prevent damage to the esophagus by coating it with a protective barrier. It will also ‘bandage’ existing ulcers and erosions in the esophagus and stomach to help them heal. It must be given an hour before or two hours after any other medication or food as it can bind with other medications preventing them from working properly or bind with food potentially causing a blockage. Acid inhibitors may also be helpful; many dogs in our group take one.  Acid inhibitors suppress or block the production of stomach acid helping to prevent acid reflux which can burn the esophagus, create ulcers or be aspirated into the lungs. Acid inhibitors are not the same thing as antacids (such as Tums or Maalox). There are a variety of acid inhibitors and some work best given twice daily. Your veterinarian can help you decide if acid inhibitors are appropriate for your dog and which one is best. If your veterinarian feels an acid inhibitor may benefit your dog, regular testing for B-12 levels may be recommended. B vitamins require an acid environment for absorption. Long term use of acid inhibitors can alter the stomach chemistry potentially leading to a B vitamin deficiency. Motility drugs may help some dogs by moving the food out of the stomach more quickly, further minimizing reflux of stomach contents into the esophagus. Be aware that many medications can have side effects or interact negatively with other medications. It is imperative that you always talk to your veterinarian before giving your dog any medication.

6) Try to get your dog to sleep with his/her shoulders and head elevated. Many dogs have more trouble at night, or very early morning. This is because dogs often lay flat with their upper bodies level to their stomachs, which may promote reflux. If you can, get your dog to lay with shoulders and head on a pillow. Or if your dog is crated, put something under one end of the kennel and encourage your dog to sleep with his/her head at the raised end. This will help keep stomach acid, food and water from flowing back into the esophagus.
 
This is a great deal of information to digest, so be sure you are sitting completely vertical to let it all settle.  :) While each case can be different, the experience of the group is that these daily care modifications will give dogs with mega esophagus the best possible chance to live happy, healthy lives. Please discuss any and all changes with your veterinarian. Mega esophagus can be managed. It is not a death sentence for your dog. With diligence and a few adaptations, your dog can live a fairly normal life. You can do this and your dog will be grateful for the chance at an improved quality of life.  We are here to help.

(Links and Pictures can be found in the Yahoo group files)
Disclaimer: The information provided in this document is based on the experience and collective knowledge of the mega esophagus group members. It is offered as a service to the veterinary profession and the public for the purpose of improving the lives of dogs with mega esophagus and their caregivers. It was not intended that any of it be plagiarism or misrepresentation of any medical information. It is also not intended to be a treatment plan for your pet.  Your veterinarian’s involvement is crucial to your success.
 
Permission granted to copy this document in its entirety & distribute responsibly, provided the document is not altered in it’s language or content and that the pamphlet is not sold for profit.
Compiled by: Janeen Klinkenborg, 2006 (PIPER’S MOM)
back to top
 
*******************


Dog Anatomy Pictures
 Megaesophagus Info Source Portal
 Megaesophagus Secondary to PRAA Dilation of the Esophagus

Join
The megaesophagus Yahoo group for information and support
chloebutton  talabutton  

The above information is simply informational. It's intent is not to replace the advice of a veterinarian nor to assist you in making a diagnosis of your pet. Please consult with your own veterinarian for confirmation of any diagnosis. Your pets life may depend on it.