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Update on Gastric Dilatation Volvulus- the King of Emergencies
What We Know 2008
 

Gastric Dilatation Volvulus is by far one of the most frightening diseases of pets. In less than 12 hours, a dog can go from healthy to less than a 25% chance of survival, even with surgery. Our understanding of this disease is by no means complete, and unfortunately, information about GDV, or twisted stomach, has changed rapidly over the last years, leading some dog owners to inadvertently increase their risk, rather then decrease it.

GDV occurs when the stomach dilates, from gas, water or food, and then flips over in the abdomen, This flipping kinks off the blood supply to both the stomach and the spleen, causing the tissue to die off. Once this tissue begins to die, which can occur as soon as 1 to 2 hours after the twisting has occurred, the prognosis for survival decreases rapidly, even with aggressive surgery and intensive care.

The initial symptoms of GDV are a swollen abdomen, drooling and nonproductive retching. The swelling can be severe- much larger than a pregnant dog, and sometimes as tight as a drum. As the dog begins to go into shock, the capillary refill time becomes prolonged and severe depression and collapse occur. A dog who is able to swallow or vomit may be bloated, but does not have the “twist” which can be so life threatening. The twist can occur at any time, so no bloating should ever be ignored.

While this disease can occur in any breed, the deep chested ones are much more likely. Great Danes are the most prone, with a few studies showing a rate as high as 42%. Also highly affected are Bloodhounds, Irish Wolfhounds, Irish Setters, Akitas, Standard Poodles, German Shepherd Dogs, and Boxers. Anatomically, having a narrow, deep chest greatly increases the chance in any breed. The incidence increases with age, and lessens with body fat (one of the few things that being obese helps.)

After years of educated guesses, several large retrospective studies have finally been done to determine the true risk factors for GDV . The results are somewhat surprising.

Factors that increase risk include:
- Elevating food bowls- once thought to decease the risk, this practice actually more than doubles the chances of GDV occurring
- Having bloated before
- Having a relative who has bloated
- Eating Quickly
- A single daily meal (doubles the chances)
- Stress
- Having a fearful, nervous or aggressive disposition
- Feeding a food with a fat in the first four ingredients
- Being male
- Being Lean
- Moistening a dry food that uses citric acid as a preservative

Factors that decrease risk include:
- Mixing canned or table food with dry food
- Larger food particles (greater than 30 mm, or about 1 1/2 inches)
- Happy or easy-going temperament
- Feeding multiple meals per day
- Being a mixed breed
- Being Heavy
- Feeding a a dry food containing a calcium-rich meat meal (such as meat/lamb meal, fish meal, chicken by-product meal, meat meal, or bone meal) listed in the first four ingredients of the ingredient list


Non-factors, which don’t influence either way
- Vaccines
- Brands of dog food
- Exercise after eating
- Water consumption before or after eating
- Neutering or spaying

Once GDV occurs, surgery to replace the stomach in its natural position and remove any dead stomach or spleen tissue is required. After this, a gastropexy, or tacking of the stomach to the body wall, is done to help prevent a twist from reoccurring. There are many different gastropexy methods, which are beyond the scope of this article. Some veterinarians advocate a preventative tack, or prophylactic gastropexy, in prone breeds before GDV ever occurs. This procedure is still controversial for some people due to cost of the procedure and possible complications.

I have no doubt there will be future updates on this frightening disease as more information is discovered.

(references available upon request)