Features June 2016 Issue

Bloating in Dogs Treatable with Gastropexy

If you have a bloat-prone breed, consider a gastropexy, a surgical procedure that can prevent stomach torsion.

It was a beautiful fall day, and I was at a dog show. In the ring was a gorgeous veteran Greyhound – strutting his stuff in one of those peacock moments that transport gray-faced show dogs back to their youthful selves, with nothing but time and promise before them. A short time later, I heard a commotion from the parking area, and then the awful news: The handsome old dog was bloating.

Thankfully, this was a group of highly experienced dog people, and the dog’s handler immediately ran to her van to procure the bloat kit that she always traveled with. As several people helped hold the dog, she inserted a tube down his esophagus to help expel the trapped gas that was causing his ribs to expand like barrel hoops, taped the tube in place, and sped off to the nearest emergency vet. I heard through the grapevine later that the dog had, mercifully, survived.

old great dane

There’s good reason why veterinarians call bloat “the mother of all emergencies.” It can come on suddenly and, if left untreated for only a handful of hours, can spell a death sentence for a dog.

Symptoms of bloat, which is incredibly painful for the dog, include pacing and restlessness; a distended abdomen; turning to look at or bite at the flank area; rapid, shallow breathing; retching without actually vomiting up any food, and excessive drooling.

Bloat is a two-part disorder, telegraphed by its formal name: gastric dilatation and volvulus. The first part, gastric dilatation, refers to an expansion of the stomach due to the presence of gas and/or food. The second part, volvulus, is the fatal blow: The distended stomach begins to twist, cutting off the blood supply and causing its tissue to die off. As if that wasn’t trouble enough, the enlarged stomach may press on the blood vessels that transport blood back to the heart, slowing circulation, creating cardiac arrhythmia, and sending the dog into shock.

Once the stomach has torsioned, emergency surgery is required to restore it to its normal position, and to evaluate whether so much tissue has died off that the dog has any hope of surviving.

This was precisely the scenario that the quick-thinking Greyhound handler had sought to avoid: By inserting the bloat tube down the esophagus and into the stomach, she not only created an avenue of escape for the trapped stomach gases, but also ensured that the stomach could not twist while the tube was inserted. As you can imagine, this is not something that most dogs entertain willingly, and, indeed, on the ride to the veterinarian, the dog struggled and the tube was dislodged. Still, it bought enough time for his survival.

Many owners, however, don’t have the inclination or the fortitude to stick a tube down their dog’s throat, even if he is bloating. And for those who have breeds that are at a higher risk for bloat, the constant stress of worrying “Will she bloat?” after each meal is enough to prompt them to consider gastropexy, a preventive surgical procedure where the stomach is sutured to the body wall. While gastropexy won’t prevent a dog from dilating, it does greatly reduce the likelihood that the stomach will flip – which is the life-threatening “volvulus” part of gastric dilatation and volvulus.

Dog Bloat Risk Factors

Owners who are determined to prevent bloat nonetheless want to understand its causes before submitting their dogs to an elective surgery like gastropexy. The problem is, veterinary science is still unclear about precisely what triggers an episode, and instead can only offer a long and varied list of risk factors.

The mother of all bloat studies was done two decades ago by Dr. Lawrence T. Glickman and his colleagues at the Purdue University Research Group, and is still being discussed and quoted today. The 1996 study and its follow-up research found that many food-management practices that were initially believed to help reduce the risk of bloat – like feeding from a raised food bowl, moistening dry food before serving, and restricting water access before and after meals – actually increased the odds of a dog bloating.

Other risk factors include eating only one meal a day; having a close family member with a history of bloat; having a nervous or aggressive temperament; eating quickly; being thin or underweight; eating a dry-food diet with animal fat listed in the first four ingredients, and/or eating a moistened dog food, particularly with citric acid as a preservative.

Not surprisingly, certain breeds were found to be at high risk for bloat, particularly large or giant breeds. Topping the list were Great Danes, followed by St. Bernards and Weimaraners. The study found that breeds with deep and narrow chests – like the Greyhound that started this story – are also at higher risk for bloating, as are males and older dogs.

Also according to the Purdue study, the risk of bloat was more than twice as high in dogs seven to 10 years old compared to dogs two to four years old, and more than three times as high in dogs age 10 and older.

Reducing the Risk of Bloat

While not a guarantee that your dog will avoid experiencing an episode of bloat, these steps can help lower the risk.

1. Feed several smaller meals per day.

Feeding a large, once-a-day meal can extend the stomach and stretch the hepatogastric ligament, which keeps the stomach positioned in the abdominal cavity. Dogs that have bloated have been found to have longer ligaments, perhaps due to overstretching.

