"Beating Bloat -
An Analysis of Risk and Prevention"

This is a subject near and dear to my heart.  My beloved Yanko vom Unserhund, known to many as "Tag", passed away after suffering from GDV in his seventh year.

BLOAT is the second leading killer of dogs. Cancer is the first. BLOAT is a canine medical emergency. BLOAT can occur in two forms: gastric dilatation (swelling of the stomach from gas); or, gastric dilatation with volvulus, i. e., torsion, which occurs when the stomach twists on its axis. Often, both forms of bloat occur in a single episode with the second form quickly following the first. When this happens, BLOAT is fatal in minutes. BLOAT is also known as gastric dilatation-volvulus or GDV.

Know The Symptoms

My Bloat Notes

It's an owner's nightmare:  returning home or waking up to find a beloved pet has died of gastric dilatation-volvulus, or bloat and torsion as it more commonly is known, an agonizing condition that can strike suddenly and fatally.  Sadly, for many owners this nightmare has become a traumatic reality.

Dogs that succomb to the condition suffer immense pain and an obscenely distended abdomen that can grow to as large as a beach ball.   They exit this world too early jarringly, and they leave their owners feeling helpless and confused.  As new research emerges, however, owners may be able to fend off the fatal grasp of bloat and torsion and take steps to minimize the risks to their dogs.

Bloat is a condition in which there is a rapid accumulation of air in the stomach causing dilatation.  Volvulus, or torsion, occurs when the dilated stomach twists, cutting off contact with the esophagus at one end and the small intestine at the other.  This effectively isolates the stomach and traps the air.

The very enlarged, twisted stomach puts pressure on the blood vessels, often twisting them in the abdominal cavity and this impairing blood flow back to the heart.  Because the heart receives an insufficient amount of blood to pump, blood flow decreases to the rest of the body.  With this, there is the fairly acute onset of death of the tissues that are deprived of oxygen, including the stomach wall itself, which rapidly undergoes necrosis.

The early signs of bloat include discomfort.   The dog paces or repeatedly gets up and then lies back down.  There also is excessive salivation, panting and unsuccessful attempts to vomit.  As the condition worsens, the abdomen distends in most - but not all - dogs and feels taut like a drum.   Shock follows (i.e. pale gums, weakness, shallow pulse, cool extremities, etc.).   Often, dogs then go into a coma, and death is the ultimate outcome if they are untreated.

Uncovering Etiologies:
Given that GDV is one of the leading causes of death on giant and large breeds, one would expect that much research into the cause of this pervasive killer would be under way.   Yet, Larry Glickman, V.M.D., Dr.PH, a veterinary researcher at Purdue University's School of Veterinary Medicine, presently is one of the only researchers pursuing this area of study.  According to him, other groups currently researching the condition typically focus on its treatment and not the cause.

Glickman presented some of the findings from his most recent "Five Year Purdue University Prospective Study of Gastric Dilatation-Volvulus" at Canine Health Conference held in St. Louis in October 1999 and sponsored by the AKC Canine Health Foundation.  The purpose of the study was to isolate risk factors in order to identify the environmental situations and characteristics of dogs that make them more susceptible to the condition.

"We followed nearly 2000 dogs belonging to 11 breeds for up to five years to determine which one would develop bloat and which ones would not.  Then, we related that data back to things like their breed, size, shape, personality, age, genetics, diet and how they were managed," he explains.

The study was a two part risk analysis performed at the breed individual dog levels.  At the conference, Glickman reported on the first part, the breed analysis findings, which are complete, but reported only the preliminary findings of the second part, the individual dog risk factors, which still are being analyzed at the time of this writing.

