Those who have heard about Gastric Dilatation Volvulus (also referred to as GDV, Bloat, or Gastric Torsion) will be aware of just how serious this medical condition is. Owners and vets alike live in fear of the dreaded GDV. It is well known that larger breeds and those with deep chests are most prone to developing the condition, so owners of these dogs should pay particular attention to this article, as it may just save a life.
The symptoms of a GDV come on very quickly, meaning owners need to be paying close attention at all times. Affected dogs can go from being normal to passing away within a few short hours if their symptoms are not picked up on, and the animal is not brought to the vet. As both the diagnosis and treatment of GDV are relatively straight-forward, most vets will be able to tell what is going on very quickly and start the treatment without delay, improving an animal’s prognosis.
What Is Gastric Dilatation Volvulus?
‘Gastric’ refers to the stomach, while ‘Dilatation’ refers to the stomach’s enlargement with contents such as food, liquid, and gas. In some dogs, their stomach will dilate, and they will be bloated, but the condition will not progress further. However, for others, the stomach will twist over on itself, which is called a ‘Volvulus.’ Once the stomach twists, we are working against a ticking time bomb.
There is nowhere for the contents to go as both exit routes (through the mouth and into the gut) are blocked off. The stomach continues to enlarge, putting pressure on the surrounding organs and leading to stress, pain, and, eventually, circulatory shock. Blood vessels are compressed, and blood is unable to flow adequately to the heart. Similarly, the blood flow to the stomach itself is cut off. This is also the case when it comes to the spleen, which lies in close proximity to the stomach. In some cases, the stomach will become so stretched that it can even burst.
Is It Commonly Seen in Veterinary Practices?
One study carried out by Purdue University in 2000 found that about one in five large dogs and one in four giant dogs will develop a GDV at some stage throughout their lifetime. However, it should be pointed out that this study focused on purebred show dogs already thought to be predisposed to GDV, and a study performed by O’Neill et al. in 2017 showed that only roughly 6 in 1,000 dogs in the UK would go on to develop a GDV.
Signs & Symptoms of GDV
The symptoms of GDV are quite specific and difficult to ignore. They come on quickly and with little warning. An owner may first notice that their dog does not seem right. Initially, they fail to settle down, pace around the room, and look behind at their abdomen worryingly from time to time. They often stretch out to alleviate the pressure of the gas building up and may strain to pass faeces.
As the condition progresses, they will typically start to pant, drool, and retch unproductively. They may also moan and whine with the pain. Their abdomen will look noticeably bloated and, when touched, will be hard and tense. If left untreated, animals will become weak, develop pale gums, and then collapse and potentially die.
Are Some Dogs More at Risk than Others?
There is no doubt that certain dogs are more at risk than others, and this has been proven time and time again in studies around the world. While many of us are aware that specific breeds are more predisposed than others, several other factors come into play.
The poster child of GDV has to be the Great Dane, and they are thought to develop GDVs far more often than any other breed. Pedigree large and giant breeds are over-represented in general, and other examples of those at risk include the Bloodhound, Rottweiler, Saint Bernard, Standard Poodle, and the Irish Wolfhound. Indeed, genes have a big influence, and GDV has been observed to run in families. This is critical as, through controlled breeding programmes, it may be the key to reducing this devastating disease’s incidence in the future.
We now also know that age plays a role and the older a dog is, the more likely they are to have a GDV episode. Stress is also believed to be a factor, meaning that stressful incidents can precipitate an event, and dogs prone to stress are more likely to be affected.
On top of this, dogs who went through splenectomy (removal of the spleen) are more likely to develop GDV. Finally, being a scavenger and ingesting foreign bodies is also linked to an increased incidence of GDV.
What Causes GDV?
Determining the cause is important as it can potentially help us to prevent the condition from occurring. However, we do not always know what the reason is, and it is still unclear exactly which factors play a role. Many theories exist, and there have been several studies conducted looking into this matter. Possible causes include:
- Feeding a fatty, kibble diet composed of small biscuits
- Feeding large meals
- A dog eating their food too quickly
- A dog exercising vigorously directly after a meal
- Feeding on an increased height
- Stressful events, such as car rides, kennelling or grooming
How Is GDV Diagnosed?
