Q: We put our 5½ year old Maine Coon cat to sleep yesterday because her esophagus was completely blocked with scar tissue. She began throwing up immediately after eating two weeks ago, stopped eating and progressed to throwing up all liquids (water). Her vet suspects that she had acid reflux for a long period of time. She had an average of three to four small hairballs a week with no signs or symptoms of illness.
My questions is, how common is acid reflux in cats? Could we have helped her when she was a kitten if we knew what to look for? Her diagnosis was confirmed with lab tests and an endoscope procedure. We have a male Maine Coon from the same breeder and I’m scared that I won’t know if he has this problem, too. I’ve never seen anything in Cat Fancy or cat health books about the possibility of acid reflux in felines.
A: I’m so sorry to hear about your Maine Coon. Reflux esophagitis (inflammation of the esophagus caused by stomach acid) is a very uncommon condition in cats. My veterinary practice has been open for almost seven years, and we’ve seen only two or three cases. Reflux esophagitis occurs when gastric acid, which is very irritating, flows backward from the stomach into the esophagus, causing ulceration. Scar tissue can form at the site of the ulceration, causing a stricture. This prevents food from passing, and cats will regurgitate chronically as a result. Reflux esophagitis sometimes occurs after anesthesia, if the cat is poorly positioned during surgery, or if the cat was not fasted prior to anesthesia. There are other causes, such as a hiatal hernia, a foreign body in the esophagus, and esophageal cancer. Chronic, frequent vomiting can also be a cause. Since your cat was vomiting three or four times a week, every week, this may very well have been the cause of the reflux.
Endoscopy (insertion of a long thin tube-like instrument with a camera on the end) is the best way to confirm the diagnosis.
The treatment of acid reflux consists of feeding small meals frequently throughout the day, using gastric acid inhibitors such as cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid), or omeprazole (Prilosec), and giving drugs that tighten the sphincter muscle between the esophagus and the stomach so that acid cannot back up into the esophagus. Metoclopramide (Reglan) is a good drug for this. It tightens the muscle, plus it causes the stomach to contract in the forward direction, propelling food (and acid) into the intestine and away from the esophagus. If ulceration is seen with the endoscope, another drug called sucralfate (Carafate) can be given. This coats and protects the irritated esophagus.
Once a stricture forms, the prognosis is poor. The stricture can be widened using instruments designed for this purpose, but the narrowing usually recurs. In some cases, a stomach tube can be placed. This tube bypasses the esophagus and leads directly into the stomach. Feeding can be accomplished through this tube. Some cats have been known to tolerate a stomach tube for several months with no complications. This is a temporary measure, of course, designed to give you extra time with your cat. Ultimately, if the stricture cannot be widened enough so that food can pass through the esophagus into the stomach, the cat cannot survive and will need to be put to sleep.