Dysphagia as a Missing Link Between Post-surgical- and Opioid-Related Pneumonia.

PURPOSE: Postoperative pneumonia remains a common complication of surgery, despite increased attention. The purpose of our study was to determine the effects of routine surgery and post-surgical opioid administration on airway protection risk. METHODS: Eight healthy adult cats were evaluated to determine changes in airway protection status and for evidence of dysphagia in two experiments. (1) In four female cats, airway protection status was tracked following routine abdominal surgery (spay surgery) plus low-dose opioid administration (buprenorphine 0.015 mg/kg, IM, q8-12 h; n = 5). (2) Using a cross-over design, four naive cats (2 male, 2 female) were treated with moderate-dose (0.02 mg/kg) or high-dose (0.04 mg/kg) buprenorphine (IM, q8-12 h; n = 5). RESULTS: Airway protection was significantly affected in both experiments, but the most severe deficits occurred post-surgically as 75% of the animals exhibited silent aspiration. CONCLUSION: Oropharyngeal swallow is impaired by the partial mu-opioid receptor agonist buprenorphine, most remarkably in the postoperative setting. These findings have implications for the prevention and management of aspiration pneumonia in vulnerable populations.

Cricopharyngeal and thyropharyngeal myectomy for management of cricopharyngeal achalasia in a 6-month-old coton de Tulear dog.

A 6-week-old intact female coton de Tulear dog presented to a veterinary teaching hospital (VTH) internal medicine service for dysphagia that was persistent since birth. The patient was diagnosed with cricopharyngeal achalasia based on a fluoroscopic swallow study. To facilitate surgical intervention, a percutaneous endoscopic gastrostomy (PEG) tube was placed to bypass the upper esophageal sphincter and provide nutritional support until the dog was larger. At 6 mo of age, the dog underwent unilateral cricopharyngeal and thyropharyngeal myectomy. Marked improvement in dysphagia was noted immediately postoperatively. Improvement in dysphagia persisted in this dog, with continued marked improvement in clinical signs noted 1 y postoperatively. Key clinical message: Cricopharyngeal achalasia can be successfully managed with surgical intervention with a good long-term prognosis. Before surgical intervention, nutritional support is of critical importance. A combined procedure of cricopharyngeal and thyropharyngeal myectomy may be associated with outcomes superior to those of alternative procedures.

Myectomie cricopharyngée et thyropharyngée pour prise en charge de l'achalasie cricopharyngée chez un chien coton de Tuléar âgé de 6 mois. Une chienne coton de Tuléar femelle intacte âgée de 6 semaines a été présentée au service de médecine interne d'un CHU vétérinaire pour une dysphagie persistante depuis la naissance. Le patient a reçu un diagnostic d'achalasie cricopharyngée sur la base d'une étude fluoroscopique de la déglutition. Pour faciliter l'intervention chirurgicale, un tube de gastrostomie endoscopique percutanée (PEG) a été placé pour contourner le sphincter supérieur de l'oesophage et fournir un soutien nutritionnel jusqu'à ce que le chien soit plus gros. À l'âge de 6 mois, le chien a subi une myectomie cricopharyngée et thyropharyngée unilatérale. Une nette amélioration de la dysphagie a été notée immédiatement après l'opération. L'amélioration de la dysphagie a persisté chez ce chien, avec une amélioration continue et marquée des signes cliniques notée 1 an après l'opération.Message clinique clé :L'achalasie cricopharyngée peut être gérée avec succès par une intervention chirurgicale avec un bon pronostic à long terme. Avant l'intervention chirurgicale, le soutien nutritionnel est d'une importance cruciale. Une procédure combinée de myectomie cricopharyngée et thyropharyngée peut être associée à des résultats supérieurs à ceux des procédures alternatives.(Traduit par Dr Serge Messier).

Videofluoroscopic swallow study abnormalities identify aerodigestive disorders in dogs with respiratory disease versus healthy controls.

