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Causes of and Cures for Heartburn

Heartburn refers to an unpleasant sensation (burn) in the upper abdomen, chest, and throat. It is caused by the overproduction of stomach acid, irritation of stomach lining, and reflux of the stomach content upward past the cardiac sphincter (upper gate of stomach) into the esophagus. It can be acute (sudden), producing severe symptoms such as dry heaving or retching, or it can become a low-grade chronic problem making pets vulnerable to digestive upset caused by seemingly minor stressors. The following is a brief description of typical symptoms, triggers, and management for this common type of digestive upset.

Symptoms

Most of my patients will treat heartburn as any other type of bodily pain and try to address it by scratching at the skin overlaying the sensitive area. Pet owners often report digging at the chest, armpits, and the bottom of neck. This behavior can lead to skin damage and present as dermatitis (inflamed or infected skin), scratches/scabs, and weeping sores (hot spots). Depending on the severity of heartburn and the upward extent of acid reflux, skin damage can extend all the way up to the area below the lower jaw. Other common symptoms include ravenous appetite and drinking, halitosis, licking of the front feet and forearms, suckling on blankets and dog beds, excess eating of grass and other nonfood items, and retching or heaving that resembles a cough. Heaving can progress to acid or bile reflux, Bringing up small amount of foam or clear to yellow fluid.

Common Triggers

Food: Commercial diets can be rough on a pet’s stomach. Many will find dry kibble dehydrating and mechanically abrasive. As with any mucous membrane, including the stomach lining, proper hydration is necessary to protect its integrity and minimize chance of tears (ulcers). Mixing kibble with equal volume of fluid helps re-hydrate it to around 70 percent moisture content and makes it less irritating.

Overeating and rich snacks: Overloading the stomach leads to excess stretching and makes it more susceptible to lining tears. Snacks rich in fat and sugars can trigger an excess release of stomach acid and resultant chemical burn.

Mechanical trauma: Some pets ingest gravel, stones, wood chips, pieces of bones, and other types of shards that can cut and traumatize stomach lining, leading to irritation and ulcers. Many pets will do this as a reaction to stomach pain, trying to dislodge unpleasant sensations by swallowing nonfood items, turning this type of behavior into a vicious cycle of irritation and reinjury.

Inflammation/infection: The physiological stress of inflammatory or infectious disease can divert blood flow and energy away from normal housekeeping activity of the continuously regenerating digestive tract lining. This type of stress can also lead to reduced appetite and drinking, and subsequent dehydration.

Chronic pain: Pain is stressful, and it usually leads to the release of stress hormones such as cortisol. Being a potent anti-inflammatory, cortisol can alter blood flow to organs of digestion. As in the case of inflammatory disease, the stress of chronic pain diverts energy away from the gut lining, leaving it less able to maintain itself in proper working order.

Management

Restore hydration: An adequate volume of body fluid is necessary for proper blood supply to all tissues, including lining of the digestive tract. Dehydrated patients have a hard time repairing those tissues and can experience prolonged, if not worsened, symptoms. Plain water does not always feel good on an injured mucous membrane, which is why isotonic fluids are superior at restoring hydration. Low-salt broth, coconut water, and children’ electrolyte solutions are easier to assimilate and produce less discomfort when swallowed. Subcutaneous fluids can be administered to patients who are not able to drink due to nausea.

Offer coating agents and fast-acting antacids: Coating agents are often slurries of inert salt of calcium, bismuth, or other minerals. More naturopathic options include various types of pulverized clay, slippery elm, and other mucogenic herbals. They coat and cover injured mucous membranes allowing them to heal faster. This approach is analogous to placing a bandage on injured skin: covering damaged lining protects it from additional injury and creates a microenvironment conducive to healing. Most mineral salts also act as fast-acting antacids by binding and neutralizing hydrochloric acid released from glands in the stomach wall.

Fasting: When the stomach lining is ripped, it often helps not to send solids into it. Stomachs will react to food by churning and releasing digestive juice, both factors able to further injure broken mucous membrane. Fasting for 12 to 24 hrs can help speed up the repairs, but it can be difficult in patients that turn ravenous when experiencing stomach discomfort.

Bland diet: When fasting is not possible, or immediately afterward, the diet for patients with stomach upset should be easy to process and gentle on mucous lining. This is what veterinary professionals commonly refer to as a bland diet. It usually consists of 75 percent well-cooked or softened carbohydrate such as oatmeal, white rice, or boiled potato; and 25 percent lean protein such as cooked chicken or turkey breast, canned tuna in water, cottage cheese, or yogurt. It is best not to mix protein sources in a bland diet, but totally fine to make several different batches to test which one works best for the patient. Bland diets are made as soupy as possible to help support hydration and are offered in small but frequent portions. It is possible to overwhelm the stomach with too much bland food at a single feeding and cause more digestive upset.

Acid reducers: An irritated stomach often produces excess amounts of digestive juice (stomach acid). This reaction can aid in initial expulsion of irritating food from the stomach but is usually excessive and leads to the scalding of the mucous membranes of the stomach and the esophagus. This leads directly to the symptom being discussed in this article: burning sensation in the area over the heart (heartburn). If coating agents and fast-acting antacid salts are not sufficient, the next phase of treatment is to temporarily shut off stomach-acid production. There are plenty of over-the-counter remedies used to such effect, including Famotidine, Ranitidine, and Omeprazol. Please consult your veterinarian regarding an appropriate dose, which is typically based on a patient’s body weight.

Heartburn is unpleasant if not painful, and it can become a significant source of stress further exacerbating digestive upset. Fast recognition and treatment of symptoms can lead to recovery within a few days. If not addressed quickly enough, heartburn can progress toward acid reflux and vomiting, and frequently, lower-digestive tract symptoms such as diarrhea. The longer it lasts, the more likely it is that the patient will require serious medical intervention, including hospitalization and intravenous hydration.

Z. Adam Piaseczny, D.V.M., C.V.A., has built and leads the team of Healthy Pets Veterinary Hospital, a three-doctor integrative practice located in the West Portal neighborhood of San Francisco. He lives in adjacent Sunnyside with his partner, daughter Sofia, dogs, and chickens. He is a graduate of Cornell University College of Veterinary Medicine class of 2000, and he received acupuncture certification from the Chi Institute of Traditional Chinese Medicine in 2006.

Main article photo by: Photo by Konstantin Sutyagin-CC