Reflux in dogs as a clinical and nutritional problem: A summary of the webinar with vet Aleksandra Szyguła
- Ecommercy
- 2026-09-22
- 15:04
- 0 comments
Reflux in dogs is one of those gastrointestinal conditions that has been diagnosed and discussed increasingly often in recent years. On the one hand, this reflects greater awareness among owners, who are beginning to recognise signs beyond classic vomiting. On the other hand, reflux remains diagnostically challenging because its clinical presentation can be non-specific, variable and often overlaps with other gastrointestinal disorders.
During the webinar presented by vet Aleksandra Szyguła, particular emphasis was placed on the fact that reflux in dogs should not be viewed simply as the “backflow of stomach contents” or occasional regurgitation. It is a chronic problem associated with impaired lower oesophageal sphincter function, altered gastrointestinal motility and exposure of the mucosa to gastric contents and, in some cases, duodenal contents. Clinically, it is not only the reflux episode itself that matters, but also the duration of oesophageal mucosal exposure to acid, pepsin, bile and digestive enzymes.
Watch the webinar recording
What is reflux in dogs?
Gastro-oesophageal reflux involves the backflow of gastric contents into the oesophagus. Under normal physiological conditions, the lower oesophageal sphincter limits the movement of stomach contents back into the oesophagus. If sphincter tone is reduced or upper gastrointestinal motility is impaired, gastric contents may move towards the oesophagus and irritate its mucosa.
Hydrochloric acid is not the only concern. Refluxed contents may also contain pepsin, bile salts and digestive enzymes. Their effects, particularly during repeated episodes, may lead to oesophagitis, erosions, pain when swallowing, secondary reluctance to eat and, in more advanced cases, oesophageal strictures.
In clinical practice, duodenogastric reflux should also be considered, in which contents from the duodenum flow back into the stomach. Both mechanisms may coexist and contribute to inflammation within the upper gastrointestinal tract.
Signs that may suggest reflux
One of the most important aspects of history-taking is distinguishing vomiting from regurgitation. Vomiting is an active process, usually preceded by nausea and involving contraction of the abdominal muscles and diaphragm. Regurgitation is passive. Food or fluid moves back into the mouth without obvious abdominal effort.
Signs commonly reported by owners include lip smacking, excessive lip licking, repeated swallowing, salivation, panting, belching, grass eating, licking surfaces, restlessness at night, coughing, reduced appetite, difficulty swallowing or intermittent refusal to eat. In some patients, signs become more pronounced after meals, exercise, when lying down or during stressful situations.
Particular attention should be paid to brachycephalic dogs. In these patients, reflux may be mistaken for a respiratory problem, coughing or signs associated with the anatomy of the upper airways. In practice, some patients are initially referred for investigation of coughing, while the underlying problem becomes apparent only after assessment of the oesophagus and stomach.
The signs of reflux are non-specific. Lip smacking or grass eating alone is not sufficient to establish a diagnosis, but these signs should prompt a thorough history to determine whether there is a recurring pattern related to time of day, feeding, activity, stress, diet or medication.
Reflux as part of a broader problem
Reflux rarely occurs entirely in isolation. It may coexist with gastritis, motility disorders, chronic vomiting, hiatal hernia, intestinal disease, pancreatic disease, food allergy or food intolerance. In some patients, reflux is secondary to an underlying disorder; in others, it becomes a factor that perpetuates chronic inflammation.
The webinar strongly emphasised the concept of a “vicious cycle” within the gastrointestinal tract. Oesophageal irritation may increase discomfort, reluctance to eat and motility disturbances. Delayed gastric emptying may increase the risk of reflux. Inflammation of the stomach or intestines may exacerbate reflux signs. Stress, pain, environmental changes or an inappropriate feeding schedule may additionally trigger exacerbations.
In this context, managing reflux involves more than prescribing a single medication. It requires assessment of the patient as a whole, optimisation of the diet and feeding schedule, appropriate pharmacotherapy, management of post-meal activity and monitoring of the clinical response.
Diagnosing reflux
A thorough clinical history remains the foundation of the initial assessment. Questions should cover not only vomiting but also regurgitation, lip smacking, licking, grass eating, belching, salivation and coughing, as well as the timing of signs, their relationship with meals, type of diet, number of meals, activity after eating, medications and previous anaesthetic procedures.
Ultrasonography can help assess the stomach, intestines, pancreas and other abdominal structures, but it cannot definitively confirm reflux. Endoscopy remains the gold standard for assessing the oesophagus, stomach and duodenum. It allows direct evaluation of the mucosa, the presence of bile, signs of inflammation, erosions and strictures, and enables biopsy samples to be collected for histopathological examination.
Differential diagnoses should include megaoesophagus, foreign bodies, oesophageal strictures, hiatal hernia, vascular anomalies, motility disorders, neuropathies, neoplasia, gastric and intestinal diseases, and pancreatic disease. In patients presenting with coughing, particularly brachycephalic dogs, reflux should be considered as part of a broader differential diagnosis.
In selected cases, dynamic investigations such as contrast fluoroscopy, as well as pH and impedance monitoring, may be useful. In clinical practice, the extent of diagnostic investigation should depend on the severity and duration of signs, response to treatment and the presence of warning signs.
The role of pharmacotherapy
Pharmacological treatment of reflux disease should be tailored to the individual patient. The webinar focused primarily on the role of prokinetic drugs and mucosal protectants. Prokinetics such as cisapride or metoclopramide are intended to promote normal movement of gastrointestinal contents and improve gastrointestinal motility. Their effectiveness, however, depends on regular administration and adherence to treatment recommendations.
