1	Problems of the Esophagus Carla Sommardahl, DVM, PhD, DACVIM Assistant Professor
2	Normal Anatomy
3	Common and not so common problems Choke – esophageal obstruction with feed material Foreign body obstruction/irritation Esophagitis Megaesophagus Congenital Disorders
4	Early Signs of Choke Excess drooling of saliva and feed material or froth Saliva and feed material from nostrils Extend head and neck Restless behavior Attempt to drink Cough, retching
5	Other Signs of Choke Partial choke – signs may occur on and off depending on diet Long term or recurrent choke – depression, dehydration, weight loss
6	Esophageal Obstruction Common types of obstruction material: Beet pulp, pelleted feed, corncobs, grain, hay, pieces of fruit, “crab apples”, boluses Wood shavings and other foreign bodies
7	Esophageal Obstruction Sites of obstruction: Esophageal opening (retropharyngeal LN) Mid cervical region Thoracic inlet Terminal Esophagus
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9	What can you do? Not an immediate emergency, but can be life threatening due to complications Call your veterinarian immediately Remove all feed and water Put in unbedded stall
10	Initial Examination and Treatment Complete physical exam Sedation Passage of a nasogastric tube to identify obstructed location Lavage of esophagus with head down
11	Further Examination Endoscopy of the esophagus Radiographs of the neck area with and without contrast Ultrasound examination of neck region Radiographs of the lungs
12	Treatment Tranquilization and relaxation of esophagus for lavaging Intravenous fluids and electrolytes in more severe cases No Oral Intake for 24 hours NSAIDs Antibiotics for aspiration pneumonia
13	Treatment (cont) Refractory cases may require general anesthesia Pass cuffed endotracheal tube into esophagus then nasogastric tube Lavage with water keeping horses head ventral to facilitate drainage Gentle lavage to avoid esophageal rupture Surgical Treatment (esophagostomy) Only in severe case, stricture likely
14	Prognosis Good in most cases (< 24 hours duration) Prognosis depends on length and duration time in which obstructing material remains in esophagus Endoscopic evidence of esophageal ulcer 24 hours is general concern
15	Complications of Choke Dehydration Electrolyte imbalances Aspiration pneumonia Upper airway irritation and inflammation
16	Complications of Choke Esophagitis Motility disorders = megaesophagus Esophageal ulcers and stricture Esophageal rupture or tear
17	Prevention Proper dental care Good quality hay Rapid eaters Feed separately, place large object in grain bucket to slow down eating Older horses or horses with previous choke Avoid dry pelleted feeds and beet pulp – expand when wet. Moisten these prior to feeding. Avoid hay cubes or large fibrous horse treats if new to horse
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21	Esophagitis Inflammation of the esophagus with or without ulceration Regurgitation of gastric fluid into the esophagus Gastric ulcer disease Increased stomach volume from motility disorders or outflow obstruction Impaired lower esophagus sphincter function Chemical Injury Trauma from foreign bodies, choke, nasogastric tubes
22	Signs of Esophagitis Discomfort or gagging when swallowing Signs similar to choke Loss of appetite, weight loss Signs of underlying disease Colic Depression
23	Diagnosis of Esophagitis Endoscopic examination Contrast radiographs Underlying disease process with high risk for esophagitis Gastric ulcers Enteritis Gastric outflow obstruction
24	Treatment of Esophagitis Treat underlying problem Decrease stomach acidity Mucosal protectants Dietary modifications Frequent small meals of moistened pellets and fresh grass
25	Motility Disorders of Esophagus (Megaesophagus) Often secondary to choke or esophagitis Extraesophageal tumors or abscesses causing obstruction Pleuropneumonia Neurological diseases EPM, Equine Herpesvirus, Botulism, Idiopathic vagal neuropathy
26	Congenital Disorders Very rare Stenosis Persistant right aortic arch Idiopathic megaesophagus