Incidence of gastric dilatation-volvulus following a splenectomy in 238 dogs.

There is contradicting information in the veterinary literature regarding canine splenectomy and the increased risk for subsequent gastric dilatation-volvulus. The main purpose of this study was to determine the rate of occurrence of gastric dilatation-volvulus following splenectomy in medium to large breed dogs compared with a control group undergoing other abdominal procedures. Follow-up was performed by reviewing the medical records and conducting phone interviews. Weight, gender, and presence of a hemoabdomen at the time of surgery were not significantly associated with occurrence of gastric dilatation-volvulus, while increasing age was. Ten of 238 (4%) dogs in the splenectomy group and 3/209 (1.4%) dogs in the control group subsequently developed gastric dilatation-volvulus, which was not significantly different (P = 0.08). While the findings approach significance and support a need for future investigation, the current recommendation for gastropexy at time of splenic removal should be made on a case by case basis and while considering previously documented risk factors.

Incidence de la dilatation gastrique-volvulus après une splénectomie chez 238 chiens. Il existe des renseignements contradictoires dans la littérature vétérinaire concernant la splénectomie canine et le risque accru pour la dilatation gastrique-volvulus subséquente. Le but principal de cette étude consistait à déterminer le taux d'occurrence de la dilatation gastrique-volvulus après la splénectomie chez des chiens de race moyenne ou grande comparativement à un groupe témoin subissant d'autres interventions abdominales. Le suivi a été réalisé en examinant les dossiers médicaux et en réalisant des entrevues par téléphone. Le poids, le sexe et la présence d'un hémoabdomen au moment de la chirurgie n'étaient pas significativement associés à l'occurrence de la dilatation gastrique-volvulus, tandis que l'âge avancé l'était. Dix des 238 (4 %) chiens dans le groupe de splénectomie et 3/209 (1,4 %) des chiens dans le groupe témoin ont subséquemment développé la dilatation gastrique-volvulus, ce qui n'était pas significativement différent (P = 0,08). Bien que les résultats soient près du seuil significatif et supportent le besoin d'études supplémentaires, la recommandation actuelle pour la gastropexie au moment de l'enlèvement splénique devrait être faite au cas par cas et en tenant compte des facteurs de risque documentés antérieurement.(Traduit par Isabelle Vallières).

Gastric dilation-volvulus in dogs attending UK emergency-care veterinary practices: prevalence, risk factors and survival.

OBJECTIVE: To report prevalence, risk factors and clinical outcomes for presumptive gastric dilation-volvulus diagnosed among an emergency-care population of UK dogs. METHODS: The study used a cross-sectional design using emergency-care veterinary clinical records from the VetCompass Programme spanning September 1, 2012 to February 28, 2014 and risk factor analysis using multivariable logistic regression modelling. RESULTS: The study population comprised 77,088 dogs attending 50 Vets Now clinics. Overall, 492 dogs had presumptive gastric dilation-volvulus diagnoses, giving a prevalence of 0·64% (95% Confidence interval: 0·58 to 0·70%). Compared with cross-bred dogs, breeds with the highest odds ratios for the diagnosis of presumptive gastric dilation-volvulus were the great Dane (odds ratio: 114·3, 95% Confidence interval 55·1 to 237·1, P<0·001), akita (odds ratio: 84·4, 95% Confidence interval 33·6 to 211·9, P<0·001) and dogue de Bordeaux (odds ratio: 82·9, 95% Confidence interval 39·0 to 176·3, P<0·001). Odds increased as dogs aged up to 12 years and neutered male dogs had 1·3 (95% Confidence interval 1·0 to 1·8, P=0·041) times the odds compared with entire females. Of the cases that were presented alive, 49·7% survived to discharge overall, but 79·3% of surgical cases survived to discharge. CLINICAL SIGNIFICANCE: Approximately 80% of surgically managed cases survived to discharge. Certain large breeds were highly predisposed.

Risk factors of bloating and its association with common gastrointestinal disorders in a sample of Iranian adults.