BACKGROUND: Aerodigestive diseases (AeroD) pathologically link respiratory and alimentary tracts. Dogs with respiratory signs lacking dysphagia, vomiting, or regurgitation typically do not undergo diagnostic testing that identifies comorbid alimentary disease. A videofluoroscopic swallow study (VFSS) identifies defects in swallowing, reflux, and aspiration. OBJECTIVES/HYPOTHESIS: We hypothesized that dogs with respiratory and no alimentary disease (RESP) would have significantly more abnormal VFSS metrics versus controls (CON). We hypothesized RESP dogs with pulmonary parenchymal disease would have more reflux and higher penetration-aspiration score (PAS) than those with airway disease. ANIMALS: Client-owned dogs: RESP (n = 45) and CON (n = 15) groups. METHODS: Prospectively, all dogs underwent VFSS. The RESP dogs had advanced respiratory diagnostic testing. Eight subjective and 3 objective VFSS metrics (pharyngeal constriction ratio [PCR], PAS, and esophageal transit time [ETT]) were assessed. Fisher's exact test compared differences between groups (presence or absence of VFSS abnormalities). The Mann-Whitney rank sum test was used to compare PCR and PAS. RESULTS: Subjective VFSS abnormalities were present in 34/45 (75%) RESP and 2/15 (13%) CON dogs, with RESP dogs significantly more likely to have VFSS abnormalities (P = .01). No difference in PCR was found between groups. Pathologic PAS was more common in RESP than CON dogs (P = .03). The RESP dogs with airway disease had higher PAS than CON dogs (P = .01) but not RESP dogs with parenchymal disease (P = .25). CONCLUSIONS: Most (75%) RESP dogs had VFSS abnormalities, emphasizing that AeroD are common. The VFSS has value in diagnostic evaluation of respiratory disease.

Incidence, clinical signs, and videofluoroscopic swallow study abnormalities associated with airway penetration and aspiration in 100 dogs.

BACKGROUND: Videofluoroscopic swallow studies (VFSS) utilizing penetration-aspiration (P-A) scoring assesses airway protection in people. On VFSS, penetration (ingesta or secretions immediately cranial to the vocal folds) and aspiration (material caudal to the vocal folds) are associated with increased risk of lung injury in people. Penetration-aspiration (P-A) scoring has been validated in animal models, but the incidence of P-A, clinical signs (CS), and dysphagic disorders associated with P-A in dogs are unknown. OBJECTIVES: Using VFSS, identify the incidence of P-A, compare CS between dogs with and without P-A, and identify predisposing dysphagic abnormalities for P-A. ANIMALS: One hundred client-owned dogs. METHODS: Sequential VFSS and associated medical records from dogs presenting to the veterinary teaching hospitals at Auburn University (n = 53) and the University of Missouri (n = 47) were retrospectively reviewed. Statistical comparisons were made using Mann-Whitney tests, one-way analysis of variance (ANOVA) on ranks, multiple linear regression, and Spearman rank order correlation (P < .05). RESULTS: On VFSS, the incidence of pathologic P-A was 39%. No significant differences in CS were found between dogs with or without P-A (P > .05), with 14/39 dogs with P-A presenting without respiratory CS. Pharyngeal (P < .001) and esophageal (P = .009), but not oral-preparatory (P = .2) dysphagia was more common with P-A. Pharyngeal weakness (P < .001) and esophago-oropharyngeal reflux (EOR; P = .05) were independent predictors of P-A and were moderately and weakly positively correlated with P-A score respectively (P < .001, r = 0.489; P = .04, r = 0.201). CONCLUSIONS: Penetration-aspiration occurs in dogs in the absence of respiratory CS (i.e., occult P-A). Dogs with pharyngeal weakness and EOR should be considered at risk for P-A.

Intralesional steroid injection after endoluminal esophageal stricture dilatation in a cat.

