Esophageal Stricture in Cats

 

The esophagus is the tubular organ that runs from the throat to the stomach; an esophageal stricture is an abnormal narrowing of the internal open space of the esophagus. There is no apparent genetic factor involved, and it occurs in cats at any age.

 

Symptoms and Types

 

• Regurgitation (return of food or other contents from the esophagus)
• Liquid meals are often tolerated better than solid meals
• Difficulty swallowing is seen with upper esophageal strictures
• Howling, crying, or yelping during swallowing when the cat has active inflammation of the esophagus
• Good appetite initially; eventually, lack of appetite with progressive esophageal narrowing and inflammation
• Weight loss and malnutrition as the disease progresses
• Weight loss to severe weight loss with muscle wasting in cats with chronic or advanced stricture
• Excessive production of saliva and drooling, and/or reacting in pain when touched on the neck and esophagus may be seen in cats with inflammation of the esophagus at the same time the stricture is present
• Progressive regurgitation and difficulty swallowing may lead to aspiration pneumonia
• Abnormal lung or breathing sounds, such as wheezing and coughing, may be detected in cats with aspiration pneumonia

 

Causes

 

• Backward or reverse flow of stomach contents into the esophagus (gastroesophageal reflux) during anesthesia - most common
• Backward or reverse flow of stomach contents into the esophagus, unrelated to anesthesia (gastroesophageal reflux disease)
• Esophageal surgery
• Ingestion of chemical irritants
• Esophageal retention of pills and capsules
• Esophageal foreign object
• Persistent vomiting
• Cancer
• Mass lesion (known as a granuloma) secondary to the parasite Spirocerca lupi; occasionally seen in the southeastern United States

 

Diagnosis

 

Your veterinarian will want to rule out many of the possible diseases or conditions that might cause these symptoms. For example, if your cat has just been weaned, an abnormality called vascular ring anomaly may be the problem. In order to arrive at a definite diagnosis, your doctor may conduct a barium-contrast X-ray, which uses a radiopaque fluid in the esophageal passage, so that the passage of the liquid shows on the X-ray image, revealing abnormalities in the passage. An X-ray may reveal a foreign body caught in the esophagus. An insertable visual diagnostic tool called an endoscope can also be useful for visually examining the esophagus in closer detail. Your doctor will also be looking for tumors and masses.

 

 

Treatment

 

Your cat may be kept in the hospital initially. Once hydration needs are addressed and the affected portion of the esophagus is dilated, you may be able to take your cat home. If your cat has aspiration pneumonia and/or inflammation of the esophagus, it may need to remain under medical supervision longer. Intravenous fluids may be needed for correcting hydration status and medications may be given by injection following dilation procedures to facilitate healing. Oxygen may be necessary for patients with severe aspiration pneumonia.

 

Also, cats that have severe inflammation of the esophagus, and those that have had dilation procedures will not be able to take food through the mouth. A temporary feeding tube may be placed at the time of esophageal dilation as a means of providing continual nutritional support. When you do restart feeding your cat by mouth you will need to give bland, liquid foods that are easily digestible. Your veterinarian will advise you on the most appropriate foods to help your cat through the recovery process.

 

Prevention

 

• Proper preparation prior to anesthesia (12-hour pre-operative fast)
• Avoid certain drugs prior to anesthesia, if possible
• If gastroesophageal reflux is present, avoid late-night feedings, as they tend to decrease the ability of the muscle between the stomach and esophagus to remain closed during sleep
• Protect your cat from ingesting caustic substances and foreign bodies

 

Living and Management

 

A barium contrast X-ray, a method which uses a radiopaque liquid in order to trace a passageway and to define abnormalities within, or endoscopy, using an insertable tubular instrument for visually examining the interior of the esophagus, will need to be repeated every two to four weeks until clinical signs have been resolved, and adequate esophageal lumen size (the inner space of the esophagus) has been achieved.

 

A life-threatening complication of esophageal stricture dilation, called esophageal tear or perforation, usually occurs at the time of dilation. This complication has been observed after several days to weeks have passed, so you will need to observe your cat for signs of this. Also, remain observant for symptoms of aspiration pneumonia due to food, liquid, or objects being pulled into the lungs, because the risk remains high. Generally, the longer the stricture, the more guarded the prognosis. With esophageal strictures due to scarring, the prognosis is generally fair to guarded. Many strictures will recur despite repeated esophageal dilation; improvement without cure is a more realistic goal.