BACKGROUND/AIMS: Bloating is an unpleasant but common gastrointestinal symptom that is experienced by many people at some stage in their lives. The current survey was conducted to investigate the epidemiology and risk factors of bloating and functional bloating (FB). In addition, we aimed to assess the association between bloating and functional gastrointestinal disorders (FGIDs). MATERIALS AND METHODS: In this cross-sectional study, the self-administered modified Rome III questionnaire was used to assess gastrointestinal symptoms and FGIDs. Severity of bloating, demographic and anthropometric measurements, physical activity level, psychological distress, and depression and anxiety were also assessed. RESULTS: Among the 4763 participants, 52.9% reported having experienced bloating at least occasionally in the past three months (among which 14.1% had severe or very severe symptoms); 19.7% of subjects were found to have FB. After adjusting for multiple variables, female gender, university degree, obesity, and anxiety were associated with both bloating and FB, while depression and psychological distress were only associated with bloating. The positive predictive value and negative predictive value of bloating for the diagnosis of functional bowel disorder were 92.9% and 80.1%, respectively. CONCLUSION: Bloating and FB are highly prevalent in the study population. We also identified several demographic, psychological, and lifestyle-related risk factors of bloating in this population.

Hinchazón/distensión funcional: un enfoque práctico / Functional abdominal bloating/ distension: a practical approach

Although abdominal bloating and distension are frequent symptoms, they are considered a challenge in medical practice. Treatment alternatives with varying efficacy levels, associated to the lack of knowledge about this problem, generate difficulties in the doctor­patient relation, and patient's frustration and anxiety. Advances in understanding their etiopathogenetic factors have lead treatment of these patients towards a personalized approach. The purpose of the article is to provide a brief description about abdominal bloating and distension, and ultimately give a practical approach of this condition.

A pesar de que la hinchazón (bloating) y la distensión abdominal son síntomas altamente frecuentes, son considerados un desafío en el quehacer médico. Alternativas terapéuticas con grados de eficacia variables, asociado a un desconocimiento en el enfrentamiento clínico, generan dificultades en la atención de estos pacientes por parte de los médicos, además de frustración para el paciente. Avances en la comprensión de su etiopatogenia han permitido dirigir el tratamiento de estos pacientes de manera personalizada. Este artículo tiene como objetivo realizar una breve descripción del cuadro, y dar finalmente un enfoque práctico frente a esta condición.

Gastric dilatation volvulus: a retrospective study of 203 dogs with ventral midline gastropexy.

OBJECTIVES: To evaluate the recurrence rate of gastric dilatation volvulus and the incidence of complications in subsequent coeliotomies following ventral midline gastropexy. METHODS: The medical records of dogs treated for gastric dilatation volvulus by ventral midline gastropexy were retrospectively reviewed. Owners were contacted and invited to complete a questionnaire and to return to the clinic for ultrasonographic and radiographic follow-up. RESULTS: The questionnaire was completed by 203 owners 2 to 123 months postoperatively, 24 of whom attended the follow-up examination. Of the 203 dogs, 13 (6 · 4%) underwent subsequent ventral midline coeliotomy and none developed complications related to the gastropexy site. In 23 of the 24 re-evaluated dogs, the stomach was closely associated with the abdominal on radiography and/or ultrasound. The recurrence rate for clinical signs of gastric dilatation or gastric dilatation volvulus after ventral midline gastropexy was 6 · 4%. CLINICAL SIGNIFICANCE: This study shows that the recurrence of gastric dilatation volvulus after ventral midline gastropexy is low and adhesion of the stomach to the abdominal wall is persistent in almost all dogs that were re-examined. The gastropexy site did not appear to interfere with subsequent coeliotomy.

An Internet-based survey of risk factors for surgical gastric dilatation-volvulus in dogs.

