Gazette Vet: Barfing, Or Not

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If you own a dog or a cat, you are likely well versed in cleaning up the occasional puke. A common misconception when talking about “puke” is that vomiting and regurgitation are the same thing.  These two words, however, mean quite different things and telling the difference between them is an important part in figuring out why you are having to use so much Nature’s Miracle to clean your carpets.

Vomiting, quite simply, is bringing food or fluid up that has already made it all the way down into the stomach. Vomiting almost always comes with abdominal contractions, aka “retching.” There is no better alarm to get you out of bed than the “glurg, glurg, glurg” of your pet about to vomit somewhere.

The causes of vomiting are many and can be divided into mainly local causes (there is something terrible going on inside my stomach) or central (I feel dizzy and nauseous and I think I’m going to be sick).

Regurgitating, on the other hand, is bringing food or fluid up that has been sitting in the esophagus.  The esophagus is the muscular tube that connects your mouth to your stomach. Regurgitation is an esophageal problem and there is usually no abdominal retching at all. Most describe regurgitation as a passive pouring out of food or fluid from the throat. A classic example is a dog who gets up from a laying position and immediately seems to gag and then out comes some food and fluid.

Regurgitation is usually a lot more specific in its cause – either an irritated esophagus, a dilated esophagus that isn’t moving, or there is a stricture in it that is not allowing stuff to pass by.

Making this distinction is mostly an issue for dogs, because cats rarely regurgitate. Cats are, however, masters of vomiting, aren’t they?

So why am I talking about gross stuff? My apologies, but making this distinction is important because vomiting and regurgitation are very different problems with very different causes.

Often times an owner will describe anything coming out of their dog’s mouth as vomit. If we take that at face value, we completely miss the possible causes for regurgitation. So, a good veterinarian will always ask you a few more questions to help determine if what you are seeing is indeed vomiting or is possibly regurgitation. I usually just have to make a few good abdominal retching sounds to portray “vomiting” and then I use the getting up and pouring out a pitcher of water analogy for my portrayal of “regurgitation.”

Quick trivia that illustrates my point that these words are often used incorrectly: We all know that adult wolves will bring food home and regurgitate it for the pups to eat, right? Wrong! They are vomiting up food for their pups! After consuming their meal of meat, etc. out in the wild, all of that food goes into their stomach. Normally we all have a very quick esophageal transit time. Once we swallow our food, it only takes a few seconds for that food to get into our stomachs. So those wolves out in Montana who consume a delicious elk carcass run back to the den with food solidly in their stomachs. Then, the young pups start jumping up and licking them on their muzzles which in an amazing act of nature stimulates the adult wolf to actually vomit up partially digested food – from their stomach. I guess “regurgitate” sounds better for a nature show, but it’s vomit for sure.

By far the most common cause for regurgitating in dogs is esophagitis (an irritated esophagus) from acid reflux. Yes, dogs get acid reflux, too, and it can definitely cause harm and irritation to their esophagus. Stomach acid is a strong acid and it belongs in the stomach. If we start to get it sloshing back up into the esophagus, the lining gets inflamed, often to the point of discomfort (heartburn pain) and then even decreased movement or motility of the esophagus. For a horizontal creature like dogs, food and fluid can more easily get stuck in an inflamed, slow-moving esophagus and then pour out later when they get up or jump down off of something. There may be an underlying problem that is causing the acid reflux, but we usually cure these cases with simple acid reducers like Pepcid and Prilosec.

Another cause for regurgitation is a condition called megaesophagus. As the name implies, these dogs have a huge, flaccid esophagus that has difficulty moving food from the mouth to the stomach.  These dogs tend to be in rough shape because holding food down becomes a very difficult chore every day. This is usually a genetic disorder but can also be acquired later in life. There is no easy treatment for these dogs.

Chronic regurgitation also puts dogs at a high risk for getting aspiration pneumonia. Pneumonia is defined as a bacterial infection in the lungs, and aspiration pneumonia happens when food or fluids from the mouth/throat “go down the wrong tube” into the lungs. When dogs have regurgitation and food and water hanging around in their esophagus, it is pretty easy for some of it to come up and get inhaled down into the windpipe and lungs. This is even more common in dogs that have swallowing problems in combination with their esophageal problems.

Vomiting has so many more causes, so we tend to need to cast our net much wider to come up with the exact culprit. But generally, once we have ruled out regurgitation, we can start to whittle down the possible causes.

So, if your dog has made you purchase a carpet cleaner because of some weekly vomiting, try to figure out if it seems like its vomit or regurgitation first, and then see your vet to come up with a plan for cleaner floors.

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