Background: Benign esophageal strictures arise from various etiologies, mostly severe esophagitis. Although endoscopic balloon dilation is still the first-line therapy, refractory or recurrent strictures do occur and remain a challenge to the endoluminal treatment. The aim of this report was to communicate a recurrent esophageal stricture resolution in a cat treated with balloon dilatation and steroid injections in Ciudad de Buenos Aires, Argentina. Case Description: A 1-year-old spayed mix-breed female cat was consulted to the Veterinary Endoscopy Service for recurring regurgitation after two previous esophageal dilations. The cat had received doxycycline for Mycoplasma spp. infection and 20 days after the treatment consulted for dysphagia and regurgitation. Upper esophagogastroscopy (UGE) was performed with an Olympus CV-160 8.7 mm diameter endoscope; an annular 7 mm stricture was observed 3 cm caudal to the cranial esophagus sphincter. Three balloon dilatations procedures were performed with a Boston Scientific Controlled Radial Expansion (CRE) balloon 8-10-12 mm of 1 minute each. Because of ongoing clinical signs, another UGE was performed 15 days from the first procedure: a 3 mm stricture was encountered, balloon dilatation was repeated with 6-10-12 mm diameter, and a four-quadrant triamcinolone was injected in the submucosa. Clinically, the cat could eat with no alterations until day 20, where it started with mild dysphagia. Another UGE was performed, and the known stricture conserved a 11 mm diameter and balloon dilatation 12-15-16.5 mm with triamcinolone injection was repeated 30 days after the previous procedure. The cat could eat kibbles with no clinical signs in an 11-month follow-up. Conclusion: The alternative to triamcinolone injection after balloon dilatation presented in this clinical report was successful and it could be a therapeutic option for recurrent esophageal strictures in cats as it is in human medicine.

When Changing the Hay Makes a Difference: A Series of Case Reports.

Dry hay (composed of grass, legumes, or a mixture of the two) provides the primary source of alimentary fiber in stabled horses with limited access to fresh pasture. However, hay can also give rise to health problems in the horse, depending on the quality and quantity of its components. Pathologies may be rooted in biological problems, such as inadequate digestion disturbances, or reflect mechanical difficulties-for example, due to the presence of sharp plant parts that irritate the oral mucosa, or due to physical intake problems that inhibit consumption. Unwanted plants in the hay may cause stomatitis and affect the oral mucosa, resulting in inappetence, hemorrhagic drooling, gingival hyperemia, edema, and ulcerative lesions, as reported in case 1 of the present study. Horse dysphagia, defined as a difficult in ingesting feed through the mouth and esophagus, is another important cause of malnutrition in the horse, and identifying the site of its origin is important in order to provide practical advice for nutritional management, as reported in case 2. Free fecal water syndrome (FFWS) is a condition where the horse exhibits 2-phase feces expulsion, with an initial solid phase followed by a liquid phase. Although the etiology of FFWS is still unknown, hay quality seems to play a key role, as the outcome of case 3 suggests. This case series highlights the importance of hay quality and of providing an appropriate and adequate fiber intake. Moreover, good hay management becomes crucial when horses are affected by contextual pathologies, such as stomatitis, dysphagia, or FFWS.

Anomalous branching of the aortic arch in a dog.

Anomalies in the subclavian and common carotid arteries can be of interest in cases of cranial mediastinal surgeries, as well as to diagnose the cause of oesophageal constrictions leading to clinical signs of dysphagia (dysphagia lusoria). The development and regression of the aortic arches are of key importance in understanding the origin of these type of vascular anomalies. This report describes the congenital anomalous aortic origin of the common carotid and the subclavian arteries in a 14-year-old dog and the plausible developmental pattern failure. Academic dissection revealed a common bicarotid trunk and bisubclavian trunk arising from the most cranial aspect of the aortic arch. Despite the abnormal origin, these vessels displayed a predominantly standard anatomical course. All the anticipated branches were identified and described. Cardiac abnormalities were also noted including right atrial dilation, coronary sinus enlargement, right and left valvular endocardiosis, a patent foramen ovale and marked concentric left ventricular hypertrophy with compensatory left atrial dilation. Additionally, the right recurrent laryngeal nerve demonstrated an aberrant course consistent with a 'non-recurrent laryngeal nerve' (non-RLN). Awareness of the anatomical variations of the aortic arch is important for surgical interventions of the cranial mediastinum as well as radiological interpretation. Although infrequent, the variants similar to the one described here have been reported in different species.

Clinical characteristics of non-infectious inflammatory myopathy in the boxer dog.