When a vet is presented with a dog that fits the description (a large dog with a deep chest) and shows the classic symptoms of having a GDV, they will usually be able to tell what is going on immediately. To confirm the diagnosis and determine what state the animal is in, general bloodwork, an ECG, and abdominal X-rays will be carried out.
The X-rays will show a large, dilated stomach and the classic ‘double-bubble’ indicating that there has been a twist. Most of the time, X-rays are performed consciously as the dog is so unstable. Two X-ray views may be needed to visualise the stomach correctly.
Treatment of GDV
GDV is a true emergency, and the animal requires immediate treatment (even if it is 3 a.m. on a Sunday!) and cannot be treated at home. As most animals are critically ill by the time they reach the vet, they must first be stabilized, as they may not be well enough to withstand an anaesthetic, and going immediately to surgery is rarely the best plan.
An IV catheter will be placed, and dogs will be started on a high rate of fluids to treat the shock. Some vets may alleviate the tension in the abdomen bypassing an orogastric tube to remove some of the gas and liquid. Alternatively, a procedure known as ‘trocharization’ may be performed, whereby a needle is inserted into the stomach via the abdomen to release some of the trapped air.
Those with cardiac arrhythmias (irregular heart rhythms) may require specific medication to normalise the heartbeat. On top of this, patients should be given strong pain relief and supplemental oxygen.
Once the patient is stable, surgery must be carried out straight away to correct the problem and de-rotate the stomach. Not only will the stomach be repositioned, but the surrounding organs will also be examined for any signs of damage. It is not uncommon for the spleen to have to be taken out due to the local damage caused by the lack of blood supply. Similarly, part of the stomach may even need to be removed if it is beyond repair.
A procedure known as a ‘gastropexy,’ whereby the stomach is tacked to the abdominal wall permanently to prevent rotation, is often carried out simultaneously as the emergency surgery to avoid the GDV from recurring in the future. In fact, some at-risk dogs will have a gastropexy performed prophylactically in the hopes that they will never develop a GDV. This is often done at the time of neutering and can laparoscopically be done, so it is minimally invasive.
Aftercare & Outcome
Even after a successful operation, dogs are by no means out of the woods. Complications, such as cardiac arrhythmias, electrolyte imbalances, and peritonitis, are just a few examples of potential obstacles encountered during the recovery period. Many vets will tell you that the dog’s care during the first 24 hours after the surgery is the most important factor when it comes to survival.
Dogs need to be hospitalised and monitored very closely. During this time, they will require medications including pain relief and gastric protectants and often also need intravenous fluids and assisted feeding. As with all abdominal surgery, dogs will need to be strictly rested, and their exercise must be reduced and controlled while they recover. Many require an Elizabethan collar to prevent them from licking at the incision site. For most, the recovery period will last a week or two.
Prognosis for Dogs
The prognosis typically depends on how long the dog’s stomach was rotated for as those who had a GDV for a long time and whose blood supply was compromised have a far worse prognosis than those who were treated promptly. Most agree that the mortality rate is somewhere between 15% and 30%.
How Can You Prevent GDV?
Of course, no owner wants their dog to develop GDV, and vets are often asked how to prevent it. It would be prudent not to breed from dogs with GDV and seek out puppies from families with no history of the disease. Many vets agree that gastropexy surgery is a good idea in dogs known to be prone to the condition.
Feeding little and often is advised. It is not recommended for dogs to be fed from a height (as was once thought). It may help feed low-fat meals and use a slow-feeding bowl to decrease the speed at which the food is ingested.
References & Further Reading
Gastric Dilatation-Volvulus: https://www.acvs.org/small-animal/gastric-dilatation-volvulus
Glickman L.T., Glickman N.W., Schellenberg D.B., Raghavan M., Lee T.L. (2000).
Incidence of and breed-related risk factors for gastric dilatation-volvulus in dogs. J Am Vet Med Assoc: 216 (1): 40-5.
O’Neill, D.G., Case, J., Boag, A.K., Church, D.B., McGreevy, P.D., Thomson, P.C. & Brodbelt, D.C. (2017). Gastric dilation-volvulus in dogs attending UK emergency-care veterinary practices: prevalence, risk factors, and survival. J Small Anim Pract: doi:10.1111/jsap.12723.