Mucosal protectants may be an important component of treatment in patients with oesophageal or gastric irritation. In practice, products that form a protective barrier and support mucosal healing may be used. The duration of treatment should depend on the clinical presentation and the attending vet’s assessment.
Proton pump inhibitors are a separate consideration. The webinar highlighted that their use in reflux is subject to debate and should not be automatic. It is particularly important to distinguish patients with confirmed erosive or ulcerative lesions from those presenting with reflux signs without such findings. Prolonged or unjustified PPI treatment may fail to provide the expected improvement and, in some patients, may have undesirable effects on the gastrointestinal tract.
Dietary management as a cornerstone of treatment
One of the key conclusions from the webinar was that dietary management is not merely an addition to reflux treatment but one of its fundamental components. In many patients, establishing an appropriate feeding routine is what ultimately reduces recurrence and improves quality of life.
Regularity is particularly important. Meals should be small, frequent and provided at consistent times whenever possible. In small dogs, 4–6 meals per day may often be considered, while larger dogs should generally receive at least 3 meals. The aim is to avoid overloading the stomach, reduce intragastric pressure and limit prolonged fasting periods, which may exacerbate signs in some patients.
The diet should be highly digestible and have a controlled, usually reduced, fat content. Excess dietary fat may delay gastric emptying, exacerbate reflux and increase the risk of recurrence. In practice, this means carefully assessing not only the main diet but also treats, chews, added fats and foods given outside regular meals.
Fibre intake should also be controlled. In some patients, a small amount of appropriately prepared fibre, for example in the form of a soft gruel, may be beneficial. In others, even a small amount may reduce dietary tolerance. The amount and source of fibre should therefore be selected individually based on the patient’s clinical response.
For home-prepared diets, highly digestible, low-fat ingredients that are well tolerated by the individual patient are generally preferred. If carbohydrates are included, they should be thoroughly cooked, processed and easy to digest. Depending on the patient’s tolerance, suitable options may include purées made from carefully selected starchy vegetables or other energy sources.
When selecting commercial diets, attention should be paid not only to labels such as “gastrointestinal” but, more importantly, to the actual fat content, ingredients, digestibility, individual tolerance and clinical response. Some dogs may do well on wet or cooked diets because their softer consistency may be better tolerated by the oesophagus. Other patients may stabilise only on a dry diet with appropriate nutritional characteristics. This is another example of why there is no single universal feeding strategy for reflux.
The most common dietary mistakes
In practice, many recurrences result not from a lack of treatment but from inconsistent management. Skipping meals, excessively long intervals between meals, infrequent large portions, fatty treats, chews, sausages, cheese, table scraps or intense physical activity after eating can all destabilise the patient.
A large meal increases the volume of gastric contents and may promote reflux. A high fat content delays gastric emptying. Lying down after eating may contribute to reflux, but at the same time the patient should not engage in vigorous activity immediately after a meal. A calm post-meal period without running, jumping or strenuous walks is generally recommended.
The timing of the final meal is also important. For many patients, providing it approximately two hours before bedtime works well, although this should be adjusted according to the patient’s daily routine, signs and individual response. The aim is not to follow a rigid schedule, but to establish a feeding pattern that reduces both night-time signs and excessive gastric filling before rest.
Monitoring the patient
Patients with reflux require monitoring, particularly when transitioning to a low-fat diet or experiencing intermittent reluctance to eat. Regular body weight checks can help identify insufficient energy intake, deterioration in appetite or progression of the underlying disease. In some dogs, it may be necessary to increase the energy density of the diet without significantly increasing fat intake, which requires a highly individualised approach.
Treatment efficacy should not be assessed solely by the number of regurgitation or vomiting episodes. Appetite, post-meal behaviour, night-time lip smacking, licking, belching, grass eating, comfort after meals, stool quality, body weight and medication tolerance should also be monitored. Reflux is a chronic condition, so the therapeutic goal is often not to “cure it once and for all”, but to achieve stability, reduce the frequency of exacerbations and minimise mucosal damage.
The importance of collaboration between the vet and nutritionist
Collaboration between the vet and nutritionist is particularly important in patients with reflux. The vet is responsible for diagnostics, assessing indications for pharmacotherapy, endoscopy and additional testing, and investigating concurrent diseases. A nutritionist can help formulate a diet with appropriate digestibility, energy density, fat content and meal structure, as well as a practical feeding schedule that the owner can realistically maintain.
This collaborative approach is particularly useful in patients with additional dietary or medical restrictions, including allergies, food intolerances, pancreatic disease, chronic enteropathies, underweight, obesity, liver disease or the need for multiple medications. Reflux often requires a compromise between an ideal nutritional plan and what the patient’s gastrointestinal tract can actually tolerate.
Summary
Reflux in dogs is a multifactorial, chronic and often underdiagnosed condition. It may present not only as regurgitation, but also as lip smacking, grass eating, belching, night-time restlessness, coughing, salivation, reduced appetite or difficulty swallowing. Distinguishing regurgitation from vomiting, taking a thorough clinical history, performing appropriate differential diagnostics and assessing concurrent diseases are essential.
Management should combine pharmacotherapy, dietary management, owner education and monitoring of the clinical response. Diet should be tailored to the individual patient, taking into account digestibility, fat content, fibre tolerance, consistency, energy density and the owner’s practical ability to follow the feeding plan. In many cases, the greatest improvement comes not from a single medication or a particular food, but from a consistently maintained routine: small portions, regular feeding times, reduced fat intake, elimination of inappropriate treats and a calm daily routine.
Reflux cannot be effectively managed using a single universal protocol. It requires careful observation, individualisation and collaboration between the vet, nutritionist and owner. This consistency is often what determines whether a patient remains stable or experiences repeated recurrences of clinical signs.