OBJECTIVES: To evaluate the clinical characteristics, treatment, outcome and potential association between non-infectious inflammatory myopathy and malignancy in boxer dogs. MATERIALS AND METHODS: Boxer dogs histologically diagnosed with non-infectious inflammatory myopathy at the Comparative Neuromuscular Laboratory, University of California San Diego from 2010 to 2018 and with complete medical records were included in this retrospective study. Signalment, history, clinical signs, clinicopathologic findings, treatment and outcome were documented. RESULTS: Twenty-eight boxer dogs with non-infectious inflammatory myopathy, aged 1 to 11 years, were included. Eighteen were male (16 neutered; two entire) and 10 were female (seven spayed; three entire). Clinical signs included generalised weakness (n=17), dysphagia (n=11) and weight loss (n=10). Serum creatine kinase activity was elevated in all 20 cases tested (range 908 to 138,000 IU/L). One dog had undifferentiated round cell neoplastic infiltration within the muscle at the time of inflammatory myopathy diagnosis. Five dogs historically had mast cell tumours and 21 dogs were not diagnosed with neoplasia prior, at the time of or after inflammatory myopathy diagnosis. Treatment included glucocorticoid monotherapy (n=12), cyclosporine monotherapy (n=1) or multiple immune-suppressive medications (n=14). Six dogs neurologically improved, 11 improved but relapsed while on treatment, seven did not improve. Eight dogs were euthanased, one died, four were lost to follow-up. CLINICAL SIGNIFICANCE: Boxer dogs with non-infectious inflammatory myopathy can present for generalised weakness and dysphagia; long-term successful outcome is uncommon. The relationship between neoplasia and non-infectious inflammatory myopathy in boxer dogs remains unclear; future prospective studies evaluating a larger cohort are warranted.

The effect of neonatal dysphagia on subsequent racing performance in Standardbred horses.

BACKGROUND: Previously we described a clustering of dysphagic foal cases on a Pennsylvania (PA) Standardbred farm which was associated with exposure of pregnant mares to high concentrations of polycyclic aromatic hydrocarbons (PAHs) in the well water. The effect of dysphagia on future athleticism was uncertain. OBJECTIVES: To determine if, as adults, dysphagic foals were less likely to race and if athleticism (age of first race, Speed Index and Earnings Per Start Index) differed from that of healthy foals that raced as adults. STUDY DESIGN: Prospective cohort study. METHODS: All foals born during the study period (2014-2017) on the affected PA or an unaffected New York (NY) farm with the same proprietor were eligible for inclusion in the study. Foals with dysphagia attributed to causes other than PAH environmental exposure were excluded. The proportion of foals from both farms that raced, their age of first race, Earnings Per Start Index and Speed Index were compared between the dysphagic and normal foals using Chi-Square and Wilcoxon Rank Sum Tests. Significance level was P < .05. RESULTS: A total of 116 foals met the inclusion criteria. No significant difference was found in the percentages of foals that raced from each farm: On the PA farm, 54% of healthy and 72% of dysphagic foals raced; 70% of healthy NY farm foals raced. Median (interquartile range) age of first race, Earnings Per Start Index or Speed Index for dysphagic foals (2 years (2, 2); 57 (49, 60); 60 (45, 66) was not different from those of healthy foals from both farms (2 years (2, 3); 55 (39, 78)) or the PA farm (2 years (2, 2); 61(24, 73); 68 (57, 85)). All P > .05. MAIN LIMITATIONS: Small sample size and unique type of dysphagia. CONCLUSIONS: The athleticism of formerly dysphagic foals does not appear to be negatively impacted compared with normal foals as measured by age of first race, Earnings Per Start Index and Speed Index.

Management of postoperative dysphagia after prosthetic laryngoplasty or arytenoidectomy.

OBJECTIVE: To evaluate the efficacy of various treatments for dysphagia after laryngeal surgery. STUDY DESIGN: Retrospective. ANIMALS: Horses treated for dysphagia after laryngeal surgery. METHODS: Medical records of horses treated for dysphagia after prosthetic laryngoplasty (PLP) or partial arytenoidectomy (PA) were reviewed. Signalment, prior surgery, preoperative videoendoscopic diagnosis, and surgical treatments were recorded. Short- and long-term follow-up were obtained. Chi-square and logistical regression were performed to correlate independent variables and outcomes. RESULTS: Forty-four percent of horses with prior PLP and 88% of horses with prior PA had persistent resting dorsal displacement of the soft palate (DDSP). Vocal fold augmentation (VFA) as a single treatment was most commonly performed (n = 22), followed by laryngoplasty removal (LPR; n = 1). Fifteen horses received a combination of treatments: VFA (n = 15), LPR (n = 4), laryngeal tie-forward (LTF; n = 2), and esophageal release (n = 1). Short-term clinical outcomes were reported; 80% of horses treated with VFA (n = 35) had resolution of dysphagia, and 20% were improved. Among the 33 horses available to long-term follow-up, 31 (94%) returned to some level of work, and DDSP during work was reportedly resolved in 23 of 25 horses. CONCLUSION: Vocal fold augmentation resulted in resolution of symptoms relating to dysphagia in 81% of horses. Twenty percent of horses treated with LPR had sustained resolution of dysphagia. A combination of LPR, VFA, LTF was performed in 18% of horses. CLINICAL SIGNIFICANCE: Treatment options directed at altering laryngeal geometry and/or position of the larynx were successful in resolving 86% of dysphagia in horses previously regarded as very difficult to treat.

