Canine Gastric Dilatation-Volvulus (Bloat)

School of Veterinary Medicine Purdue University, West Lafayette, IN 47907-1243

BLOAT NOTEs

News from the Canine Gastric Dilatation-Volvulus Research Program
Phone: (765) 494-6301 FAX: (765) 494-9830

January, 1997

EPIDEMIOLOGY PROGRAM RESEARCH TEAM

Department of Veterinary Pathobiology

Larry Glickman, VMD, DrPH

Diana Schellenberg, MS

Tana Lee

Department of Veterinary Clinical Sciences

Gary C. Lantz, DVM

William R. Widmer, DVM, MS

Center for the Human-Animal Bond

Nita Glickman, MS, MPH

Enrollment in Prospective Study of Risk Factors Tops 1500

Enrollment of show dogs in the ongoing prospective study of bloat risk factors has climbed to 1507 and is heading toward the target of 2,000. The enrollment period for the 10 breeds in the study has been extended through March 1997 to allow the Purdue investigators to attend large specialty shows in California. As far as we know, this is the largest prospective study ever conducted in companion animals, both in terms of the total expected enrollment and the length of follow-up (up to 4 years for some Irish Setters and Great Danes that were enrolled in 1994).

The study is intended to evaluate (a) the incidence of bloat in each participating breed; (b) the relationship between body conformation and bloat risk in individual dogs within a breed; (c) the influence of family history of bloat on bloat risk; and (d) whether diet and personality characteristics are predisposing factors for bloat. Dogs are measured and enrolled at a show. Then the owner completes a Current Status and History Questionnaire to provide baseline information about the dogís diet, temperament, etc., and the dogís health status is followed over time to see which dogs bloat and which remain bloat-free.

Table 1 lists the number of dogs in each of the 10 breeds enrolled as of November 14, 1996. This table also shows the bloat risk of each breed relative to the risk in mixed-breed dogs, who are arbitrarily assigned a risk of 1.0. Thus the breed risk of 41.4 for the Great Dane implies that Danes are 41 times more likely to bloat as mixed-breed dogs. The breed risk comparisons are based on retrospectively collected data from an earlier Morris Animal Foundation-sponsored study of 1,934 dogs with bloat and 3,868 without bloat (LT Glickman et al.: J. Amer. Vet. Med. Assoc. 104:1465-1471, 1994). Earlier comparisons based on these data included only the more common breeds. Table 1 includes 3 less common breeds which are part of the ongoing prospective study, i.e., Akita, Bloodhound, and Irish Wolfhound.

Table 1

* Breed risk of bloat relative to risk in mixed-breed dogs, who are arbitrarily assigned a risk of 1.0. For example, Great Danes have 41 times the risk of bloat than mixed-breed dogs.

Negotiations are underway with the AKC Canine Health Foundation to expand the study to 11 breeds by adding the Newfoundland in March 1997 and extending their follow-up through 1998.

Success of the prospective study ultimately depends on the participating breed clubs, i.e., the owners' willingness to have their dogs measured and enrolled at the remaining specialties, cooperation in completing the questionnaire with baseline data that is essential to the study, and willingness to provide follow-up information on the health status of their dogs. Completed questionnaires are rolling into Purdue, and the data are being entered into the computer. We are very grateful to the owners who have completed their questionnaires. A reminder postcard was sent to non-responding owners in September, and those still unheard from are being "hounded" in a phone reminder campaign.

There are no reliable population-based estimates of the incidence of GDV in dogs. However, a large computerized multi-hospital record system, the Veterinary Medical Data Base (VMDB), indicates that the frequency of GDV in dogs seen at veterinary teaching hospitals in the US has increased dramatically from 0.036% of all hospital admissions of dogs in 1964 to a peak of 0.57% in 1994, an increase of approximately 1500% (see Figure 1 below). This increase is unlikely to reflect changing diagnostic criteria or disease recognition. The increasing frequency of GDV starting about 1969 affected most of the large and giant dog breeds. Therefore, it is also unlikely to be caused by genetic factors. However, this apparent epidemic of GDV could be explained by introduction of one or more novel environmental factors such as a new ingredient in dry dog foods or a change in the manufacturing processes. It might also be related to changes in canine vaccines or their pattern of use, e.g., multivalent vaccines. Epidemiologic studies will be required to identify the causes of this bloat epidemic in the US and to monitor future trends. Keep in mind that despite appropriate veterinary medical care, approximately 25% of all dogs with GDV will die of the disease.

