Gastric Dilatation Volvulus (Bloat)

Written by Dr. Patty Khuly, VMD MBA

Summary

Bloat is often labeled, "the mother of all emergencies." That's because every second counts when we're dealing with this disease process.

Dogs who suffer the sudden accumulation of stomach gas and its twisting (known as "gastric dilatation volvulus" or "bloat") have only a short time to get to the veterinarian for treatment. That's because the blood vessels that supply the stomach are involved in the twisting process. This pinching off of the blood supply leads to irreversible stomach death, shock and the release of deadly toxins if it's not dealt with quickly.

Unfortunately, this is a condition for which we understand the treatment far more than the cause--a frustrating problem for owners of affected dogs and for veterinarians who deal with them on a regular basis.

Symptoms and Identification

Classic symptoms for the typical bloat are seemingly unmissable. Nonetheless, owners can be confused by the signs: non-productive retching and other signs of nausea, abdominal distension (which isn't always so obvious, depending on a dog's size, weight or conformation), depression and/or restlessness.

Though sometimes the diagnosis may seem obvious to a trained professional, diagnosis is best achieved through X-rays that reveal a characteristic, bi-lobed pattern of gas accumulation in the stomach. Although bloodwork and other lab tests will invariably be part of the deal, these bits of information are actually more helpful for treatment than for diagnosis.

Affected Breeds

Studies demonstrate that dogs weighing 99 pounds or more have a 20% risk of bloat. That alone tells us that very large and giant breed dogs are especially predisposed. Nonetheless, the list of top three affected dog breeds includes one that doesn't necessarily meet this very large breed criteria:

In fact, the reality of gastric dilatation volvulus is that any size or conformation of dog can theoretically be affected. Even Chihuahuas and Pugs can bloat.

Treatment

Treatment of bloat is always undertaken on an emergency basis if it's to be successful. Fluid therapy to counteract shock, stomach decompression to relieve the gas and its pressure on the stomach and its vessels, and stabilization of any heart rhythm abnormalities are the first order of business. After this basic approach is initiated, surgery is invariably required.

The surgical approach to bloat is one where the stomach is assessed, fully relieved of its contents and then manually untwisted. Because some stomach death may have occurred, and because the nearby spleen may also have been wound up in the process, a partial resection of the stomach and/or complete resection of the spleen may be required.

Finally, what remains of the stomach should always be "tacked" to the abdominal wall to limit the possibility of any twisting action in the future. This is called a gastropexy procedure. Without this, the risk of future bloat may be as high as 75%.

Unfortunately, many dogs do not survive this process. Because many toxins may be released for days after a stomach is realigned, the heart and many other organs may continue to suffer in the wake of a successful surgery. For this reason, dogs are typically kept in the hospital for several days after surgery.

Veterinary Cost

The cost of a bloat emergency leads many owners to opt for euthanasia. In one study, 10% of dogs were euthanized due to cost concerns or very poor prognoses.

As much as $1,500 to $7,500 is required to take on a bloat. And sadly, there are never any guarantees to the success of treatment ahead of time.

Prevention

Though we don't understand what causes dogs to bloat (and therefore cannot always prevent it with any certainty), we do understand that some risk factors come to bear:

  • Feeding only once a day

  • Other family members with history of bloat

  • Eating quickly

  • Being underweight

  • Wetting dry foods

  • Feeding from a raised bowl

  • Restricting water

  • Feeding a dry diet high in animal fat

  • Having an anxious temperament

  • A history of aggression

  • Being male

  • Being 7-12 years old

Prevention therefore comes down to not breeding dogs from a family that seems predisposed to bloat, and taking to heart the risk factors above. Additionally, a prophylactic gastropexy is commonly recommended for dogs in high-risk breeds or of high-risk sizes. This relatively uncomplicated surgery may be more easily undertaken at the same time as a spay or other abdominal procedure.

References

Beck, J.J., Staatz, A.J., Pelsue, D.H., Kudnig, S.T., MacPhail, C.M., Seim H.B, and Monnet, E. Risk factors associated with short-term outcome and development of perioperative complications in dogs undergoing surgery because of gastric dilatation-volvulus: 166 cases (1992-2003). Journal of the AVMA, Vol 229, No 12, December 15, 2006: 1934-1939.

Brockman DJ, Holt DE: 2000. Management Protocol for Acute Gastric Dilatation-Volvulus Syndrome in Dogs. Compendium 22: 1025-1034.

Brockman DJ, Holt DE, Washabau RJ: 2000. Pathogenesis of Acute Canine Gastric Dilatation-Volvulus Syndrome: Is There a Unifying Hypothesis: Compendium 22: 1108-1114.

Broome CJ, Walsh VP: 2003. Gastric Dilatation-Volvulus in Dogs. NZ Vet J 51(6): 275-283.

Glickman LT, Glickman NW, Schellenberg DB et al: 2000. Non-dietary risk factors for gastric dilatation-volvulus in large and giant breed dogs. JACMA 217(10): 1492-1499.

Meyer-Lindenberg A., Harder A., Fehr M., Luerssen D., Brunnberg L. Treatment of gastric dilatation-volvulus and a rapid method for prevention of relapse in dogs: 134 cases (1988-1991) Journal of the AVMA, Vol 23, No 9, Nov 1 1993, 1301-1307.

Monnet E: 2003. Gastric dilatation-volvulus syndrome in dogs. Vet Clin Small Anim 33: 987-1005.