Videofluoroscopic swallow study features of lower esophageal sphincter achalasia-like syndrome in dogs.

BACKGROUND: Megaesophagus (ME) carries a poor long-term prognosis in dogs. In people, lower esophageal sphincter (LES) disorders causing functional obstruction are rare causes of ME that may respond to targeted treatment. Functional LES disorders are reported rarely in dogs because of challenges in diagnostic methodologies. HYPOTHESIS/OBJECTIVES: To identify dogs with videofluoroscopic swallow study (VFSS) features of LES achalasia-like syndrome (LES-AS). We hypothesized that dogs with LES-AS could be distinguished from normal dogs using standardized VFSS criteria. ANIMALS: Dogs with LES-AS by VFSS (n = 19), healthy normal dogs (n = 20). METHODS: Retrospective study. One-hundred thirty dogs presented to the University of Missouri Veterinary Health Center (MU-VHC) between April 2015 and December 2017 for a free-feeding VFSS; 20 healthy dogs were included as controls. Swallow studies were evaluated for failure of the LES to relax during pharyngeal swallow (LES-AS). Affected dogs subsequently were evaluated using standardized criteria to identify metrics important for identifying and characterizing dogs with LES-AS. RESULTS: Nineteen dogs with LES-AS were identified out of 130 VFSS. Megaesophagus was present in 14 of 19 (73.7%) dogs with LES-AS. A baseline esophageal fluid-line and "bird beak" were present in 68.4% (95% confidence interval [CI], 47.5%-89.3%) and 63.2% (95% CI, 41.5%-84.8%) of affected dogs, respectively. The esophagus was graded as acontractile (8/19), hypomotile (8/19), or hypermotile (3/19). CONCLUSIONS AND CLINICAL IMPORTANCE: Dogs with LES-AS may successfully be identified by VFSS using a free-feeding protocol. These data are of critical clinical importance because a subpopulation of dogs with functional LES obstruction may be candidates for targeted intervention.

Retrospective analysis of esophageal imaging features in brachycephalic versus non-brachycephalic dogs based on videofluoroscopic swallowing studies.

BACKGROUND: Idiopathic esophageal dysmotility (ED) is increasingly recognized in young dogs of brachycephalic breeds. Few studies have objectively associated specific videofluoroscopic swallowing study (VFSS) features with brachycephaly, leading to under-recognition of ED in brachycephalic breeds. HYPOTHESIS/OBJECTIVES: To describe and compare VFSS in brachycephalic dogs versus non-brachycephalic dogs presented for dysphagia or regurgitation, and to investigate associations between these imaging findings and patient signalment. METHODS: Retrospective analysis of VFSS of dogs presented for dysphagia or regurgitation (not megaesophagus) from 2006 to 2017. Cases were divided into brachycephalic and mesaticephalic breeds. The VFSS were reviewed using a standardized protocol by 2 examiners. Esophageal motility was assessed using specific criteria, and particular imaging features were noted and graded. Fisher's exact test was used to determine associations among signalment (including brachycephaly), final diagnosis, outcomes, and ED features. RESULTS: Thirty-six dogs were included (n = 10 normal, n = 26 presumed ED). Twenty dogs (77%) with presumed ED were brachycephalic with a median age of 1 year (range, 0.2-10.5 years). Most common were prolonged esophageal transit time (ETT; n = 21/26), decreased propagation of secondary peristaltic waves (n = 20/26), and gastroesophageal reflux (GER; n = 18/28). Eight dogs (all brachycephalic) had hiatal herniation (HH). Morphological esophageal variations were only observed in brachycephalic dogs. Brachycephaly was significantly associated with ED (P = .005), prolonged ETT (P = .41), GER (P = .02), and HH (P = .03). CONCLUSIONS AND CLINICAL IMPORTANCE: The majority of dogs with presumed ED was young and brachycephalic and had specific abnormalities that were less frequent in mesaticephalic dogs with regurgitation or dysphagia.

