A 3-year-old spayed female Akita was presented to Cornell’s Small Animal Emergency Service for a one-month history of regurgitation. The episodes of regurgitation increased from only occasionally to about two dozen times per day over the course of the month and were not related to eating or exercise. She experienced intermittent decreases in appetite, lethargy, and weight loss. Initial diagnostics performed by the referring veterinarian included a normal positive contrast gastrointestinal series and contrast esophagram, and a normal T4. Treatment trials included maropitant, omeprazole, and sucralfate.

On presentation to the Internal Medicine Service, she was bright and alert, and her physical exam was largely unremarkable. She regurgitated foamy bile once during her physical exam. She did not fatigue on repeated testing of her palpebral reflex, which ruled down focal myasthenia gravis. Her complete blood count revealed a mild leukopenia, her chemistry panel revealed a mild hypernatremia, and her urinalysis revealed the presence of trace protein and glucose. Upon further review of the radiographs from the referring veterinarian, a dilation at the distal esophagus was noted.

Our primary differential diagnoses for chronic regurgitation included idiopathic megaesophagus (idiopathic dysmotility), esophagitis, or a sliding hiatal hernia. Other potential but less likely differentials included esophageal stricture, myasthenia gravis, hypothyroidism, Addison’s disease, dysautonomia, polymyositis, botulism, or organophosphate or lead toxicity. A barium swallow study was performed using fluoroscopy, which revealed a sliding hiatal hernia and gastroesophageal reflux disorder (GERD).

This seminar will discuss various differential diagnoses for chronic regurgitation as well as the diagnosis, treatment options, and long-term prognosis of this case.