Megaesophagus in Dogs

Reviewed by Dr. Fiona Lee

If your dog is diagnosed with megaesophagus, you might feel overwhelmed and a little scared. The condition means your dog's esophagus has trouble moving food and water into the stomach. This can lead to dangerous complications, including pneumonia from aspiration. And while this is a serious disease, the symptoms can often be managed with medications and new mealtime strategies at home, helping improve the quality of your dog's life.¹

In this guide, we'll walk you through the signs of megaesophagus, the underlying causes and strategies that can help.

What Is Megaesophagus in Dogs?

Megaesophagus in dogs is a condition where the esophagus—the muscular tube that carries food from the mouth to the stomach—loses its ability to function properly. Instead of rhythmically contracting to push food down, the esophagus becomes weak and dilated. As a result, food and water often just sit there, unable to move into the stomach.

This leads to regurgitation, which is not the same as vomiting. Vomiting is active—there's heaving and retching. Regurgitation is passive. The food just comes right back up, often without warning.² While this condition is more commonly seen in older dogs, it can be diagnosed at any age and can even be congenital.¹

Megaesophagus isn't an isolated issue. It's often caused by underlying health issues, and the symptoms can lead to complications like aspiration pneumonia if your dog inhales food or water while regurgitating.¹ Dogs that aren't treated and have frequent cases of pneumonia might also develop pulmonary fibrosis.³

Causes of Megaesophagus in Dogs

There are two main types of canine megaesophagus: congenital (dogs are born with the condition) and acquired (developed after birth, usually as an adult).²

Acquired megaesophagus causes

Certain underlying conditions that can cause megaesophagus include:¹

• Myasthenia gravis²
• Botulism
• Addison's disease²
• Cancer or tumors
• Dysautonomia (rare)²
• Esophagus scarring/stricture²
• Esophagitis
• Hypothyroidism
• Infectious disease⁴
• Lead poisoning
• Obstruction in the esophagus²
• Tetanus

Congenital megaesophagus causes

Some large-breed dogs and even smaller-breed dogs are more likely to be born with the congenital form. Affected breeds may include:⁵

• Fox Terrier
• German Shepherd
• Golden Retriever
• Great Dane
• Irish Setter
• Labrador Retriever
• Miniature Schnauzer
• Newfoundland
• Shar Pei

Congenital megaesophagus is often caused by incomplete nerve development in your puppy's esophagus. In these cases, nerves might develop as your puppy grows, and about 20% to 46% of cases recover. Another type involves a vascular ring anomaly, where tissue made of fetal blood vessels constricts the esophagus. Surgery can help about 40% of these cases.²

Symptoms of Megaesophagus

Some of the most common symptoms that your dog is sick may include:¹

• Trouble swallowing
• Excessive saliva because they can't swallow correctly⁴
• Regurgitating (you'll notice it happening more frequently over time)⁴
• Coughing
• Weight loss

Vomiting vs. regurgitation

A key factor in identifying megaesophagus is understanding the difference between vomiting and regurgitation.

• Vomiting is more active because food is brought back up from the stomach. When vomiting, your dog will likely gag, heave and retch until throwing up. They may lick their lips or look uncomfortable from feeling nauseous.
• Regurgitation is more automatic and unexpected. Something as small as a cough or bump can cause your dog to expel food or water from their esophagus with no warning.² The food they do dispel will appear undigested.³

Aspiration pneumonia symptoms

You should also watch for symptoms of aspiration pneumonia, a common complication. These include:⁴

• Lethargy
• Lack of appetite
• Difficulty or increased rate of breathing
• Breathing with their head or neck extended out
• Coughing
• Fever
• Gums or tongue that are pale or blue

How Is Megaesophagus Diagnosed?

While symptoms can point to megaesophagus, your veterinarian will order extra tests to confirm the diagnosis and rule out other causes:²

• X-ray with barium contrast: This test shows if the esophagus is enlarged and how food moves through it.¹ Some veterinarians might diagnose without barium or take extra caution to ensure the barium isn't regurgitated. A chest X-ray also reveals if there's a secondary aspiration pneumonia complication.
• Blood tests: To screen for underlying conditions like myasthenia gravis and Addison's disease.
• Additional tests: To look for other underlying causes.