Esophageal pythiosis in an ostrich (Struthio camelus) / Ptiose Esofágica em avestrus (Struthio camelus)

Uma avestruz-do-pescoço-vermelho, com dois anos de idade, apresentava um nódulo no terço médio do esôfago e foi submetida a procedimento cirúrgico. Histologicamente, observou-se uma área focalmente extensa de necrose estendendo-se da túnica mucosa à muscular, e, em algumas secções, à túnica adventícia. Circundando a área de necrose, observou-se uma reação inflamatória composta principalmente por granulócitos e macrófagos, associada à fibroplasia e neovascularização. Em meio às áreas de necrose e inflamação, verificavam-se numerosas imagens negativas de hifas em seções longitudinais e transversais, melhor apreciadas pela coloração de metenamina nitrato de prata de Grocott. O diagnóstico definitivo de infecção por Pythium insidiosum foi confirmado por imuno-histoquímica. A avestruz recebia água para consumo de um lago localizado em uma área de pastagem, no qual alguns cavalos haviam desenvolvido pitiose cutânea anteriormente.(AU)

Reversible dysphagia secondary to guttural pouch mycosis in a gelding treated medically with voriconazole and surgically with carotid occlusion and esophagostomy.

A gelding was diagnosed with dysphagia and left guttural pouch mycosis. Treatments included topical antifungal drugs, systemic voriconazole, and balloon occlusion of the internal carotid artery. Ongoing dysphagia of neurological origin necessitated extra-oral feeding through an esophagostomy tube. Complementary case management included acupuncture. Clinical remission occurred over 10 weeks.

Dysphagie réversible secondaire à une mycose de la poche gutturale chez un hongre traité médicalement avec du voriconazole et chirurgicalement par l'occlusion de la carotide et l'œsophagostomie. Un hongre a été diagnostiqué avec de la dysphagie et une mycose de la poche gutturale gauche. Les traitements ont inclus des médicaments antifongiques topiques, du voriconazole systémique et l'occlusion par ballon de l'artère carotide interne. Une dysphagie non résorbée d'origine neurologique a nécessité une alimentation extra-orale par un tube d'œsophagostomie. Une gestion du cas complémentaire a inclus l'acupuncture. Une rémission clinique s'est produite pendant 10 semaines.(Traduit par Isabelle Vallières).

Prospective evaluation of an indwelling esophageal balloon dilatation feeding tube for treatment of benign esophageal strictures in dogs and cats.

BACKGROUND: Despite multiple dilatation procedures, benign esophageal strictures (BES) remain a recurring cause of morbidity and mortality in dogs and cats. OBJECTIVE: Investigate the use of an indwelling Balloon Dilatation esophagostomy tube (B-Tube) for treatment of BES in dogs and cats. ANIMALS: Nine dogs and 3 cats. METHODS: Animals with BES were recruited for our prospective study. Endoscopic and fluoroscopic evaluation of the esophagus and balloon dilatation were performed under general anesthesia, followed by placement of an indwelling B-Tube. The animals' owners performed twice daily at-home inflations for approximately 6 weeks. Repeat endoscopy was performed before B-Tube removal. Animals were reevaluated for changes in modified dysphagia score (MDS) after B-Tube removal. RESULTS: The B-Tube management was relatively well tolerated and effective in maintaining dilatation of a BES while in place. These animals underwent a median of 2 anesthetic episodes and were monitored for a median of 472 days (range, 358-1736 days). The mean MDS before treatment was 3.1 ± 0.5/4.0 and final follow-up MDS were significantly (P < .0001) improved at 0.36 ± 0.65/4.0. Eleven of 12 animals (91.7%) had improved MDS at the end of the follow-up period, with 8/12 (66.7%) having an MDS of 0/4, 2/12 (16.7%) an MDS of 1/4, and 1/12 (8.3%) an MDS of 2/4. One dog died. CONCLUSIONS AND CLINICAL IMPORTANCE: The B-Tube offers an effective, and more economical method, and often decreased anesthetic time to repeated balloon dilatation procedures for the treatment of BES in dogs and cats.

