Gastric Dilatation
Volvulus (GDV), Bloat and Torsion

Ron Hines DVM PhD 4/21/06
Gastric dilatation is a life-threatening condition that occurs in mature large dogs. I do not see many of these cases but when I do I have work diligently if I am to save the animal. Another term for the condition is gastric dilatation/volvulus or GDV. Volvulus is a twisting of an organ along its long axis. In this disease, the stomach flips over on itself and expands with trapped swallowed air and fermentation gases. Circulation to the stomach and spleen are cut off to the point where the dog may go into shock and die. A startling finding is that the incidence of bloat has increased by more than 1500% over the past 30 years.
The Cause of GDV:
We are unsure why GDV occurs. Exercise just after or before eating may bring
on GDV. We used to think that dogs developed GDV when they ate too much. In
this theory, dogs that drank after a meal of dry chow caused the food to rapidly
expand. This theory assumed that the enlarged stomach then flipped over during
rough exercise. We now know that the actual explanation is not that simple.
We also know that GDV is associated with abnormal muscular contractions of the
stomach. These, plus the kinks that forms in the stomach’s openings, prevent
the dog from belching swallowed air. Lack of normal motility and circulation
in the stomach cause the body to become too acidic (metabolic acidosis). We
also know that dogs who eat from elevated dishes are more likely to become bloated.
Their dishes should always be on the floor.
A recent Purdue University Study shines much light on this perplexing disease. They found that certain factors increased the incidence of GDV. The first and most important factor was age. The older the dog was the more commonly they develop GDV. The second most common factor was having a relative that had developed GDV. This shows that genetics plays a part in the disease. The third factor was feeding the dog in a raised food bowl. Raising the food bowl is often suggested in large breeds that have trouble swallowing. So there may be some linkage between esophageal problems and GDV. There was a 2.7-fold increase in the risk of GDV in dogs that ate dry dog food that contained fat as its most common or first ingredient. The risk of GDV increased 4.2-fold in dogs that ate dry foods containing citric acid when the food was moistened prior to feeding. Dry foods containing meat meal with bone among the first four ingredients significantly decreased GDV risk (53.0%). Approximately 30% of all cases of GDV in this study were attributed to consumption of dry foods containing fat among their first four ingredients, while 32% could be attributed to consumption of owner-moistened dry foods that also contained citric acid. Citric acid in the stomach is conducive to gas formation. So choosing your dog's diet is probably the most important thing you can do to prevent gastric dilatation/volvulus bloat and torsion.
It may also be helpful to withhold water for one hour before meals and three hours after. Dry dog foods swell when they become wet and theoretically, this could swell the stomach. If you feed grains such as rice, be sure they are completely cooked.
Diagnosis:
The condition appears suddenly. Gastric dilatation/volvulus occurs almost always
in deep- chested large breeds. Borzoi’s, Setters, Afghans, German Shepherds
and Greyhounds are a few of the breeds commonly affected. These dog arrive at
the veterinary hospital panting and weak. When the problem is advanced, there
is a pronounced swelling on the dog’s lower left side. When I push on
the abdomen in this area the tummy is abnormally firm and drum-like. The dogs
may attempt to retch and belch but are not successful. They salivate and are
restless and in obvious pain and distress. When we x-ray these dogs, the gas-filled
stomach is quite apparent. The pressure the enlarged stomach places on the blood
vesicles of the abdomen decreases the efficiency of blood circulation through
the stomach and spleen leading to depression and shock.
Laboratory examination of the blood confirms metabolic acidosis. It is also
common for blood potassium to be low. Low blood potassium affects cardiac rhythm
and causes muscle weakness.
As circulation through the stomach is hindered, the stomach wall begins to necrose or die. This liberates many toxic products into the blood stream. These products interfere with normal blood clotting and cause a condition known as disseminated intravascular coagulation (DIC) or clumping of the red blood cells. DIC alone can be fatal.
Treatment:
Gastric torsion is a life threatening illness that needs to be dealt with quickly.
To fight circulatory collapse, I immediately place a catheter into the large
vein of the arm for easy access. Then I administer large volumes of intravenous
salt solutions with bicarbonate at a rather rapid rate. I monitor the dog’s
body weight and urine flow so as not to flood the lungs with fluid.
I also give these dogs intravenous potassium chloride and corticosteroids (prednisolone,
dexamethasone). It is important that pressure within the stomach be quickly
removed. Most dogs are so shocky that they need no tranquilizers or anesthetics.
I first try to pass a stomach tube through the dog’s mouth and into the
stomach to remove the air. Giving them simethicone helps decrease froth and
pockets of air. In many cases, the kink in the stomach does not allow the tube
to pass. When this is the case I insert a large bore needle called a trochar
through the side of the dog and into the stomach or cut down on the stomach
and temporarily suture the opening I cut in the stomach to the body wall (see
diagram). I give all these dogs large amounts of antibiotics because I must
move so rapidly that sterility is compromised. Antibiotics are also necessary
to combat the bacteria that proliferate in the stomach and intestinal wall.