Analysis At The Breed Level:
"In the first part, we tried to look for breed related risk factors," Glickman explains.  "That is, characteristics that would put a breed per se at higher risk than any other breed in the study".  The large breed dogs in his research were characterized as weighing between 50-99 pounds at adult weight and the giant breeds were 99 pounds and greater.  (Smaller breeds were not studied because, for the most part, they are not largely affected by bloat.)  The 11 breeds included in the study - chosen because they were known to be high risk - were the Akita, Bloodhound, Collie, Great Dane, Irish Setter, Irish Wolfhound, Newfoundland, Poodle (standard), Rottweiler, Saint Bernard and Weimaraner.  Dogs were measured at AKC shows.  On the breed level, the following characteristics were analyzed:

Breed Size:
In terms of breed risk factors, Glickman found the incidence of bloat was high and almost identical in both the giant and large breed dogs in the study.  the actual incidences of bloat in both the large and giant breeds were 23 and 26 cases, respectively, per 1000 "dog years" at risk.  (Each dog followed for one year represented one "dog year" at risk.)  Out of the more than 1900 dogs in the study, a total 105 developed bloat.  Their fatality rate was 29 percent.

The breeds at highest risk in the study were the Great Dane with a cumulative incidence rate of 15.7 percent, and the Bloodhound, with a rate of 8.7 percent.  To figure lifetime rate of incidence, Glickman took observed incidence rates for the different breeds and made the assumptions that the average life span is 10 years for the large and 8 years for the giant breeds.  He then calculated what the lifetime risk of bloat would be for these breeds.  It was 23 and 26%.   In the case of the Great Dane specifically, it was 42 percent!  That means more than four out of ten Great Danes will bloat in their lifetimes.  Of those that do, one third will die.

Breed Shape:
According to Glickman, it's not just a breed's size that influences the rate of bloat, however.  As the breed analysis also revealed, "Breeds that have a deeper and narrower abdomen are at greater risk, with the abdomen depth/width ratio being a much stronger predictor than the chest depth/width ratio for breeds.  We think that the deeper and the narrower the abdomen, the greater the room for the stomach ligaments to stretch down or lengthen as part of the aging process.  The deeper abdomen provides more room for the stomach to actually descend with age.  The combination of stretched ligaments and the greater room allows the stomach to "twist".

Glickman says the fact that the smaller breeds with deep, narrow abdomens have a higher incidence rate of bloat further supports the correlation of the abdomen depth/ratio and increased risk.  "The only breeds of lesser size with fairly high incidence of bloat are Basset Hounds and Basset Hound shaped breeds including Dachshunds.  Compared to the size of the dog, they have a very deep, narrow abdomen.

Study findings also revealed the risk of bloat between two breeds of roughly the same size.  Glickman believes this is due to the difference in shape.  "Compare the setters - Irish and English - to the retrievers - Golden and Labrador.  Here are two breed types that are roughly the same size, yet, the setters have a much higher incidence.  Setters have a very deep, narrow abdomen, while retrievers have a shallower, wider abdomen."

Temperament:
Interestingly, personality also turned out to be a major predictor of bloat at the breed level.  Glickman explains, "we asked each individual in the survey to rate their dog on a scale of 1 to 10 for things like aggressive to people, aggressive to dogs, submissive to people and dogs, excitability, fearfulness, happiness, trainability, and whether the dogs are easily upset by strangers or new situations.  We took the average score for each breed to get a breed average score for each of these characteristics.  Then, we looked at the relationship between the scores and the risk of bloat for the breed as a whole.  Two clear trends emerged.  First, the more fearful the breed, the higher risk of bloat, and the second, the more happy and easy going the breed, the lower the risk."

According to Glickman, it's not the amount of stress per se in a dog's life that is significant, but the way in which the animal's body reacts to it.  That reaction is mediated by personality.  "This is an important distinction because clearly there is nothing we can do about stress.  What is significant, though, is that a happy individual, whether a person or a dog, is less influenced by stressful situations than a highly anxious, fearful one."

Differing responses to stress might influence the risk of bloat for the following reasons.  "When animals are placed under stress, there are certain stress hormonal and neural responses.  Some of these responses clearly affect gastric motility.  A fearful dog may have a very different response physiologically to stress than a happy, easygoing dog.  We think those physiological responses may contribute to the rotation of the stomach because of the motility.  This is the second or third time we have demonstrated temperament-particularly easygoingness or fearfulness-is related to the risk of bloat,"  Glickman reports.  (Note:  There were significant differences among breeds in the study in terms of how the owners scored them for happiness/fearfulness.  In addition, Glickman reports that even within breeds, there was variance of owner response; the scores represent averages. 