You can now access BLOAT NOTEs from the World Wide Web! Some people may ask, "What is the World Wide Web?" It is a subset of the Internet -- so-- "What is the Internet?"

The Internet is a series of interconnected computer networks from all over the globe. Computers can "talk" to each other because they use the same communications protocol: TCP/IP (Transmission Control Protocol/Internet Protocol). Through the Internet, we can use electronic mail (e-mail), log-on to other computers connected to the Internet, and transfer files from these "host" computers to our own computer.

The World Wide Web is a subset of the Internet where you can view documents that not only have text, but also graphics, video, and audio. Documents on the World Wide Web have "links," usually underlined and blue in color, that allow you to click and connect to other documents or maps or movies, etc. Each document in the World Wide Web has an "address." The address of the web page which contains links to BLOAT NOTEs is: http://www.vet.purdue.edu/depts/vad/cae

This web page is titled Center for Applied Ethology and Human-Animal Interaction. Under "Research Programs," you will see links to Canine Gastric Dilatation-Volvulus (Bloat), which describes Purdue University's bloat research program and links to several BLOAT NOTEs issues. To "surf" the World Wide Web, you need a "web browser." This software allows your computer to access the World Wide Web through your Internet connection. The most popular web browsers are Netscape Navigator (from Netscape Communications) and Internet Explorer (from Microsoft). We will be continually adding information to our web page about Purdue's bloat research project and the most current issue of BLOAT NOTEs as soon as it is available.

Here are a few other addresses of interesting animal-related web pages: http://www.vet.purdue.edu (Purdue University School of Veterinary Medicine)

Several times a week I receive a phone call from someone whose dog has died of bloat. Usually my role is to provide a sympathetic ear and assure the callers that there was nothing they could have changed to prevent the incident. Our current knowledge of bloat does not allow us to identify specific events that ìtriggerî an acute episode in susceptible dogs, although some form of "stress" was probably involved. One of our long-term research objectives is to better define what constitutes stress for dogs and to measure their physiological response to it. However, the primary goal of the research is to determine why some dogs are more susceptible to bloat than others, i.e., what are the risk factors for bloat. This has led to studies of the physical conformation of dogs, their diet, vaccination histories, and even to new ways to evaluate a dogís temperament and personality.

The overall bloat fatality rate approaches 30% for dogs with a dilated, rotated stomach. Approximately half of the dogs that die with a rotated stomach will do so before veterinary medical or surgical treatment is obtained. Dogs may be found dead or die on the way to the hospital, or may be euthanized by the veterinarian because of their poor prognosis or the owner's financial considerations. In contrast, dogs properly treated have >80% probability of surviving a bloat episode and then leading a normal life. Veterinarians over the past 2 decades have reduced dramatically the postoperative fatality rate from gastric dilatation-volvulus (GDV) from >50% to <20% by using improved therapy for shock, safer anesthetic agents, and better surgical techniques.

Too often, however, owners of dogs that died of bloat tell me that they had recognized that the dog had a serious problem and rushed the dog to a veterinarian, only to be told that it was probably only a "belly ache," or that the dog's stomach was dilated, but not rotated. Sometimes the veterinarian recognized dilatation, but not a rotation (volvulus, torsion), passed a stomach tube to relieve the pressure, and sent the dog home. Or the dog was diagnosed as having dilatation and rotation, and a stomach tube was passed to relieve the pressure, but surgery (gastropexy) to permanently correct the rotation was delayed, either because the dog was thought to be too ill to withstand the surgery, or the veterinarian was not adequately equipped or prepared at the time to perform the operation. The latter may occur if the veterinarian is in the midst of busy office hours or if -- especially at night -- there is insufficient technical help available to properly perform the surgery, which requires careful administration of anesthesia, appropriate fluid therapy, and close monitoring of the dog's vital signs.

Numerous clinical reports from Europe and the United States show that gastropexy to prevent gastric rotation should be performed as soon as possible following stomach decompression on all dogs with gastric dilatation, whether or not the stomach is thought to be rotated at the time. The recurrence rate of gastric volvulus in dogs treated for bloat conservatively, i.e., without surgery, approaches 100%, whereas the recurrence rate following gastropexy is <5%. The stomach of a dog that has had a gastropexy can still dilate, but it is unlikely to rotate, so if dilatation does occur after gastropexy, it can probably be treated conservatively.

