Acid Reflux in Cats

If you’ve ever experienced acid reflux, you know how annoying and uncomfortable it can be. And you also may be wondering, “can cats have acid reflux?” Unfortunately, the answer is yes — acid reflux can also affect our pets. 

While the true prevalence of acid reflux in cats is unknown, a study of 27 cats anesthetized for dental cleanings showed that 33 percent of the cats experienced some degree of acid reflux during their procedure [1]. This suggests that acid reflux may be more common in cats than many pet parents realize. 

What Is Acid Reflux in Cats?

Acid reflux is thought to be a relatively common condition in cats, although most cases probably go undiagnosed. Diagnosis is challenging because the signs of acid reflux are vague, and diagnosis requires specialized testing. 

Acid reflux can have serious consequences for affected cats. The flow of stomach acid and digestive enzymes up into the esophagus can damage the lining of the esophagus, causing esophagitis (inflammation of the esophagus). Additionally, the stomach and intestinal contents brought up during an episode of acid reflux can make their way into your cat’s lungs, leading to a form of pneumonia known as aspiration pneumonia.

Brachycephalic cats (smooshed-faced cats) are at higher risk of acid reflux, due to differences in their anatomy. This means that breeds like Persians, Himalayans, and Burmese cats are more likely to develop acid reflux. 

What Causes Acid Reflux in Cats?

Acid reflux, also known as gastroesophageal reflux disease (GERD), occurs when stomach or intestinal contents flow into the esophagus. This is typically caused by relaxation of the sphincter (opening) that separates the esophagus from the stomach. 

Causes of acid reflux in cats may include: 

• Chronic (long-term) vomiting
• Hiatal hernia (a hereditary or traumatic opening in the diaphragm, which allows the stomach to protrude into the chest)
• Inappropriate diet (table scraps, high-fat diet)
• Stress
• Gastric foreign body
• Intestinal obstruction
• Viral or bacterial infections
• Anesthesia (which relaxes the esophageal sphincter, causing short-lived acid reflux)

While there are numerous causes of acid reflux, not all cases have an identifiable cause. In some cases, your veterinarian may not be able to find a cause for your cat’s acid reflux.

Cat Acid Reflux Symptoms

The signs of acid reflux are typically vague and nonspecific. This can make acid reflux difficult to diagnose. Many signs related to acid reflux are associated with inflammation of the esophagus caused by reflux. Other signs may be associated with the underlying disease that is causing the cat’s reflux. 

Signs of acid reflux may include: 

• Decreased appetite
• Vomiting or regurgitation
• Gagging
• Repeated swallowing
• Licking lips
• Increased salivation
• Grinding teeth
• Extending the neck abnormally, especially when swallowing
• Pain when swallowing
• Weight loss
• Lethargy

While these signs are associated with acid reflux, they can also be seen with many other conditions. This makes the diagnosis of acid reflux challenging.  

How to Diagnose Reflux in Cats

Your veterinarian will start by performing a thorough physical exam on your cat. They’ll assess your cat’s overall health, while looking for signs of neck/throat pain, palpating your cat’s belly, and assessing your cat’s body condition and hydration. While many cats with acid reflux will have a normal physical exam, your veterinarian may find abnormalities to explain your cat’s signs. 

Next, your veterinarian will likely perform some basic laboratory screening tests. These tests can help rule in or rule out potential causes of your cat’s clinical signs. Initial laboratory testing may include blood tests (such as a complete blood cell count and serum biochemistry testing) and urinalysis. 

Your veterinarian may recommend radiographs (x-rays) of your cat’s chest and abdomen. Imaging is a valuable test to screen for gastrointestinal disease, but most cats with acid reflux have normal radiographs. However, it’s important to perform these tests before moving on to more invasive testing, to ensure that other diseases are not missed. 

Esophagoscopy is the best test to diagnose acid reflux. Your veterinarian may refer you to a veterinary specialist for this procedure, because general practices do not typically have the equipment required for this test. In an esophagoscopy, your cat will first be placed under general anesthesia. Next, a small camera will be inserted into your cat’s esophagus. This allows the veterinarian to look for esophagitis and esophageal sphincter abnormalities.   

Cat Acid Reflux Treatment

Dietary changes can help in the treatment of acid reflux, especially if your cat has been receiving table food or a diet that is high in fat. However, you should avoid trying any further cat acid reflux home remedies. Your cat’s treatment will depend on the underlying cause of their acid reflux. Once your veterinarian figures out the likely cause of your cat’s symptoms, they will be able to recommend treatment options.

Some causes of acid reflux can be cured. For example, if your cat has vomiting and acid reflux caused by a foreign body in the stomach, surgical removal of the object should resolve your cat’s signs. Medications may be needed to help your cat heal, but addressing the underlying cause should permanently resolve the acid reflux. 

If no treatable underlying cause for your cat’s acid reflux can be found, however, long-term medical management may be needed. Your veterinarian will talk to you about medications that can be used to manage your cat’s clinical signs. 

Cat Acid Reflux Medication

Common medications for acid reflux are divided into several categories: 

• Antacids: These medications decrease acid production in the stomach, reducing damage to the esophagus. Examples include famotidine, cimetidine, and omeprazole. 
• Mucosal protectants: These medications coat the lining of the esophagus, further reducing damage to the esophagus. The most common gastric protectant in pets is sucralfate. 
• Pro-motility agents: These medications promote normal movement of food and gastrointestinal contents through the stomach and intestinal tract. Pro-motility agents used in cats include cisapride and metoclopramide. 

Your veterinarian may prescribe additional treatments, depending on the underlying cause of your cat’s acid reflux. Antibiotics may also be prescribed if there are signs of aspiration pneumonia.

General Cost for Treatment

The cost of treatment will vary, depending on the cause and severity of your cat’s illness. 

The first step in addressing acid reflux is diagnostic testing. If your cat’s clinical signs are mild, your veterinarian may only recommend minimal testing (physical exam, bloodwork, and radiographs) before trying symptomatic treatment. These tests cost approximately $400-$600. If your cat needs to be referred to a specialist, you can expect to spend another $2,000-$4,000 for esophagoscopy. 

Treatment costs will vary, depending on the underlying cause of your cat’s illness. Medication may cost as little as $20 per month, while surgery to remove a mass or foreign body may cost several thousand dollars. Your veterinarian will provide you with an estimate of costs once they have arrived at a diagnosis and developed a treatment plan for your cat’s illness. 

How to Prevent Acid Reflux in Cats

There is no guaranteed way to prevent acid reflux in cats. However, you can reduce your cat’s risk by following these steps: 

• Feed a veterinarian-recommended diet 
• Avoid table scraps and high-fat treats
• Limit your cat’s access to string, hair elastics, and other small objects they might ingest
• Keep your cat indoors to reduce their risk of traumatic hiatal hernia
• Ensure your cat is up to date on all vaccines recommended by your veterinarian
• Seek prompt veterinary care if your cat begins vomiting. 

While some causes of acid reflux are unavoidable, these simple steps can help prevent some common causes of acid reflux. 

If you have concerns about your cat and the potential for acid reflux, talk to your veterinarian. 

References

1. Garcia, R S et al. “Prevalence of Gastroesophageal Reflux in Cats During Anesthesia and Effect of Omeprazole on Gastric pH.” Journal of veterinary internal medicine vol. 31,3 (2017): 734-742. doi:10.1111/jvim.14704