*Based on owner's reports.   These scores represent averages for the purpose of the study.  All dogs of any breed are individuals capable of expressing a variety of temperaments and personalities.

Aging:
Although dogs of all ages were included in the study, in general, Glickman found the incidence of bloat increased with advancing age.  That means that we have to think about how bloat ties into the aging process (i.e. the stretching or lengthening of the stomach ligaments.)  Breed level analysis revealed the incidence of bloat in large breed dogs started to increase dramatically at 3 years of age.  In giant-breed dogs, that increase with age started much sooner - as early as 6 months.  Given that blat is a disease of aging, Glickman says these findings were predictable because giant breed dogs age faster than do large breed dogs and therefore do not live as long.

Genetics:
Given the findings of this and previous studies, Glickman does not believe bloat is genetically based in the sense that one gene is responsible for causing it.   "We're dealing with a complex condition where several genes interact to produce bloat.  For example, things like size, shape and personality have a genetic basis.  Certain inherited characteristics predispose breeds or individuals dogs to bloat."

Individual Dog Analysis:
At the breed level, Glickman compared factors that differed among the 11 breeds in the study.  "In the second part, we looked at individual dogs to see why those dogs were at increased risk compared to other dogs in the study," he says.  A lot more data were collected at the individual dog level because, as mentioned earlier, there was a total of more than 1900 dogs in the study.  87% of their owners completed questionnaires, so detailed information was obtained on more than 1600 dogs.

Risk factors analyzed in the individual dog level portion of the study included characteristics such as gender, neutering/spaying, weight, belching and flatulence, speed of eating and genetics; and environmental factors such as housing, travel, vaccination, restriction of water and exercise around mealtime, use of elevated food bowls, moistening food, giving preventive medications and number of meals fed.  The following outlines some of the results:

Gender:
Individual dog level analysis confirmed there is only a minimal difference in the risk of bloat between males and females.  Males in the study had only a 14% higher incidence than did females.

Neutering:
Likewise, neutering did not emerge as an important factor.

Weight:
Weight, on the other hand, did prove to be significant.  "We have consistently found, and have been able to replicate it in this study, that dogs characterized by their owners as chronically underweight are at higher risk than dogs characterized as average weight or even overweight,"  Glickman notes.   "This is a very important finding now that we've seen it for the third or fourth time.  It suggests that, while bloat occurs acutely in dogs that show no previous indications they will bloat, these dogs may, in fact, have problems with their gastrointestinal tract long before they bloat, which may explain why they're chronically thin.  A lot of factors point to the fact that there may be related, underlying problems within the GI tract that are manifested as doing poorly in terms of weight gain.   Or it may simply be because they're fearful.  It's hard to put weight on fearful dogs."

Diet:
The individual dog analysis also looked at the different types of food fed to the individual dogs in terms of amount, brands, specific ingredients, fat preservatives used, fat sources used, kibble size, etc.  Study participants reported more than 150 types of food being fed.  Due to the magnitude of collecting information on such a large number of foods, the diet analysis is not complete at present but will be forthcoming shortly.

Speed of Eating:
Although specifics about the contents of diets still are being considered, Glickman did find in this study, as he had in previous studies, that the faster the dog ate, the greater risk of bloat.  He believes the increased risk may be related to gulping air while eating, which is one theory as to bloat's cause.  The fact that many dogs that bloat do not do so immediately after eating seemingly contradicts this, however. 

"one of the most confusing things in studying bloat is trying to determines why the stomach fills and distends so rapidly,"  Glickman says.  "We used to think food was the cause.   Now, we know most bloat does not occur immediately after eating.  In another study, we found that 70% of bloat cases occur late at night or early in the morning.   We also know that what's in the stomach is air, which can only come from one place.   It has to be ingested or gulped.  So, the issue becomes what causes some dogs to ingest large amounts of air and others not to.  This suggests there is some underlying problem that does not just occur during the acute episode, but that happens repeatedly and that may be exacerbated by temperament.  That is, dogs that don't cope well gulp air."