OBJECTIVE: To evaluate risk factors for gastric dilatation-volvulus (GDV) in a large number of privately owned dogs across a wide geographic area. DESIGN: Internet-based, cross-sectional study. ANIMALS: 2,551 privately owned dogs. PROCEDURES: A questionnaire addressed dog-specific, management, environmental, and personality-associated risk factors for GDV in dogs. Respondents were recruited through the posting of the electronic link to the questionnaire on websites for dog owners; the information was also disseminated at meetings of dog owners and via newsletters, e-mail lists for dog owners and breeders, owner-oriented dog publications, and e-mails forwarded by participants. Descriptive statistics and logistic regression analysis were performed. RESULTS: Factors significantly associated with an increased risk of GDV were being fed dry kibble, anxiety, residence in the United Kingdom, being born in the 1990s, being a family pet, and spending at least 5 hours a day with the owner. Factors associated with a decreased risk of GDV were playing with other dogs and running the fence after meals, fish and egg dietary supplements, and spending equal time indoors and outdoors. A significant interaction between sex and neuter status was observed, with sexually intact females having the highest risk for GDV. CONCLUSIONS AND CLINICAL RELEVANCE: In dogs with a high risk of GDV, regular moderate daily and postprandial activity appeared to be beneficial. Feeding only commercial dry dog food may not be the best choice for dogs at risk; however, supplements with fish or eggs may reduced this risk. The effect of neuter status on GDV risk requires further characterization.

A retrospective study of gastric dilatation and gastric dilatation and volvulus in working farm dogs in New Zealand.

AIMS: To present findings from a case series of gastric dilatation (GD) or gastric dilatation and volvulus (GDV) in working farm dogs in New Zealand that were examined at veterinary clinics, and to identify possible risk factors for GD or GDV in working farm dogs in New Zealand using a case-control study. METHODS: This retrospective study included a case-series and a case-control study. The case series analysed information from 62 case records of GD or GDV in working farm dogs seen between August 2004 and September 2009 at 13 veterinary clinics throughout New Zealand. Cases were classified as GD or GDV if the diagnosis was confirmed by radiography, surgery or post-mortem examination. Details of history and treatment, as well as outcomes, were obtained for each case. For the case-control study, records of 41 working farm dogs with GD or GDV (cases) seen between April 2008 and April 2009, and 82 working farm dogs examined because of trauma over the same period and in the same 13 clinics (controls), were used to model the risk factors for GD or GDV. RESULTS: From the case-series study, 40/62 (65%) cases of GD or GDV that were examined and treated at the veterinary clinics returned to work. Of the 41 dogs where the gastric contents were recorded, 25 (61%) had predominantly food or bones in the stomach, and 26/27 dogs had a history of having eaten meat, bones or scavenged a carcass. The case-control study showed that the significant risk factors for GD or GDV, compared with control dogs presenting with trauma, were breed, age and season. The odds that a case of GD or GDV was a Huntaway, after adjusting for age and season, was 19 times higher than the odds a control was a Huntaway. Gender and bodyweight were not identified as risk factors. CONCLUSIONS AND CLINICAL RELEVANCE: A high proportion of farm working dogs with GD or GDV were successfully treated by veterinarians. The risk of a case of GD or GDV being a Huntaway was significantly higher than for a dog presenting as a trauma case. However the influences of the season of the year, climatic factors and nutritional factors on the pathogenesis need to be identified before adequate preventative measures can be recommended.

Risk factors for gastric distension in patients with acute appendicitis: a retrospective cohort study.

PURPOSE: There has been no report on risk factors for gastric distension (GD) when inducing general anesthesia in an emergency situation. The aim of this study was to clarify the risk factors for GD in patients with acute appendicitis at their hospital visit. METHODS: We reviewed medical records of patients from April 2007 to March 2010 who underwent open appendectomy for acute appendicitis and were diagnosed pathologically. GD was defined as a larger anteroposterior diameter and larger lateral diameter of the stomach than those of the left kidney in computed tomography (CT) imaging. The primary outcome was the presence of GD. Candidate variables such as patient characteristics, physical findings, and CT imaging findings associated with GD were assessed. Time after beginning of abdominal pain was categorized and compared. Determinants with significant univariate association (P < 0.20) with the primary outcome were used to construct multivariable logistic regression models. RESULTS: We enrolled 121 patients and divided this cohort into a GD group (44 cases, 36%) and a non-GD group (77 cases, 64%). Results of univariate analysis showed longer duration of time after beginning of abdominal pain (P = 0.016), younger age (P < 0.001), and more frequent distended small bowel (P < 0.001) in the GD group than in the non-GD group. In multivariate analysis, age [odds ratio (OR) = 0.939, P = 0.002] and time after beginning of abdominal pain (OR = 1.807, P = 0.031) were shown to be independent risk factors. CONCLUSION: Younger appendicitis patients with acute abdominal pain for 1 or more days should be treated as patients with high risk for GD.

