Is it Acid Reflux or Indigestion?

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Is it Acid Reflux or Indigestion?

I remember 30 years ago we all used the word “indigestion” to refer to heartburn or stomach pain. With the advent of scientific research, we coined the phrase “acid reflux” and quickly people were using it interchangeably with “indigestion”. While the first line of treatment options for both conditions is the same – dietary or lifestyle changes, antacids or probiotics – we now recognize them as symptoms of different disorders. 

Indigestion, medically known as dyspepsia, resides in the stomach or upper gastrointestinal area. If the area between the esophagus is weakened or compromised, stomach acid and possibly bile will creep up into the esophagus causing acid reflux, which is also known as heartburn or gastroesophageal reflux disease (GERD). 

When you go to the doctor with internal burning sensations or general discomfort, he will ask you if the feeling is in your chest or below your ribcage. This helps him determine if it is dyspepsia, localized in the stomach, or acid reflux.

Symptoms

The signs of GERD in dogs are more noticeable than dyspepsia and include regurgitation and incessant lip licking or smacking. Pets with dyspepsia may show general malaise or discomfort; extreme cases may cause constipation, diarrhea or vomiting. 

But, if this persists at all, please see your veterinarian promptly. After all, our companion pets do not have the advantage that we have to describe in detail what is happening in their digestive tracts!

Causes

Since GERD and dyspepsia are so common, humans have readily available over-the counter medications to alleviate the symptoms. I wonder if this familiarity has lulled us into a sense of complacency, so that we forget the bigger picture.

We need to backtrack here:

What is causing these symptoms?
We know acid reflux is typically caused by a weakened or damaged esophageal sphincter (the valve between the esophagus and stomach). It can occur from anesthesia. Another cause is when the hiatus (the muscular wall separating the chest cavity from the abdomen) is compressed from a stomach bulging into the chest, thereby causing a hiatal hernia. Then, bile, pepsin and/or stomach acid can creep into the esophagus. When this happens, it causes an inflammation in the esophagus called esophagitis. With dyspepsia, companion pets and humans will get gastritis, which is an inflammation of the stomach lining.

What is causing the gastritis?
Gastritis can be caused by infection, stress, injury, NSAIDs (non-steroidal anti-inflammatory drugs like ibuprofen or the commonly prescribed veterinary products), other drugs, immune system disorders or food sensitivities. Bile reflux or biliary reflux can also occur, which is when bile passes through the duodenum (first part of the small intestine) into the stomach. It is an “invader”, so the stomach reacts to it. Now, if a pet or person has the additional hiatal hernia or weakened esophageal sphincter, it will cause or heighten the esophagitis.

What is causing esophagitis?
In addition to herniated hiatus or a weakened esophageal sphincter which is allowing acid to leak into the esophagus, other causes of esophagitis can be infections, medications or the presence of high levels of eosinophils. Eosinophils are specific white blood cells that accumulate in response to such local inflammatory stimuli as a food allergen causing a sensitivity or heightening the occurrence of acid reflux. This condition is called eosinophilic esophagitis.

Can esophagitis or gastritis lead to any other conditions?
Yes; gastritis can eventually produce stomach ulcers. Esophagitis can also lead to esophageal strictures (constrictions) or scarring. If left untreated, both inflammations can lead to other diseases or even cancer.

Treatment Options

We can heal the damage as much as possible with gastric acid inhibitors and other medications such as drugs to stabilize gastrointestinal motility. However, these are not the preferred long-term solutions, as we have not figured out the actual trigger – particularly if it is an undiagnosed food sensitivity. We need to reduce or eliminate the problem. 

For people, we often recommend dietary changes such as eliminating alcohol, spicy foods, or foods with high acidity. We can normally figure this out for ourselves after we eat an offending food. Plus, we tend to eat a variety of food, rather than single ingredients and rotate our meals.

This is not usually the case with our companion pets. Remember they cannot tell us what upsets their stomachs. We do not rotate commercial pet foods often enough to pinpoint a potential problem and nearly all pet foods have several ingredients. Additionally, you do not know what is causing the dyspepsia or acid reflux without specific diagnostic and /or clinical trial testing. Comprehensive testing is just as much about elimination of illnesses as it is about proof. These are just a few reasons why Dr. Karen Becker and I recommend testing your affected pet with the NutriScan Food Sensitivity & Intolerance test to help reduce the recurrence of acid reflux or dyspepsia.

W. Jean Dodds, DVM
Hemopet / NutriScan
11561 Salinaz Avenue
Garden Grove, CA 92843

References

Becker, Karen, DVM. “Diagnosing Gastroesophageal Reflux Disease (GERD) in Pets.” Healthy Pets. Mercola.com, 28 Dec. 2014. Web. 21 Aug. 2016. http://healthypets.mercola.com/sites/healthypets/archive/2014/12/28/gastroesophageal-reflux-disease.aspx.

DiMarino, Michael C., MD. “Gastritis.” Merck Manual, n.d. Web. 21 Aug. 2016. https://www.merckmanuals.com/home/digestive-disorders/gastritis-and-peptic-ulcer-disease/gastritis.

“Esophagitis.” Mayo Clinic, n.d. Web. 21 Aug. 2016. http://www.mayoclinic.org/diseases-conditions/esophagitis/basics/causes/con-20034313.

Willard, Michael D., DVM. “Recognizing and Treating Esophageal Disorders in Dogs and Cats.” DVM360, 01 May 2004. Web. 21 Aug. 2016. http://veterinarymedicine.dvm360.com/recognizing-and-treating-esophageal-disorders-dogs-and-cats?id=&pageID=1&sk=&date.

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