Glickman's next study, which he already has begun and is funded by the Collie Club of America, will be a replication of a study done in Europe five years ago.  The European study found that the vast majority of dogs that have repeated episodes of bloat have defects in their swallowing mechanism.   That is, when they swallow food, it doesn't flow as it should from the mouth to the stomach.  In order to get the food to flow, the dogs have to gulp air to force it down.  So far only two dogs have been tested by Glickman.  Both already had an episode of bloat and both had swallowing defects.  For the first time, some clues as to what the primary physical defect may be in terms of allowing this rapid intake of air.   In the future, owner's of dogs at high risk may have a test taken to determine if the dog's swallowing mechanism is defective.  A bowl of barium coated dog food and following the progression of the food through the esophageal tract with a procedure called fluoroscopy.

Gas:
"We also asked owners to characterize their dogs in terms of flatulence and belching to see if they were associated with increased risk of bloat,"   Glickman explains.  "In fact, both were.  In dogs that belch often there was a bout a 60% increased risk of bloat.  In dogs that had flatulence often vs. rarely, there was about a 20 percent increased risk.  Dogs that had abdominal distention after eating regularly had about an 80% increased risk.

Genetics:
In the individual dog analysis, having a first degree relative that bloated turned out to be one of the strongest predictors.  In fact, dogs with such relatives had a 3 and 4 fold increased risk of developing bloat.  A first degree relative was defined as ether a parent, sibling, or offspring, in other words, dogs that shared 50% of the gene pool.

Glickman believe s that grandparents that bloated also indicate risk.  Pedigree analysis is difficult, however, because bloat is a disease of aging that may not manifest until a dog is 7 or 8 years old.  Because of this, dogs have to live almost their whole lives before bloat in the pedigree could be known.  Bu that time, people often have lost track not only of grandparents, but parents and siblings as well.

Management:
In terms of environmental risk factors, which included management, the individual dogs analysis looked at things such as how the animals were housed, if they traveled, the frequency of vaccination, etc.  No one of these appeared to be associated with an altered risk of bloat.  However,r the study did reveal an increased risk of bloat associated with things such as restricting water before and after eating, giving preventative medications, moistening the food and raising the bowl's height.   These findings were of great interest to Glickman because these measures commonly were thought to be preventive.

To further clarify these seemingly contradictory findings, Glickman compared the rate of use of these preventative measures in dogs that had a first degree relative that bloated and in those that did not.  He found that these practices more commonly were used by owners with dogs at high risk. Glickman then further analyzed the data to determine whether these practices are associated with bloat simply because the owners accurately had identified the high risk dogs ahead of time, or it they actually were harmful or had no effect.

Prior to this last step in his analysis, his gut feeling was that all these practices probably would prove to have no effect.   Indeed, his "final analysis shows that this is correct-except for raising the food bowl, which does appear to increase the risk of bloat.  The higher the bowl, the higher the risk."  Glickman says the elevation may be causing an increased incidence of aerophagia (excessive swallowing of air), which could account for the higher risk.

Meal Frequency:
Another commonly recommended measure for preventing bloat is feeding smaller, multiple meals.  This procedure's effectiveness was born out by the individual analysis part of the study.  "In previous studies, we showed that as the number of meals increased per day, the risk of bloat decreases.  We found the same thing in this study.  If you take that to the fullest, the free feeding should be best.   We don't have the data to support that conclusion, however, because we don't have enough data on free feeding in any of these studies to look at it by itself, since free feeding is not commonly done with large/giant breeds."  He believes that the link between feeding multiple meals and a lower incidence of bloat may be related to less distension of the stomach with smaller meals.