When I am lucky, the dog’s condition stabilizes when the pressure is removed.

When I think the dog can tolerate surgery it is time to enter the dog’s
abdomen and place the stomach and spleen back in their proper positions. Then
I perform a procedure called a gastroplexy, which entails sewing the stomach
to the inner wall of the abdomen so that it can not shift in the future. If
the dog is stable enough, I remove the surface layers of a two inch square area
on the left middle surface of the stomach and a similar area on the left body
wall and sew the two remaining structures together. If the animal is too weak
for me to take the time to do this, I incorporate the stomach section in the
body wall incision made to reach the stomach. In these cases I also suture a
latex drain tube that leads from the interior of the stomach to the dogs skin
and allows fluid and gas to drain. These dogs often have serious heart irregularities,
which keep me tense during surgery.
Whether or not the dog survives the surgery depends on the degree of shock and stomach necrosis that has occurred. This in turn depends on how soon the dog was brought to me for treatment. A little more than half the dogs survive. Since we do not understand why this condition occurs it is hard for us to plan a life style and diet for the dog that might prevent reoccurrence. Usually, gastroplexy prevents future episodes from being as severe as the first.
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Threads:
8/16/06
Dear Mr. D,
Thank you for writing to me about Whisky. Fila Brasilieros mastiffs are especially
prone to bloat and gastric torsion.
I think we need to immediately change Whisky's diet. Dry dog foods often contain
too much fat as well as citric acid.The dog food you use is imported from
Europe or the US. By the time it reaches New Delhi it could easily be stale.
You can make your own diet by feeding ground beef that is low in fat. You
can feed this raw, if the beef is very sanitary - that is- if it is processed
in a very clean facility. Be sure it is not beginning to spoil. If that is
in doubt, feed it well cooked. You can also feed ground or diced chicken.
But it must be an old egg-laying chicken or a farm-grown chicken that is not
fat and the skin and fat must be removed. Big chicken farms in the US grow
their chickens much to fat and it is impossible to get all this fat off. I
would make two thirds of his diet lean meat and one third boiled rice or mashed
potato or a combination of the two. Be sure the rice and potato are very well
cooked so that they do not expand in the stomach after they are eaten. You
will also need to crush a complete human multivitamin tablet and mix it with
each day's food. Add it after the food has cooled off. You will also need
to give him a calcium supplement. Because Whisky is already showing signs
of bone disease, you need to give him a substantial dose.Human calcium tablets
are fine. Most are calcium carbonate or ground oyster shell. Give him the
suggested human dose. Plain no-fat yogurt is also a good source of calcium.
You also need to add fiber to his diet. You can used ground up carrots or
beets. Feed enough fiber to keep his stools bulky and soft. You must feed
Whisky very little of this food at a time - but feed it 4 times a day. If
he still bloats, feed him even less an amount even more frequently. Do not
feed him from your hand. Be sure his food bowl is not elevated but rather
is on the floor. Keep water out for him during the day, but remove it for
an hour before and an hour after he eats. Add no salt to his food. Do not
feed him treats, other than cooked beef. Do not let him eat fatty meat or
oily foods. Be sure he eats no citric acid . Citric acid is often used as
a preservative in foods. Do not allow Whiskey to exercise for 1 hour before
he eats or 3 hours after.he eats. Do not allow Whisky to eat rapidly. Keep
a product that contains Simethicone to give after a meal if there is the slightest
sign of bloating or discomfort such as burping up gas. Your chemist should
have this product. Simethicone is sold to prevent gas attacks in human babies
and also for adults. Any human product that prevents gas usually contains
simethicone but the less additional ingredients, the better. . Some people
think that the spice, nutmeg, helps prevent bloat. I would not give Ranitidine
(Zantac) because it may slow digestion and cause the food to stay in the stomach
too long. I am not acquainted with many of the medicines you are using in
India because they are not used in America. All Sulfocamphocainum references
I could find were in Russian. We in America call Cocarboxylase hydrochloride,
Thiamin or vitamin B-1. I see no harm in giving it but I do not understand
why one would. Again, I am not aquatinted with Destsinon and the only references
to this drug that I find are in Russian. To my knowledge, Cirucal is also
not used in the US or Western Europe. Charcoal tablets are quite good to give
just after an episode of bloat has been treated because it can absorb toxins
that may still be present in the stomach. However I do not know of any effect
of charcoal in preventing bloat. There is certainly no harm in giving it in
moderate amounts. I could find no references to Espumisan Syrup in English,
Spanish or German and those are the only Western languages that I understand.
I would like to know more about espumisan and any information you might provide
on its uses would be most appreciated. Best wishes and please keep me informed
frequently
R.S.H.
Ask the Veterinarian, Veterinary question, Ask the Vet, Veterinary Advice, Dr. Ron Hines.