What does all this mean to you? If your dog suddenly develops a distended abdomen, appears uncomfortable, and gets progressively worse, rush the dog to a veterinarian, preferably one equipped to do emergency surgery. Gastric distention is a life-threatening condition, even if the stomach has not rotated. Immediate decompression is required to relieve pressure on blood vessels and to restore circulation to the heart, because shock can occur within minutes of the first clinical signs. Fluid therapy is indicated to treat shock, and drugs may be needed if the heart rhythm is irregular. This should be followed as soon as possible by surgery to reposition and immobilize (gastropexy) the stomach before it is irreversibly damaged. The best indicators of how well the dog will do postoperatively are its physical condition (state of shock) prior to surgery and the appearance of the stomach during surgery (since dead or dying stomach tissue implies a very poor prognosis). Intensive monitoring is usually required for several days postoperatively in case complications occur.

If you suspect your dog has bloat, but the veterinarian dismisses it as a minor problem, inquire about radiographs to rule out GDV. If dilatation with or without volvulus is diagnosed and the stomach is decompressed, either by passing a stomach tube or by piercing the stomach with a large needle (trochar) passed through the body wall, the dog should be considered as a candidate for immediate surgery, unless its condition is too unstable to tolerate anesthesia. If the veterinarian recommends that surgery be delayed for any other reason, seek a second opinion immediately. Delay in surgery will increase the chance of the stomach rotating if it hasnít already, or will decrease the chance of the dog surviving if rotation has occurred.

Following is an excerpt of a letter that illustrates some of these points.

(Comment: There is no guarantee that if radiographs had been taken during the first veterinary visit, Kelly's outcome would have been different. However, radiographs might have confirmed the presence of gastric dilatation or volvulus, and thus the need for immediate gastric decompression and surgery.) Be prepared -- Teamwork between you and your veterinarian is your dogís best hope when it comes to bloat. For more information on the early signs of bloat, talk with your veterinarian. Ask what treatment he/she recommends for bloat, and if their hospital has a 24-hour emergency service. --Larry Glickman, VMD, DrPh

Life after Bloat -- Elly's Story

(Editor's note: Elly's story was sent to us by Pauline Anderson. Elly, who was in Purdue's case-control study of bloat risk factors, underwent gastropexy. Her good post-bloat condition illustrates a typical outcome of prompt emergency treatment and gastropexy -- even to the point of competing at shows.)

"I'd like to share a happy experience I had with Elly, my Standard Poodle, a bloat survivor. First, let me give a little history of Elly's bloat incident. In November of 1993, Elly suffered full-blown bloat twice in a 16-hour period. She was in a very serious condition and the decision to go forward with surgery was the only one for Elly if she was to survive. Elly was nine at the time of surgery. She is now twelve and is enjoying a very happy life, although her tummy still has a tendency to distend quite frequently. Fortunately this condition has proven to be of little consequence and there doesn't seem to be any discomfort for Elly, so we have learned to accept it.

Now, let me get to the subject that prompted me to write. On June 18, 1995, Elly earned her C.D. (Companion Dog Title) from AKC. She received a special award of a silver bowl for being the oldest qualifying dog at the trial. She also received awards for placing 4th and for being highest scoring Poodle in Novice A and B. Elly virtually began and ended her obedience career at eleven years young in less than 60 days, a full year and a half after her bloat experience. I want to say bloat is not always the end of the world, thank God, and there are still happy times to be had. Even special awards to be won." --Pauline Anderson

We extend heartfelt thanks to all the individual dog owners and breed clubs for donations for Purdue's bloat research through the Morris Animal Foundation and the AKC Canine Health Foundation. These include the Akita Club of America, American Bloodhound Club, American Rottweiler Club, Collie Club of America Foundation, Irish Setter Club of America, Irish Wolfhound Club of America, Newfoundland Club of America, and Weimaraner Club of America. We wish it were possible to publish all the names on our honor roll of donors. Purdue has also received direct donations for bloat research from:

• Cleveland Collie Club
• Great Dane Club of Western Washington
• Irish Setter Club of Milwaukee
• Poodle Club of America
• Saluki Club of America (in honor of Ch. Ariel Sonova Drama of Hasten, owned by Cheryl R. Rosenberger)

We are pleased to acknowledge memorial fund donations to Purdue's bloat research program in honor of:

• Vinnie, a Standard Poodle owned by Pat and Rose Essy (donation from Dianne Hopper)
• Misty Schott, a German Shepherd (donation from Jan Ruggles)

Epidemiologic studies of bloat and companion animal health problems by Purdue University School of Veterinary Medicine are made possible by contributions from the Morris Animal Foundation, AKC Canine Health Foundation, animal health companies, private foundations, breed clubs (national, regional, and local), and individual dog owners. We welcome your comments, suggestions, and support. 

$$ Those wishing to donate can send contributions to Purdue University in care of Dr. Larry Glickman, Bloat Research Program, Veterinary Pathobiology VPTH 101, Purdue University, West Lafayette IN 47907-1243. If you are making a donation in memory of a bloat victim, and wish to have the dog's photo published in BLOAT NOTEs and on the World Wide Web, please indicate this when sending a photo.

--Larry Glickman, VMD, DrPH, who directs the Purdue Bloat Research Program, is Professor of Epidemiology and Environmental Medicine, Department of Veterinary Pathobiology in the School of Veterinary Medicine at Purdue University. Larry received his veterinary medical training at the University of Pennsylvania School of Veterinary Medicine, and was a veterinary practitioner for several years. Most of his career has been spent in teaching and research. After earning his doctorate in Epidemiology and Public Health from the University of Pittsburgh Graduate School of Public Health, he taught preventive medicine and conducted epidemiologic research in the veterinary schools at Cornell University and the University of Pennsylvania; he came to Purdue in 1988.

His broad research interests, reported in books and >150 scientific papers, include zoonoses, particularly roundworm (Toxocara) infections in dogs and humans, rabies, and cat-scratch disease; parvovirus infection in dogs; heartworm infection in dogs and people; the efficacy and adverse effects of canine vaccines; nutritional requirements of dogs; distemper in dogs; cancer; and pet overpopulation issues. Another strong interest has been the role of pet animals and wildlife in identifying environmental hazards.

He has summarized this work as follows: "Risk assessment is the process of characterizing the potential adverse health effects of human exposures to environmental hazards. The important elements of risk assessment are hazard identification, dose-response evaluation, exposure assessment, and risk characterization. The traditional sources of data used in risk assessment are findings of human epidemiologic research and laboratory animal experiments. Because of the limitations of these approaches, we have conducted epidemiologic studies in pet animals with naturally occurring cancers to determine if the home environment is potentially hazardous to both pets and their owners. We have shown that asbestos and insecticide exposures of dogs in the home increases their risk of mesothelioma and bladder cancer, respectively. Because the time between these exposures in dogs and the onset of cancer is considerably shorter than for humans, cancers in pet animals serve as sentinel diseases or early warning signals of a hazardous home environment. We are in the process of establishing a network of veterinarians to identify these veterinary sentinel health events." 

We are also using several species of fish to develop biomonitoring methods to evaluate environmental contamination by toxic chemicals such as radioactive cesium and their potential to cause adverse health effects in humans, e.g., effects of the Chernobyl disaster."

Research on bloat in dogs has been a family affair for Larry and his wife Nita (profiled in the May 1993 issue of BLOAT NOTEs) since the late 1980s, when they first explored the use of the Veterinary Medical Data Base as a source of information about this disease. Both their son Seth, now in the MD-PhD program at the University of Pennsylvania, and daughter Danielle, a student at DePauw University in Greencastle, IN, have worked on various aspects of the research.

The Bloat Research Program at Purdue was launched in 1991 with case-control, survival, radiographic, and genetic studies of risk factors for bloat, funded by the Morris Animal Foundation. With funding from breed clubs, individual donors, and most recently the American Kennel Club Canine Health Foundation, the program has continued to grow. The goal remains the same: to help veterinarians and dog owners develop practical preventive measures to reduce the incidence of this disease. Larry realizes that, ìto accomplish our goal, many more years of hard work are still needed. However, he readily accepts this challenge as long as dog owners and breed clubs continue to give their support.

Reproduced with permission from Purdue University Epidemiology Department

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