Lowering the Risks:
After reviewing the results of Glickman's study, if you believe your dog may be in the high risk category, there are steps you can take to actively reduce the chances of bloat/torsion.  Glickman makes the following preliminary recommendations based on what already is known:

1)  Don't breed a dog if a first degree relative had suffered an episode of bloat.
2)  Consider a prophylactic gastroplexy for dogs that fit the high risk profile.  (Note: It should only be performed on dogs already neutered or will be neutered at the time of gastroplexy.  Breeders who prevent high risk dogs from bloating by opting for this surgery, but then continue to breed the dogs, mask the problem and destroy selection criteria in a breeding context.
3)  Owners who have dogs that eat rapidly should do anything that they can to slow the speed of eating.  The most common and effective strategy was to place a large object that the dog had to eat around in the food bowl.  For example:  A heavy chain.  A heavy link chain forces the dog to eat under and around it unlike a large rock that can be pushed away.
4) Owners of anxious or fearful dogs should consider behavior modification and consult a behaviorist or vet.  In some instances drug therapy is warranted.
5) Feed smaller, multiple meals instead of one large meal per day.
6)  Do NOT elevate food bowl.

Glickman believes the greatest value of this study is that it is prospective.  That means he collected all the information on the animals before the owners ever knew which ones would develop bloat and which would not.   Thus, he and the owners were totally unbiased in the way in which the information was collected.  This is very different from all the other studies that have been done up until now.  They took dogs that had already bloated and then went back and asked owners how they managed the dogs.  Of course, owners of dogs that bloated remembered things much differently than owners of dogs that did not.

The initial study findings will be published in the Journal of American Veterinary Medicine.

Is Your Dog At Risk?

Profiles of Dogs At High Risk:

• Giant Breed

• Large Breed

• Deep and narrow abdomen.

• Fearful or anxious.

• Fast eater.

• History of abdominal distention after eating.

• First degree relative that bloated.

• History of poor body condition.
  
  Profiles of Dogs Least Likely To Bloat:

• Happy temperament

• Normal to overweight
  

Remember the signs of bloat and keep the phone number to your nearest 24 hour veterinary clinic on hand at all times.   Do not take a "let's see how he is in the morning" view of the situation.   Bloat can occur any time - not just after eating - and when it does it is swift.   A quick response is necessary or the dog will most likely die.  Owners should learn form their veterinarians how to pass a stomach tube and insert a trocar.  This is especially important is owners live a long distance from an emergency clinic.

Symptoms of BLOAT may include:

• excessive salivation/drooling
• extreme restlessness/pacing
• unproductive attempts to vomit/defecate
• evidence of abdominal pain (whining and tenderness in the stomach area)
• abdominal distension
• rapid breathing/panting
• cold/pale mouth membranes

With BLOAT, the disease progresses in minutes or, at most, hours. The only treatment is emergency medical attention. In its two advanced forms, the only treatment is surgery.

 

My Bloat Notes

After losing Tag, I had so many questions.  I thought that I knew what bloat was.  I thought that "it would never happen to me".  The following are some of my notes that I have collected while yearning to answer my question:  "Why did it happen to Tag?"  Hopefully, they will help others understand this sudden and sometimes tragic illness and to avoid it or be ready for it.  The notes are in no particular order as I collect bits of information from various sources.

Gastric Dilatation/Volvulus

The physiology of bloat
Torsion or volvulus are terms to describe the twisting of the stomach after gastric distention occurs. The different terms are used to define the twisting whether it occurs on the longitudinal axis (torsion) or the mesenteric axis (volvulus). Most people use the terms interchangeably, and the type of twist has no bearing on the prognosis or treatment. When torsion occurs, the esophagus is closed off, limiting the dog's ability to relieve distention by vomiting or belching. Often the spleen becomes entrapped as well, and its blood supply is cut off.

Now a complex chain of physiologic events begins. The blood return to the heart decreases, cardiac output decreases, and cardiac arrythmias may follow. Toxins build up in the dying stomach lining. The liver, pancreas, and upper small bowel may also be compromised. Shock from low blood pressure and endotoxins rapidly develops. Sometimes the stomach ruptures, leading to peritonitis.

Abdominal distention, salivating, and retching are the hallmark signs of GDV. Other signs may include restlessness, depression, lethargy, anorexia, weakness, or a rapid heart rate.

GDV is a true emergency. If you know or even suspect your dog has bloat, immediately call your veterinarian or emergency service. Do not attempt home treatment.