Banded sleeve gastrectomy using the GaBP ring--surgical technique.

Laparoscopic sleeve gastrectomy (LSG) has been described as the first step of a two-step laparoscopic Roux-en-Y gastric bypass (LRYGB) or biliopancreatic diversion with duodenal switch (BPD-DS) in extremely obese patients. It has also been used as an independent bariatric procedure. Recently a banded sleeve gastrectomy using human dermis was published. Gastric sleeve dilatation is one of the unfavorable postoperative courses that may limit weight loss. Our technique of a banded sleeve gastrectomy using the GaBP Ring Autolock(TM) System to calibrate the sleeve and prevent distal sleeve dilatation is described in this article.

The reporting of gastric band slip and related complications; a review of the literature.

Laparoscopic adjustable gastric banding is a safe and effective treatment for morbid obesity. Long-term complications include band slippage, gastric pouch dilatation and gastric erosion. Rates of band slippage reported in the literature range from less than 1% to over 20%. The aim of this review was to explore whether differences in the reporting of this complication contributed to the variability in this outcome measure. A full literature search was undertaken using EMBASE and MEDLINE search engines. Forty studies were selected for analysis based on inclusion and exclusion criteria. Each was scrutinised for outcome reporting methods and related fields. Accurate definitions for relevant terms were derived from the best available evidence. Considerable variations in device deployed, operative approach, band fixation technique, and outcome reporting mechanisms were seen between the studies. The explanation and definition of terms used within manuscripts were also seen to vary between studies. A consensus needs to be reached on how best to report complications such as gastric band slippage. We suggest which information should be included by authors to allow for accurate and reproducible reporting of such outcomes in the future.

Assessment of the incidence of GDV following splenectomy in dogs.

OBJECTIVE: To establish if splenectomy increases the incidence of gastric dilatation and volvulus (GDV) in dogs. METHODS: Two case-series studies of cases and controls were performed. Records of dogs that had undergone splenectomy (37 cases) were compared with records of dogs that had undergone other abdominal surgery (43 cases). Records of dogs that presented for non-elective gastropexy (33 cases) were compared with records of dogs presented to the hospital for unrelated reasons (39 cases). Survival following splenectomy and development of GDV in the first 12 months following surgery were retrieved from the clinical records and by questionnaire-based canvassing of the referring clinician. The incidence of GDV following splenectomy was established and the association between a current episode of GDV and previous splenectomy was assessed. RESULTS: There was no evidence that splenectomy was associated with an increased incidence of subsequent GDV (P=0.469). No association between a current episode of GDV and previous splenectomy was found. CLINICAL SIGNIFICANCE: Splenectomy is not associated with an increase in the incidence of GDV.

A time series model of the occurrence of gastric dilatation-volvulus in a population of dogs.

BACKGROUND: Gastric dilatation-volvulus (GDV) is a life-threatening condition of mammals, with increased risk in large breed dogs. The study of its etiological factors is difficult due to the variety of possible living conditions. The association between meteorological events and the occurrence of GDV has been postulated but remains unclear. This study introduces the binary time series approach to the investigation of the possible meteorological risk factors for GDV. The data collected in a population of high-risk working dogs in Texas was used. RESULTS: Minimum and maximum daily atmospheric pressure on the day of GDV event and the maximum daily atmospheric pressure on the day before the GDV event were positively associated with the probability of GDV. All of the odds/multiplicative factors of a day being GDV day were interpreted conditionally on the past GDV occurrences. There was minimal difference between the binary and Poisson general linear models. CONCLUSION: Time series modeling provided a novel method for evaluating the association between meteorological variables and GDV in a large population of dogs. Appropriate application of this method was enhanced by a common environment for the dogs and availability of meteorological data. The potential interaction between weather changes and patient risk factors for GDV deserves further investigation.

Symmetrical pouch dilatation after laparoscopic adjustable gastric banding: incidence and management.