2. Slow down fast eaters.

Some theories suggest that air gulping can trigger bloat. To keep your dog from gobbling down his meals, invest in a slow-feeder bowl, which has compartments or grooves to require dogs to pace themselves; there are several brands available. For a low-tech version, try placing a large rock in the middle of your dog’s food bowl, which will force him to eat around it. (Of course, make sure the rock is large enough so it can’t be swallowed.)

3. If you feed kibble, add some variety.

Dogs that are fed canned food or table scraps have a lower incidence of bloat. If you feed kibble, try to avoid food with smaller-sized pieces, and opt for brands that have larger-sized pieces. While some raw feeders maintain that feeding a raw diet prevents bloat, there are no studies to support this, and raw-fed dogs are not immune to bloating.

4. Don’t go for lean and mean.

Studies show that thinner dogs are at greater risk for bloat; in fatter dogs, the extra fat takes up space in the abdomen and doesn’t give the stomach much room to move. While no one is advocating that you make your dog obese, keeping a bloat-prone dog on the slightly chunkier side might have some merit.

5. Reduce your dog’s stress.

Easier said than done, of course. But if at all possible, opt for a house sitter instead of taking your dog to a kennel. If you have multiple dogs, feed your bloat-prone dog separately, to avoid the stress (and resultant gulping) from worrying that his meal might be snagged by a housemate.

6. Don’t eat and run.

Veterinary experts recommend that you avoid giving your dog hard exercise one hour before and two hours after he eats. Many give the green light to walking, however, as it does not jostle the full stomach and in fact can help stimulate digestion.

Assembling a Bloat Kit

Because bloat strikes when you least expect it – often at night, when most veterinary practices are closed, and the nearest emergency vet might be a distance away – a bloat kit can be a literal lifesaver.

Some dog-care sites sell pre-assembled bloat kits. (One option is available from A Better Way Pet Care.) Most include clear vinyl tubing (the kind sold by aquarium stores); a wooden mouth block, to keep the mouth open while the tube is being inserted (a piece of PVC pipe can work in a pinch), and water-soluble lubricant.

Ask your vet to show you how to measure the tubing so that it is the correct length, how to insert it, and how to tell if you are passing the tube down the trachea rather than the esophagus.

Remember that a gastric tube is not a treatment for bloat; it is a first-aid measure. If you are unsure of how to use the kit, or if you are alone and don’t have someone to transport you while you work on the dog, make getting to the vet your first priority.

dog bloat emergency kit

Deciding on Surgery

If your dog bloats and her stomach has torsioned, surgery is the only recourse if you want her to survive. And if you get to the vet in time, the odds are with you: In a retrospective study of 166 cases between 1992 and 2003, researchers found that short-term mortality resulting from bloat surgery was a relatively low 16.2 percent.

Risk factors for a fatal outcome included having clinical signs more than six hours before surgery (i.e., the longer you wait, the worse your dog’s prognosis), hypotension during any time of the hospitalization, peritonitis, sepsis, and administration of blood or plasma transfusions. Dogs whose tissue damage was so advanced that they required part of their stomach or their spleen removed (partial gastrectomy or spleenectomy, respectively) also had worse prognoses.

But the decisions regarding a gastropexy – essentially, “tacking” the stomach so it cannot torsion – are not as clear-cut. If your dog has never bloated, you’ll need to weigh the risk factors: Is your dog’s breed prone to bloat? (Great Danes, for example, have a whopping 42.4 percent chance of bloating in their lifetime.) Do you know of any siblings, parents, or other close relatives who have bloated? Is your dog nervous, aggressive, or a super-fast eater?

And, most important, has your dog bloated before? Studies indicate that such dogs have a recurrence rate of more than 70 percent, and mortality rates of 80 percent.

Types of Tacks

There are several kinds of gastropexy surgery. Securing the bottom of the stomach to the right side of the body so it cannot rotate during an episode of bloat is the common goal of each type of surgery, but slightly different methods are used to accomplish this. There are no studies that compare the efficacy of the various types of gastropexy, but the general consensus is that there is not a huge difference between them. Most veterinarians will choose one over the others based on their own preference and amount of experience.

Incisional gastropexy is a straightforward procedure in which the bottom of the stomach (the antrum) is sutured to the body wall. It relies on only a few sutures until an adhesion forms.

Belt-loop gastropexy involves weaving a stomach flap through the abdominal wall. Though a relatively quick procedure, it requires more skill than an incisional gastropexy.