Do take the time to call ahead.; while you are transporting the dog, the hospital staff can prepare for your arrival. Do not insist on accompanying your dog to the treatment area. Well-meaning owners are an impediment to efficient care. Someone will be out to answer your questions as soon as possible, but for now, have faith in you veterinarian and wait.

Initial diagnosis may include x-rays, an ECG, and blood tests, but treatment will probably be started before the test results are in.

The first step is to treat shock with IV fluids and steroids. Antibiotics and anti-arrythmics may also be started now. Then the veterinarian will attempt to decompress the stomach by passing a stomach tube. If this is successful, a gastric levage may be instituted to wash out accumulated food, gastric juices, or other stomach contents. In some cases, decompression is accomplished by placing large-bore needles or a trochar through the skin and muscle and directly into the stomach.

In some cases, this medical therapy is sufficient. However, in many cases, surgery is required to save the dog. Once the dog's condition is stabilized, surgery to correct the stomach twist, remove any unhealthy tissue, and anchor the stomach in place is performed. The gastroplexy, or anchoring surgery, is an important procedure to prevent recurrence, and many variations exist. Your veterinarian will do the procedure he feels comfortable with and which has the best success rate

Recovery is prolonged, sometimes requiring hospital stays of a week or more. Post-operative care depends on the severity of the disease and the treatment methods employed and may include a special diet, drugs to promote gastric emptying, and routine wound management. Costs may run $500-1000 or more in complicated cases.

--Kathleen R. Hutton, DVM

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The exact cause of GDV has not been determined with any certainty :-

GDV is widely believed to be caused by excessive swallowing of air while eating, gastrointestinal secretions, and gas from food fermenting in the stomach. Some veterinarians feel that susceptible dogs are born with their stomachs slightly out of position allowing it to twist more easily. Dogs that eat rapidly and then exercise heavily may also be at increased risk. Apparently the heavy, food-filled stomach acts like a pendulum, swinging back and forth until it twists on itself. Composition of the diet does not generally seem to be a cause, nor does it seem to matter whether the dog eats canned or dry food. In older dogs tumors of the spleen or stomach may cause twisting and subsequent blockage. Eating indigestible foreign material may also cause bloating.

Whatever the cause, affected dogs all show similar signs :-

Symptoms typical of GDV are anxiety, evidence of abdominal fullness after meals, heavy salivating, whining, pacing, getting up and lying down, stretching, looking at abdomen, unproductive attempts to vomit, labored breathing, disinterest in food, and stilted gait. More severe symptoms follow, such as dark red, blue, grey or white gums, a rapid heartbeat and a weak pulse.

Initially affected dogs are anxious, restless, not interested in food or water, vomit once or twice then follow this with retching and gagging motions which are usually unproductive. There are no abnormal bowel movements. After 30-60 minutes the dog begins to appear swollen in its midsection due to accumulation of gas in the stomach. Dogs begin to pant heavily and breathing becomes rapid and shallow. In most cases of GDV, the stomach undergoes a "volvulus" or twist. This closes both the esophagus (inlet) and pylorus (outlet) preventing the dog from relieving the gas pressure. The condition is rapidly fatal in dogs, causing shock, coma, and death within 6-12 hours. Diagnosis is relatively easy based on breed, history, and clinical signs though your vet may take x-rays of the abdomen to confirm the diagnosis.

If you suspect your dog may be showing signs call your vet AT ONCE for instructions

Treatment is aimed at reducing the gas pressure and returning the stomach to its normal position. Your vet will remove pressure via a stomach tube or trocar tube through the body wall, then prepare the dog for exploratory surgery to find the exact problem and correct it. The stomach can be tacked down (gastropexy) to help prevent recurrence, but these stitches may break down over time. Occasionally bloat can be treated without surgery by washing out the stomach with a special stomach tube.

Death loss due to GDV is very high (sadly, approximately half of the cases do not survive). Often owners delay in presenting the dog for emergency care because they are unaware of the seriousness of the condition. Also, once the stomach has undergone volvulus, many metabolic poisons build up resulting in damage to the stomach wall, liver, spleen, and heart muscle. Frequently these poisons will cause the heart to stop during surgery or they may circulate for several days post-operatively and continue to pose a threat. Post-operative infection can also cause problems.

