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Author: Admin | 2025-04-28
Stimulation, T4) should be performed in individual suspected cases (e.g., concurrent cutaneous or metabolic manifestations).TreatmentIf secondary disease can be excluded, therapy for congenital and acquired megaesophagus should be directed at nutritional management and treatment of aspiration pneumonia.Animals with acquired megaesophagus should be appropriately differentiated from those with other esophageal disorders. Those with MG should be treated with pyridostigmine (1.0 to 3.0 mg/kg PO Q 12 H).16 Those that do not respond to pyridostigmine may need immunosuppression with corticosteroids (prednisone, 1.0 to 2.0 mg/kg PO or SC Q 12 H) or azathioprine, 2 mg/kg PO Q 24 H initially then 0.5 to 1.0 mg/kg PO Q 48 H. Mycophenolate mofetil, a novel immunosuppressive drug with relative specificity for lymphocytes, has also been recommended, but this drug has not been sufficiently evaluated. Dogs with hypothyroidism should be treated with levothyroxine (22 µg/kg PO Q 12 H), and those affected with polymyositis should receive prednisone (1.0 to 2.0 mg/kg PO Q 12 H). A detailed review of treatment of these disorders may be found in reference 4.Smooth-muscle prokinetic therapy (e.g., metoclopramide or cisapride) has been advocated for stimulating esophageal peristalsis, but these drugs will probably not have much affect on the striated muscle of the canine esophageal body.17-19 Esopha-geal 5-HT4 receptors are present in many species but are apparently absent in canine esophageal striated muscle.17 Bethanechol has been shown to stimulate esophageal propagating contractions in some affected dogs and may therefore be a more appropriate prokinetic agent.14 Because of the high incidence of esophagitis in canine megaesophagus, affected animals should also be medicated with oral sucralfate suspensions (1 g Q 8 H for large dogs; 0.5 g Q 8 H for smaller dogs; 0.25 to 0.5 g Q 8 H to Q 12 H for cats).Pulmonary infections should be identified by culture and sensitivity, and an appropriate antibiotic selected for the offending organism. This may be accomplished by trans- or endotracheal wash or by bronchoalveolar lavage at the time of endoscopy. Nebulization and coupage may be useful adjunctive therapy in the treatment of aspiration pneumonia.Antiemetic therapy (α2-adrenergic antagonists, D2-dopaminergic antagonists, 5-HT3 antagonists) and
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