In a circumcostal gastropexy, a flap from the stomach is wrapped around the last rib on the right side and then secured to the stomach wall. Proponents of this approach note that the rib is a stronger and more secure anchor for the stomach. This type of gastropexy requires more time and skill to perform; risks include potential rib fracture and pneumothorax, in which air leaks into the space between the lung and chest wall.

Gastropexy is now being performed with minimally invasive approaches such as laparoscopy and endoscopy, which shorten surgery and anesthesia times, as well as the time needed for recovery. Though both use remote cameras to visualize the surgery area, the laparoscopic-assisted approach requires an extra incision through the navel, which allows the surgeon to directly visualize the position of the stomach and make any modifications necessary.

A 1996 study of eight male dogs compared those that had laparoscopic gastropexy with those that had belt-loop gastropexy, and concluded that the laparoscopic approach should be considered as a minimally invasive alternative to traditional open-surgery gastropexy.

Complications from gastropexy are relatively minor, especially for young, healthy dogs who are undergoing the surgery electively, before any incidence of bloat. As always, be sure that your dog has a complete pre-surgical work-up to ensure there are no chronic or underlying conditions that might compromise her ability to successful recover from surgery. And again, while gastropexy isn’t foolproof, Dr. Glickman has been quoted as saying that the risk of bloat and torsion after the procedure is less than five percent – not bad odds at all.

If you do elect to have a gastropexy performed on your dog, many veterinarians do the procedure at the same time as spaying or neutering. That way, the dog doesn’t have to go under anesthesia again, or, in the case of conventional surgery, be “opened up” another time.

In the end, the question of whether or not to have a gastropexy done is arguably tougher for those whose dogs who are not at very high risk: The owner of a Great Dane has a greater incentive for getting a gastropexy than, say, the owner of a Shih Tzu, whose bloat rates are not as comparably high.

A 2003 study that looked at the benefits of prophylactic gastropexy for at-risk dogs used a financial metric to assess the benefits of surgery: Working under the assumption that elective gastropexy surgeries cost about $400 and emergency bloat surgeries cost at least $1,500 – or as much as four times that – the study concluded that the procedure was cost effective when the lifetime risk of bloat with torsion was greater than or equal to 34 percent.

As with any complex decision, assess your dog’s risk factors, as well as your individual circumstances, and then make the choice that seems right for the both of you.

Denise Flaim raises 12-year-old triplets and Rhodesian Ridgebacks, on Long Island, NY.

Comments (7)

Sitting here with my Golden Doodle, Mo, as he recovers from colon bloat / twisting. We're lucky. Mo is alive and recovering slowly but surely. Mo had gastroplexy when he was neutered so bloat did not cross my mind when he showed us that he was clearly in distress in his gut. I thought it was effectively like colic so took him for a slow walk. During that walk he tried to lay down. I called the vet and they told me to drop everything and rush in. The docs had to untack the stomach and pull out the organs in the gut to assess the colon and check for dead tissue. The colon had untwisted itself, which may be related to the muscle relaxation from sedation. And, we caught it quickly enough that a colon resection was not needed. That said, he has a foot long incision, dozens of staples, a newly tacked colon and a retacked stomach - and had to have his spleen removed (it didn't fit when everything got "put back in"). Colonic torsion is rare but not unheard of in cases where gastroplexy had been done already. After reading up, I'm looking into diet modification and relaxation massage (T Touch seems to be doing good things for him during recuperation) to help keep this at bay. I thought gastroplexy would be enough and now I know better.

Posted by: Sarah/Mo | January 26, 2017 12:00 PM    Report this comment

(continued from 1st post)
just prior to her first bloat Alibi had developed this insatiable thirst, she guzzles water but isn't retaining it(many tests have yet to find a reason for this other than high calcium levels). i'm convinced the way she drinks water and swallows air while doing so is the absolute cause of her bloat. in the morning i give her approx 1.5 cups of Pedialyte along with an antacid then force her to wait at least a half hour for food(she's a drama queen and gets very upset when she has to wait for things, some mornings i get lucky and she goes back to bed). she's a sneak so all toilets now have to have child safety locks on them, she's even tried eating water bottles. i give her 1.5 cups of water at a time several times throughout the day and burp her afterwards. i haven't tried any of the bowls designed for fast drinkers, i assume they'd work as poorly for her as the slow feeder bowls though i am thinking about trying the type that have a float in the dish the dog has to push down to access the water.

after reading this i definitely want to get a bloat kit and have the vet show me how to use it. she's gotten the tube down her throat one time at the vet's office and did fine for them although the vet said she didn't get much out.