Preventive strategy :-

Newer anesthesia methods have helped us treat this condition more successfully, but we are still unable to offer much in the way of preventive medicine. No medication or screen tests are available. The best advice at the present time is to

feed our large breed dogs small amounts more frequently,
avoid vigorous exercise, excitement and stress one hour before and two hours after feeding and avoid lots of twisting or rolling play particularly shortly after feeding (walking is okay because it helps stimulate normal gastrointestinal function),
ensure water is always available but limit the amount immediately after feeding,
watch for any actions or behavior that may signal abdominal discomfort (abdominal fullness, pacing, salivating, whining, getting up and lying down, stretching, looking at abdomen, anxiety and unsuccessful attempts to vomit, etc.)


This information is based on articles written by the veterinarians Siefried Zahn and Robert D. Hott.


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Gastric dilatation-volvulus (GDV) is a very serious condition that occurs in susceptible dogs when the stomach becomes distended with air, and then while dilated, twists on itself. This interferes with the blood supply to the stomach and other digestive organs, and blocks the passage of food, leading to worse bloat. The distended stomach impedes the normal return of blood to the heart, causing drastically reduced cardiac output and a decrease in blood pressure. Blood/oxygen-deprived tissues start to die, releasing toxins into the blood stream which among other adverse effects, cause serious disturbances in heart rhythms (cardiac arrhythmias) - a common cause of death in these dogs.

Simple gastric dilatation does not produce volvulus (twisting) in an otherwise normal stomach. Dogs most susceptible to GDV are the large, deep-chested breeds, in whom the stomach appears to be more mobile within the abdomen. Other factors that increase the risk for GDV include overeating, rapid eating, single daily feeding, high water consumption, stress, and exercise after eating.

How is gastric dilatation-volvulus inherited?

It appears that conformation and size are what predispose a particular breed to this disorder, such that breeds with a deeper and narrower chest are most susceptible. Within such a breed, dogs with a higher thoracic depth/width ratio (ie. the deepest, narrowest chests) are the most vulnerable to GDV.

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What does gastric dilatation-volvulus mean to your dog & you?

GDV is one of those thankfully rare conditions in which your dog can go from being healthy to critically ill over the course of a few hours. Even with appropriate veterinary care, approximately one third of dogs with this condition will die.

Initiation of GDV occurs when a susceptible dog swallows air while gulping food or water, possibly in association with exercise. You will first notice that your dog is uncomfortable - pacing, restless - and appears bloated. There may be unproductive retching/vomiting. Discomfort progresses to depression and if the dog does not receive treatment, to coma and death. This can all happen within 6 hours or less.

How is gastric dilatation-volvulus treated?

The two urgent priorities are to remove the gas from the stomach (via stomach tube) and start treatment for shock. Your veterinarian will then perform surgery to reposition the stomach, assess the extent of damage, and do a gastropexy to anchor the stomach to the abdominal wall and prevent recurrence of GDV.

Intensive care is required in the immediate post-operative period when dogs may face a number of life-threatening problems including shock, electrolyte imbalance, cardiac arrhythmias, and wide-spread infection (septicemia).

Prevention: There are some simple things you can do to reduce the chance of bloat, if you have a dog of a susceptible breed. Basically, you want to avoid your dog consuming a large amount of food or water all at once, especially not at the same time as vigorous exercise. Rather than feeding once a day or leaving food always available, feed in divided portions. Have fresh clean water always accessible but take it up at mealtimes (so your dog doesn't gulp it with food). Avoid exercising your dog before and after meal times.

Breeding advice

It may be possible to reduce the incidence of GDV in susceptible breeds by selectively breeding dogs with lower thoracic depth/width ratios.

Glickman, L.T., Glickman, N.W., Perez, C.M., et. al. 1994. Analysis of risk factors of gastric dilitation and dilitation-volvulus in dogs. J. Am. Vet. Med. Assoc. vol 24: 1465-1471.

Schaible, R.H., Ziech, J., Glickman, N.W., et. al. 1997. Predisposition to gastric dilitation volvulus in relation to genetics of thoracic conformation in Irish setters. J. Am. Animal Hosp. Assc. vol 33:379-383.