BACKGROUND: Laparoscopic adjustable gastric banding (LAGB) has commonly been complicated by the problem of band slippage or prolapse. Since popularization of the pars flaccida approach and improved anterior fixation, it is our impression that the problem of symmetrical dilatation of the proximal gastric pouch has become more important. METHODS: We have reviewed the results of a series of 425 LAGB all performed by the pars flaccida approach from June 2003 to October 2007 to analyze the incidence and implications of this new pattern. RESULTS: There were no posterior prolapses, 2 anterior prolapses, and 17 cases of symmetrical pouch dilatation (SPD) (revision rate 4.4%). Teenage patients had a 22% revision rate for SPD. All revisions were completed laparoscopically with no mortality, no significant complications, and a median hospital stay of 1 day. The median weight loss following revisional surgery was not significantly different from the background cohort. CONCLUSION: SPD is the most common reason for revision of LAGB in this series. We postulate that SPD is caused by excessive pressure in the proximal gastric pouch. This may be generated either by eating too quickly or too large a volume or excessive tightening of the band. The radial forces in the pouch may ultimately cause pressure on the phrenoesophageal ligament and a secondary hiatal hernia.

Review article: abdominal bloating and distension in functional gastrointestinal disorders--epidemiology and exploration of possible mechanisms.

BACKGROUND: A sensation of abdominal bloating, sometimes accompanied by an increase in girth (distension), is one of the most common and most intrusive features of functional bowel disorders. AIM: To conduct a systematic, evidence-based review of the epidemiology and pathophysiology of abdominal bloating and its relationship to distension. METHODS: The terms bloating, distension, functional bowel, irritable bowel syndrome, constipation and diarrhoea were searched on MEDLINE up to 2006. References from selected articles and relevant abstracts were also included. RESULTS: Approximately 50% of irritable bowel syndrome patients with bloating also experience an increase in abdominal girth and this is more pronounced with constipation than diarrhoea. Bloating appears to be more frequently associated with visceral hypersensitivity, whereas distension is more often related to hyposensitivity and delayed transit. Although there is little evidence for excessive gas as a cause of bloating, gas infusion studies suggest that handling of gas may be impaired in irritable bowel syndrome and there may also be abnormal relaxation of the anterior abdominal musculature in these patients. CONCLUSIONS: There is unlikely to be a single cause for bloating and distension, which probably have different, but overlapping, pathophysiological mechanisms. Relieving constipation might help distension, but the treatment of bloating may need more complex approaches involving sensory modulation.

Meteorological influence on the occurrence of gastric dilatation-volvulus in military working dogs in Texas.

Gastric dilatation-volvulus (GDV) is a life-threatening condition in dogs and other species in which the stomach dilates and rotates on itself. The etiology of the disease is multi-factorial, but explicit precipitating causes are unknown. This study sought to determine if there was a significant association between changes in hourly-measured temperature and/or atmospheric pressure and the occurrence of GDV in the population of high-risk working dogs in Texas. The odds of a day being a GDV day, given certain temperature and atmospheric pressure conditions for that day or the day before, was estimated using logistic regression models. There were 57 days in which GDV(s) occurred, representing 2.60% of the days in the 6-year study period. The months of November, December, and January collectively accounted for almost half (47%) of all cases. Disease risk was negatively associated with daily maximum temperature. An increased risk of GDV was weakly associated with the occurrence of large hourly drops in temperature that day and of higher minimum barometric pressure that day and the day before GDV occurrence, but extreme changes were not predictive of the disease.

Gastric dilation and intestinal obstruction in 76 rabbits.

Eighty-four incidents of gastric dilation (bloat) were investigated in 76 pet rabbits, and an intestinal obstruction was confirmed in 64 of them. In 49 the obstruction was due to pellets of compressed hair, in four to locust bean seeds, in five to neoplasia, in two to postspay adhesions, and in one case each to carpet fibre, tapeworm cysts, a strangulated hernia and diverticulosis. In all but four cases, the obstruction was in the small intestine. The condition affected a variety of breeds fed on a variety of diets. Radiography was a useful diagnostic tool because gas and/or fluid in the digestive tract outlined the dilated stomach and intestines. Twenty-nine of the rabbits died or were euthanased without treatment, and 40 underwent exploratory surgery; of these, 10 died during surgery, three were euthanased because of intestinal neoplasia, eight died postoperatively and 19 recovered. Fifteen rabbits in which radiography indicated that a foreign body had passed out of the small intestine did not undergo surgery; of these, 13 recovered and two died.