Dysphagia secondary to focal inflammatory myopathy and consequent dorsiflexion of the tongue in a dog.

A 14-month-old female pitbull terrier mix was presented for evaluation of dysphagia of 8 months' duration secondary to intermittent dorsiflexion of the tongue apex. Physical and neurological examinations were unremarkable with the exception of the dorsiflexed tongue. Serum creatine kinase activity was increased (703 IU/L, reference interval: 55 to 257 IU/L), and electromyography of the tongue demonstrated areas of fibrillation potentials. Histopathology of the tongue showed myopathic changes with excessive variability in myofibre size and endomysial fibrosis. Cytochemical stains verified mixed mononuclear cells throughout the endomysium and perimysium consistent with a chronic inflammatory myopathy. No improvement was reported following prednisone administration; although the dog was able to prehend kibble, it needed assistance when drinking water. This is the first report documenting a focal lingual myopathy in a non-corgi breed and highlights the utility of determining creatine kinase activity and obtaining tongue biopsies when warranted in dysphagic animals.

Fluoroscopic and endoscopic diagnosis of a lower esophageal ring causing foreign body impaction in a dog.

A dog was presented because of regurgitation over a 3-day period. Radiographic examination revealed a bean-shaped filling defect and an annular narrowing at the level of the gastroesophageal sphincter. The contractile ring-like structure was sharply demarcated, and its appearance varied according to gastroesophageal distension. Endoscopic findings revealed lower esophageal ring and foreign body impaction.

Diagnostic fluoroscopique et endoscopique d'un anneau œsophagien inférieur causant la surcharge d'un corps étranger chez un chien. Un chien a été présenté en raison de régurgitation pendant une période de 3 jours. L'examen radiographique a révélé un défaut en forme de haricot et un rétrécissement annulaire au niveau du sphincter gastro-œsophagien. La structure contractile en forme d'anneau présentait une délimitation marquée et son apparence variait selon la distension gastro-œsophagienne. Les résultats de l'endoscopie ont révélé un anneau œsophagien inférieur et la surcharge d'un corps étranger.(Traduit par Isabelle Vallières).

Aryepiglottic fold augmentation as treatment for late-onset dysphagia following surgical treatment of recurrent laryngeal neuropathy.

OBJECTIVE: Coughing and dysphagia have been described following prosthetic laryngoplasty (LP) with or without ventriculectomy/ventriculocordectomy (VE/VCE) for the treatment of recurrent laryngeal neuropathy. All previous case descriptions include patients with acute onset of clinical signs after surgery that persisted. The authors observed a late-onset of dysphagia and coughing months to years after LP ± VE/VCE. The condition was always associated with an abnormality of the aryepiglottic fold (AEF). Treatment options for those patients are limited. We suggest augmentation of the AEF as treatment for affected horses. The goal of the study was two-fold: Firstly, to describe a new condition of late-onset dysphagia in horses following LP ± VE/VCE associated with an abnormal appearance of the AEF, and secondly, to offer a minimally invasive and successful treatment for those patients. MATERIAL AND METHODS: Six horses were presented because of dysphagia and coughing with an onset of months to years after LP ± VE/VCE. Endoscopically, the AEF always appeared thinner and more flaccid to a varying degree. The food path was traceable along the AEF into the trachea using dyed molasses. An initial injection of hyaluronic acid (HA) into the AEF led to immediate improvement of the dysphagia. The procedure was performed in the standing sedated horse. The needle was placed through the cricothyroid ligament and the injection performed under endoscopic guidance. RESULTS: All horses tolerated the injection well. Injection of HA was successful only in the short term in all cases and repeated injections were needed for permanent resolution using either cross-linked HA, polyacrylamide hydrogel or platelet rich plasma. CONCLUSION AND CLINICAL RELEVANCE: Horses may develop dysphagia and coughing months to years after LP ± VE/VCE as a late-onset complication. The condition seems to be associated with an abnormal appearance and function of the AEF. Successful treatment is possible by augmenting the AEF. However, careful patient selection is mandatory.