Treatment Options for Megaesophagus

Treatment can help and sometimes even resolve megaesophagus, depending on what kind your dog has. However, this is a serious disease and results can vary. Treating megaesophagus requires not just treating the symptoms, but also the underlying condition that caused the disorder (if one was found).¹

Some medications or medical interventions that might help include:²

• Medication for underlying conditions: For example, dogs with Addison's disease may respond well to treatment.
• Surgery: Some dogs will need surgery to fix blood vessel issues contributing to the condition.³
• Metoclopramide and cisapride: These medicines stimulate muscles in the gastrointestinal tract. This can work for some dogs, but not all.
• Viagra (sildenafil): This helps with regurgitation and weight gain.¹ It helps the sphincter between the stomach and esophagus work better.
• Sucralfate vs. antacids: Sucralfate can help protect inflamed areas of the esophagus. Antacids should only be used if your veterinarian recommends them, because stomach acid can guard against pneumonia if aspiration happens.
• Bethanechol: This medicine strengthens nerve receptors that might help with esophageal muscle tone.
• Inserting a balloon into the esophagus: This surgery can help dilate the esophagus if it's damaged from scarring or tumors.
• IV, antibiotics and hospitalization: This may be required if aspiration pneumonia is also diagnosed.
• Inserting a feeding tube: This may be recommended for extreme cases.

Depending on the underlying condition causing your dog's megaesophagus, you might need to see a specialist. For example, if your dog's condition is caused by cancer, you'll likely need to see an veterinary oncologist.

Your veterinarian may also recommend certain feeding strategies to try at home to help your dog eat and drink more successfully. These are discussed in the next section.

How To Care for a Dog With Megaesophagus

Megaesophagus is a serious condition, but you can improve your dog's quality of life by implementing special feeding and drinking strategies that reduce regurgitation. Your veterinarian will first recommend that you determine what type of food (and even water) consistency is easiest for your dog to keep down. You might try these ideas:²

• Test water versus ice chips.
• Mix water with a gelatin thickener if the liquid is hard to keep down.
• Feed soft foods, like canned food. You might add honey or coconut milk to increase calories.¹
• Add a protein powder recommended by your veterinarian to help with weight gain.
• Blend kibble into a soft slurry or soak it in water.⁴

Additional strategies your veterinarian might recommend include:⁴

• Elevate food and water bowls to the height of your dog's head to reduce regurgitation. You can put the bowls on a stepladder about three steps high or put them on a cardboard box at neck level.²
• Use a Bailey chair to help keep your dog upright while eating. Your dog may need to stay in the chair for 10 to 30 minutes after eating to allow food to move into the stomach.
• Put an inflatable e-collar on your dog to keep their head up while resting. This can prevent them from aspirating on their saliva.

Living With Megaesophagus

Living with megaesophagus isn't easy, but the regular veterinary appointments, medication and at-home supportive care are worth it to help your sweet dog feel better. Just remember to keep your expectations practical.

Some dogs with acquired megaesophagus might only live a few months after diagnosis. But for others, managing the underlying disorder might resolve the issue entirely. And for dogs with the congenital form, treatment can improve their symptoms as much as 46%.¹

Check in with your veterinarian regularly to assess your dog's quality of life and to see how their conditions are resolving.

It's Best To Catch Megaesophagus Early

If you notice your dog regurgitating frequently, see a veterinarian right away. In some cases, early diagnosis of megaesophagus can help your dog have a better chance at recovery. Even if there isn't a specific medication that can help, at-home strategies and consistent care can improve your furry family member's quality of life.

Pets Best Can Help You Keep Your Dog Healthy

Pet insurance is a great way to help you protect your dog from illnesses they may encounter, like megaesophagus. At Pets Best, our dog insurance plans can be customized for your pet's unique needs. In addition, Pets Best policyholders can speak to a veterinary expert anytime through a 24/7 Pet Helpline.

Sources/ Citations

1. "The signs, symptoms and treatment of megaesophagus in dogs," Brad Hinsperger (6/17/2024), Kingsdale Animal Hospital, https://www.kingsdale.com/symptoms-and-treatment-of-megaesophagus-in-dogs

2. "Megaesophagus," (3/12/2021), Mar Vista Animal Medical Center, https://www.marvistavet.com/megaesophagus.pml

3. "Disorders of the esophagus in dogs," Patricia Walters (9/2024), Merck Veterinary Manual, https://www.merckvetmanual.com/dog-owners/digestive-disorders-of-dogs/disorders-of-the-esophagus-in-dogs

4. "Megaesophagus," Rheannon Hawkins (3/31/2021), Washington State University Veterinary Teaching Hospital, https://hospital.vetmed.wsu.edu/2021/03/31/megaesophagus/

5. "Megaesophagus in Canines," (n.d.), Livermore Family Pet Hospital, https://www.livermorefamilypet.com/services/dogs/visiocare/megaesophagus-canines