Posted by: missbreebree03 | January 2, 2017 11:14 AM    Report this comment

my 7-year-old Boxer has become a recurrent bloater(nearly daily for the past month) after bloating for the first time. luckily she's never twisted but it's always a fear. i keep Gas-x(simethicone) on hand and give 2 120mg capsules to her at the first sign she's bloating(she starts smacking her lips/licking the air), i also give her a 40mg tablet if i think she's done something(guzzling water seems to be a trigger) to put her at risk of bloating; some days we get lucky and prevent it from happening. her bloat episodes have been lasting anywhere from 2-5hrs, i usually give an additional gas-x every hour. my doctor has also prescribed metoclopramide we tried using that as a preventive, a tablet 2x a day at meal time; didn't seem to help so now i only give it when she is bloating 1 to 3 tablets dependant on how long the bloat episode lasts. i also have a prescription for cerenia, i try to avoid giving that one due to how costly the pills are and the fact it's not recommended for long-term use. still it is very effective at settling her when she's dry heaving.

as far as feeding, we tried the rice and chicken bland diet just after her first bloat and it really just seemed to make things worse. eating the rice was a pain for her poor flat-face to manage, i felt like she was swallowing more air trying to lap it up and nothing i mixed with the rice seemed to help. physically she was losing weight fast and seemed stressed and hungry all the time; i made the decision that if she was gonna die from this she'd do it with a full belly. so i kept her normal twice a day feeding schedule but split those portions in half(in the AM she gets a half serving, i burp her then give the next half; repeat in the evening). i soak her dry kibble with a little water then for her first half portion i add a tablespoon of yogurt, the second gets 1.5 tablespoons of canned pumpkin to keep her bowels moving. I AGREE WITH THE TIP ABOUT LARGER KIBBLE. i haven't found a brand i like yet with larger pieces unfortunately(i feed Taste of the Wild). i've been hand feeding her on days i have the time to, the pumpkin especially helps bind together the kibble but it's still a mess and takes forever. it definitely helps though. i just bought a new food processor so i think i'm going to try grinding up the kibble and pumpkin so i can make little food balls and hand feed that way. i'll add an update as to how that works out for us. also, i've tried every slow feeder bowl, toy, etc out there; all she does is eat faster/more frantic like. she's a bit of a jerk.

Posted by: missbreebree03 | January 2, 2017 11:12 AM    Report this comment

I wish i was aware of this horroble condition 12 years ago, when my precious 3 year old GOLDEN RETREIEVER(arent on the list?) Bloated and died. I called my vet several times that day because her behavior was, as u describe. He said sounded like NOTHING And i was a hypercondriac. I rushed her in anyway. He still couldnt diagnose her,so he asked my permission to autospsy. She did not deserve to suffer that way,. I continue to blame myself because i didnt act fast enuff wen my intuition was telling me too.

Posted by: Preciousangels | October 14, 2016 1:38 PM    Report this comment

This last year I opted for the gastropexy when I had my mastiff neutered at 2 and a half. I know it's no guarantee, but felt a bit more comfortable that if he should bloat, it would take the most dangerous parts off the table and give me more time to get him to ER(in case I didn't pick up on the symptoms as quickly as I should). It felt like some peace of mind. About 8 months later, he ended up in the ER and underwent surgery for an intestinal blockage(ham bone, raw,packed for dogs and sold at local dog supply-another lesson learned!). Thankfully, it was a success-but when the surgeon came out to discuss the surgery-he also told me that his previous gastropexy had failed! So much for peace of mind! Didn't even know that was a possibility! This is in no means a commentary on the gastropexy. As long as I have my big boys I will get this surgery-any chance for help is worth it -this is one condition that scares me to death! My point is more an observation(now that I'm aware this can happen)-how can we know and trust this procedure? If my boy hadn't had this horrible blockage-I'd have never known it was even possible. It's not like there's a way to see in side them to double check the vet's work. I do feel confident this time worked-mainly because of the experience of this Dr. Who was an actual surgeon, also, as only a surgeon can, in his confidence he "assured me this time would NOT fail"!

Posted by: Raji | June 9, 2016 10:46 PM    Report this comment

I opted for an elective gastropexy for my Labrador retriever at the same time as we did her spay. Labs don't make the list of "most likely to bloat", but they are very high on the scale. Many, many labs I know have bloated and it was a constant worry with my last dog. When we got this puppy, I decided to go for it and am very happy with my decision. I would suggest that those with deep chested large dogs consider it. Talk to your veterinarian. I am certain they will help you decide if an elective gastropexy is right for your dog!

Posted by: dalewoman | June 2, 2016 1:50 PM    Report this comment

Thanks so much for the helpful BLOAT info, I am so afraid of it....We feed our Akita's 2 times a day, and I don't overfeed them......

Posted by: tanya/Akitalover | May 19, 2016 11:42 AM    Report this comment

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