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Immediate inspection of the stomach permits evaluation of the extent of injury and the possible need for resection. Gastric wall necrosis, rupture, peritonitis, and sepsis are the most common causes of death in these dogs. Delayed exploratory laparotomy may also predispose to cardiac arrhythmias, which develop in ~40-50% of dogs with GDV.

The goals of surgical management are to assess the integrity of the stomach and spleen, to reposition the stomach to its normal location, and to fix the stomach to the abdominal body wall in an attempt to decrease the likelihood of recurrence of volvulus. Several surgical techniques have been used to prevent recurrence of volvulus, and recurrence rates are similar (5-11%) for all. Techniques include simple incisional gastropexy, tube gastrotomy, and circumcostal gastropexy. The value of pyloromyotomy and pyloroplasty in an effort to promote gastric emptying has not been substantiated. Medical management alone results in a 75% recurrence rate within a 12-mo period.



Most dogs that die of GDV (70%) do so within the first 4 days after surgery. Many dogs develop ventricular arrhythmias, the cause of which may include myocardial ischemia, autonomic imbalance, acid-base and electrolyte imbalance, catecholamine release, and the release of myocardial depressant factor.

--Merck Vet Manual


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Gastric dilatation or distension of the stomach occurs due to an excessive amount of air or gas accumulating in the stomach. Basically, the stomach begins to swell up, very much like a balloon that is slowly pumped up with air. As the stomach gets bigger and bigger, it gradually starts to rotate. As it does so, it pinches off the esophagus (the tube that runs from the mouth to the stomach), and the duodenum (the tube running from the stomach to the intestine). At this point, there is no place for all the air in the stomach to go and, just like a balloon, it may get so big that it bursts. Blood vessels become twisted and some organs like the spleen are deprived of blood. This leads to the onset of shock and if untreated, the dog will die. A question often asked is why a normal, strong, healthy dog would suddenly develop GDV with very few, if any warning signs? There are a few factors involved and often more than one of these needs to be present for the syndrome to develop.

The first to consider is diet. It has been suggested that feeding one large meal a day may encourage the stomach to enlarge, and that larger capacity stomachs are more inclined to dilate. A second factor is the accumulation of gas in the stomach. This might be caused by aerophagia (the swallowing or gulping of air), or gas may form during bacterial fermentation of food while digestion is taking place. Thirdly, moderate to heavy exercise shortly after a meal may contribute to rotation of an enlarged stomach filled with food and gas.

Other factors known to play a role in GDV include stretched or slack stomach ligaments and a hereditary predisposition. Also lying down on the left side may worsen the condition because it is much more difficult for a dog to bring up gas while in this position, than when standing upright.

Preventing GDV in those individuals who are strongly predisposed to the condition may be difficult, but there are a few suggested methods to decrease the incidence. Feeding two or even three smaller meals per day rather than one large one is important. Ideally the food should be moistened and softened by the addition of water ten to fifteen minutes prior to feeding. Consider also restricting your pets water intake prior to, and for an hour after meals. Avoid any exercise just before feeding and for at least two hours afterwards. Other suggestions include the following: don't allow your pet to drink large volumes of water at one time, no "roughhousing" after meals, no jumping with a full stomach.

While there is no current medical method of treating GDV without involving surgery, it is important to understand what this condition is and to recognize the early signs in its development. By being aware, your pet can receive the emergency treatment it needs and go on to live a normal, happy life.

Dr. Milwicki - www.thepoop.com

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Bloat/Torsion - Tips From Dr. Eve Knowles

Signs: abdominal distension, panting, attempts to vomit but can't, pale or brick red gums, painful.

Treatment: surgical only. Get to vet immediately, after 2 hours the dog can't be saved.

Prevention: don't exercise the dog for 1/2 hour after eating. Don't give large meals or large amounts of water. Don't allow dog gas-producing food such as old meats, trash, dead animals, a lot of vegetables or muddy, stagnant water.

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  Acupressure Point Can Combat Bloat

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  Phayzme-Simethicone:   Keep It On Hand In Case Of Bloat