This is the most misdiagnosed and misunderstood problem in brachycephalics.
The basics are as follows:
- Intermittent reflux and regurgitation (as well as vomiting and excessive wind) is related to airway restrictions in approximately 80% of cases
- Early airway correction has a significant chance of reducing or eliminating these gastroenteric problems
- The remaining 20% of these problems are mostly caused by pyloric stenosis, sliding hiatal hernia or IBD (food intolerances)
- Many owners of brachycephalic breeds waste thousands of dollars doing tests that are rarely rewarding
- An excellent initial approach to gastroenteric problems is airway correction for two reasons: Firstly, all dogs lead much better lives with better airways, and secondly, almost all the above signs significantly reduce or stop all together. It’s also far cheaper than chasing the diagnostics for the 20% of other reasons
Hence the option of just correcting the airways first is something owners of these breeds should consider, given all dogs benefit from that anyway regardless of gastro-enteric signs. But it is extremely important you do appropriate airway correction and understand what that means.
Performed at desexing around 8-12 months makes it affordable, easy and a single surgery. We recommend you never have a brachycephalic breed desexed without the option of a genuine brachycephalic veterinarian doing the desexing so that abnormalities can be corrected at that same time.
Why do regurgitation, reflux, burping, vomiting and wind occur due to restricted airways?
Anyone on a bulldog social media group will tell you the number of questions relating to gastro-enteric concerns is vast. There are also multitudes of hilarious posts about their wind and belching and reflux which strangely people seem to find endearing! The dog itself suffering from it doesn’t. Just like snoring. Many posts will say how adorable it is however their dog is having a restless time trying to sleep and breathe. What this is not understood on these threads, and unfortunately by most veterinarians, is that almost always these signs are secondary to restricted airways and will stop upon correction.
Think about this:
“Why are these problems, mainly reflux and intermittent regurgitation, so common in flat faced breeds but relatively uncommon (in comparison) with normal nosed breeds? The one difference that is obvious is the length of the face”.
Here’s is what happens…
Brachycephalic breeds breathe with more effort which is sometimes obvious (people often comment after airway surgery they no longer see that abdominal effort when they are breathing, even at night), and sometimes not so obvious. Subtle increased abdominal effort will not be noticed by you but will be potentially causing long term problems. This increased effort over time leads to the dogs stomach rising higher into the chest than normal nosed dogs, which squashes the stomach and results in stomach acid refluxing into the distal oesophagus.
This acid reflux causes inflammation, mild ongoing nausea (that most of these dogs are committed to live with but is often not noticed by their owners) and in some of the more extreme cases intermittent regurgitation and vomiting. Due to the significant gulping of air, these dogs also often produce a lot more wind (that is not food related, it’s restricted airways related). It’s that simple! When this is explained it is not at all hard to understand. So as soon as we have a history of this occurring, our starting point is that approximately 80-90% of the time this will be the reason why.
The other 20% –
The other approximately 20% of reasons for all the above symptoms mostly fall into the following three categories:
- Permanent or congenital sliding hiatal hernia (permanent can occur from airway restrictions not being corrected early enough)
- Pyloric Stenosis (a thickening of the outlet of the stomach)
- IBD (inflammatory bowel disease)
General practitioners that do not understand these breeds often do exhaustive initial general tests such as x-rays, blood tests and ultrasounds (which we advise clients will largely be unrewarding), then trial many medical regimes such as antibiotics, probiotics, antacids (which often temporarily work but are just masking an ongoing and worsening problem), then send the case to a specialist to work it up further when getting nowhere.
Often the specialists will start with working up the 20%: Sliding hiatal hernia, pyloric stenosis and IBD with biopsies of the small intestine. This can range in cost up to $5,000 plus. This may reveal a problem, but even so the condition may be a combination of one of these and restricted airway concerns. More often than not the results and subsequent treatment trials will be unrewarding and then the recommendation of airway correction may be suggested.
Our clinic feels a more practical approach is warranted. When we get these breeds presenting to our clinic we have an exhaustive discussion about the options but generally advise:
- Ideally consider airway correction first as that’s warranted for the improved lifestyle and long term health anyway. As well, there is a strong chance of significant reduction or cure of all the above signs, especially the earlier the airways are attended. It’s also much cheaper than a highly likely unrewarding full work up, especially if done at the same time as desexing.
- If after airway correction there is not a response, then we can consider full work-up.
- The results we see post surgery are incredible. The vast majority of patients have significant improvement which in itself is proof of what’s going on. Go to this link for some examples.
- If your breeder (who often deny these problems are due to restricted airways due to poor breeding) tells you otherwise, simply refer them to this link and the associated testimonials, and ask them their thoughts on why most dogs stop this after surgery.
Ultimately it’s about communication and choice by the dog owner as to which way they may wish to go. But if you, the owner of the dog, are well informed with a good understanding of the options, you are in a position to decide which way to go about things.
Can I just try a hypoallergenic diet first?
It’s that simple. And if it works and there are no problems at all, happy days!. Airway correction should still be done anyway as a whole separate issue, but there is no reason a hypoallergenic diet can’t be tried, as this is the usual recommendation if IBD is diagnosed via biopsies. For this reason we never biopsy for IBD when we are genuinely suspicious of that, we just trial one or two excellent hypoallergenic diets, because if everything is back to normal, we have our answer.
Why does changing food type, feeding smaller meals more often or feeding from a height sometimes help to a degree?
You will often find people saying:
“I feed small meals multiple times, or I do or don’t feed at night or in the morning, and this helps to a degree, he’s vomiting once weekly instead of 2-3 times weekly”.
This often works for a while because different dogs will feel nausea to different degrees, dependent on different reasons. And any of the above combinations may help to a degree however we feel it’s much better to cure the problem than try to manage it as best we can. What do you think your dog would prefer long term?