Development and physiology of gastric dilation air sacculitis in Chinook salmon, Oncorhynchus tshawytscha (Walbaum).

The syndrome known as gastric dilation air sacculitis (GDAS) has previously been shown to affect Chinook salmon, Oncorhynchus tshawytscha, in seawater (SW) aquaculture. Feed and osmoregulatory stress have been implicated as potential epidemiological co-factors. The development and physiology of GDAS was investigated in SW and freshwater (FW) adapted smolts. Diet A (low-cohesion pellets) and diet B (high-cohesion pellets) were fed to both FW- and SW-adapted fish. GDAS was induced only in the SW trial on feeding diet A. Stimulated gastro-intestinal (GI) smooth muscle contractility, and fluid transport by the pyloric caeca were different in GDAS-affected fish, which also showed osmoregulatory dysfunction. Cardiac stomach (CS) smooth muscle contractility in response to acetylcholine and potassium chloride (KCl) was significantly reduced in fish fed diet A relative to controls from weeks 3-5. In contrast, maximal pyloric sphincter (PS) circular smooth muscle contraction in response to KCl was significantly elevated in fish fed diet A in weeks 4 and 5. Serum osmolality was elevated in GDAS-affected fish from week 2 of the SW trial. Fluid transport from the mucosal to serosal surface of isolated pyloric caeca was significantly reduced in weeks 3, 4 and 5 in SW fish fed diet A. Gastric evacuation from the stomach of healthy fish was shown to be significantly different when diets of low- and high-cohesion were fed. The results are consistent with the intestinal brake playing a role in the development of the disease.

Does gastric dilatation limit the success of sleeve gastrectomy as a sole operation for morbid obesity?

BACKGROUND: Sleeve gastrectomy as the sole bariatric operation has been reported for high-risk super-obese patients or as first-step followed by Roux-en-Y gastric bypass (RYGBP) or duodenal switch (DS) in super-super obese patients. The efficacy of laparoscopic sleeve gastrectomy (LSG) for morbidly obese patients with a BMI of <50 kg/m2 and the incidence of gastric dilatation following LSG have not yet been investigated. METHODS: 23 patients (15 morbidly obese, 8 super-obese) were studied prospectively for weight loss following LSG. The incidence of sleeve dilatation was assessed by upper GI contrast studies in patients with a follow-up of >12 months. RESULTS: Patients who underwent LSG achieved a mean excess weight loss (EWL) at 6 and 12 months postoperatively of 46% and 56%, respectively. No significant differences were observed in %EWL comparing obese and super-obese patients. At a mean follow-up of 20 months, dilatation of the gastric sleeve was found in 1 patient and weight regain after initial successful weight loss in 3 of the 23 patients. CONCLUSION: LSG has been highly effective for weight reduction for morbid obesity even as the sole bariatric operation. Gastric dilatation was found in only 1 patient in this short-term follow-up. Weight regain following LSG may require conversion to RYGBP or DS. Follow-up will be necessary to evaluate long-term results.

The effect of ingredients in dry dog foods on the risk of gastric dilatation-volvulus in dogs.

Using dry dog food label information, the hypothesis was tested that the risk of gastric dilatation-volvulus (GDV) increases with an increasing number of soy and cereal ingredients and a decreasing number of animal-protein ingredients among the first four ingredients. A nested case-control study was conducted with 85 GDV cases and 194 controls consuming a single brand and variety of dry food. Neither an increasing number of animal-protein ingredients (P=0.79) nor an increasing number of soy and cereal ingredients (P=0.83) among the first four ingredients significantly influenced GDV risk. An unexpected finding was that dry foods containing an oil or fat ingredient (e.g., sunflower oil, animal fat) among the first four ingredients were associated with a significant (P=0.01), 2.4-fold increased risk of GDV. These findings suggest that the feeding of dry dog foods that list oils or fats among the first four label ingredients predispose a high-risk dog to GDV.