Written by Dr. Charley Gray, Edited by Jenny Ryoo

What is Acid Reflux (Gastroesophageal Reflux)

Acid reflux describes the reverse-movement of acidic stomach contents back into the esophagus (the tube that goes from your mouth to your stomach). If it happens regularly or repeatedly it can cause inflammation of the esophagus resulting in signs like drooling, repeated swallowing, pain, lack of appetite, extending head and neck. 

‘Acid Reflux’ has become a bit of a ‘buzz phrase’ in recent years with many owners feeling that their dog shows all the right signs. But did you know – there but there are lots of other causes of these same symptoms? 

Does your dog really have ‘Acid Reflux’?

What vets are referring to when we talk about “Acid Reflux” is actually gastroesophageal reflux disease, or GORD. It’s important that we don’t lump all dogs with regurgitation, swallowing, or drooling into this category. In one study in 82 dogs that were showing signs commonly associated with GORD (swallowing, pain, drooling), 62 did not actually have primary GORD. That’s about three quarters!

True acid reflux tends to be rare in dogs (rarer than lots of people think), and is generally associated with anesthesia, drugs that affect the esophageal muscles, or is the result of acute or chronic vomiting. Most dogs with the clinical signs we associate with “acid reflux” actually have underlying issues. 

Bulldogs/other brachycephalic breeds for example are prone to hiatal hernias (the stomach pokes through the diaphragm a bit) which can cause acid reflux as a symptom. For these breeds, the narrow upper airways, which predispose them to hiatal hernias in the first place, can also result in excessive air swallowing. (Ever watched a bulldog on a hot day? Pant pant pant swallow lick. Pant pant… etc). This causes very similar signs of stomach discomfort, retching and regurgitation – but in many cases is caused by their narrow airways, not GORD. In cases like this, it is important that we don’t just call these dogs “acid reflux” dogs since labelling dogs this way misses a really rather more important underlying issue. 

So if your pet has pain, nausea and vomiting, it is important not to assume it is ‘just acid reflux’.

Burping or Vomiting?

Often the burping-swallowing action is linked to acid reflux by pet parents – but it’s important not to make assumptions. In my experience this burping-vomiting action can also often be associated with other causes of nausea – like pancreatitis or IBD for example. These dogs sometimes are regurgitating (which is similar to vomiting – but with less ‘effort’) because they feel nauseous, not because they have primary GORD.

Similar Symptoms – Bilious Vomiting Syndrome aka “Hunger Pukes”

Hunger pukes is vomiting caused by excess stomach acid due to inflammation in the stomach due to bile. This often happens in anticipation of food, when the stomach is empty, or if digestion rates are very fast (so that the stomach is emptying too quickly). This can happen in raw fed dogs because many raw diets are very low on fiber and thus have faster digestion rates than previous commercial diets with moderate or high fiber.

Whilst bilious vomiting syndrome may cause esophageal inflammation (just like GORD dies), it isn’t the same condition. 

The main symptom of bilious vomiting syndrome is vomiting between meals, especially at night or in the early morning.

Does Your Dog Have Acid Reflux?

Symptoms such as nausea, vomiting, burping or swallowing are seen by owners as acid reflux, but true acid reflux is not very common in dogs. The same symptoms can also be related to bilious vomiting syndrome (aka hunger pukes), or to a more significant illness, such as IBD or pancreatitis, which can manifest as nausea and vomiting too.

If you suspect your dog has acid reflux, 

1. Check the symptoms. Are they actually hunger pukes? Is your pet simply vomiting frequently? If you aren’t sure, sometimes a vet can help you if you video what is going on! (yes really… I know it’s gross…)
2. Go to your vet. Especially if your pet has frequent vomiting. Your vet knows more than Google (honest!) and can help you to find out if there is an underlying issue. Once other issues are ruled out, they can also assist with providing medication to help protect the esophagus while it heals. For those more holistically inclined, there are sometimes alternative options – but a herbal trained vet is a good option here (far better than Dr Facebook… says me… a Dr…. on Facebook….but you know what I mean… 🙂 )

Nutritional Management of Acid Reflux

Recommended reading: Small Animal Clinical Nutrition Chapter 50

1. Low fat (less than 15% DMB)

If your dog has acid reflux (having ruled out other conditions and having worked with your vet to diagnose as acid reflux), work with a moderate fat, calorically dense food. Fat “delays gastric emptying and reduces lower esophageal sphincter pressure, which promotes reflux of food and gastric secretions into the esophagus.” (SACN Ch 50)

2. Increase zinc (aim for 3x RA)

There are some studies showing zinc increase may increase stomach pH (in some cases as effectively as medications, though that is debated). Read more about zinc and gastrointestinal disease here.

3. Try novel ingredients (if there is a chance of IBD)

If there is a chance that the acid reflux itself is a symptom of IBD (your vet can help you decide if this is the case), work with novel ingredients. See Savannah’s Elimination Diet guide here if you go this route.

Nutritional Management of Hunger Pukes

Recommended reading: Small Animal Clinical Nutrition Chapter 54

1. Increase fiber and carbohydrate content (no more than 5% DMB for fiber)

Many raw fed dogs have little to no fiber in their diets. Fiber does slow gastric transit, leading to a sensation of being “full” for longer. However, fiber should not be increased more than 5% DMB in order to reduce slow gastric emptying rates.

2. Feed frequently, especially late at night

For dogs who frequently get hunger pukes, the solution can be as simple as feeding a late night snack before bed and feeding more frequently throughout the day.

More Information on Pancreatic Disorders and IBD

Check out The Raw Vet’s Veterinary Seminars here for more information on mechanism of disease, medication and nutritional management.