Reinero Carol, Grobman Megan, Vientós-Plotts Aida, Masseau Isabelle, Gerhard Charlotte
BREATHE Clinic, Veterinary Health Center, College of Veterinary Medicine, University of Missouri, MO, USA.
Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, MO, USA.
JFMS Open Rep. 2025 Jun 29;11(1):20551169251341055. doi: 10.1177/20551169251341055. eCollection 2025 Jan-Jun.
Feline megaesophagus (ME) is a rare failure of esophageal motility leading to regurgitation, weight loss and sometimes death in cats. It has been identified secondarily to neurologic and neuromuscular disorders, mechanical obstruction of the esophagus (eg, vascular ring anomalies, esophageal stricture) and upper airway obstruction among others; when no cause is found, it is considered idiopathic. Videofluoroscopic swallow studies (VFSSs), especially using an unrestrained free-feeding protocol, are underutilized for comprehensive evaluation of cats with regurgitation, including identifying the etiology of ME. In this case report, a 3-month-old male intact domestic shorthair cat with a history of regurgitation since weaning and radiographic evidence of ME had VFSS features compatible with a functional obstruction of the lower esophageal sphincter (LES) consistent with LES achalasia-like syndrome. Medical management with sildenafil failed to improve clinical signs, and surgical correction of LES achalasia using a Heller myotomy and Dor fundoplication was declined. As a result of caregiver compassion fatigue from persistent regurgitation, euthanasia was elected.
Videofluoroscopic documentation of functional obstruction of the LES (ie, LES achalasia-like syndrome) can identify a novel etiology of feline ME. Free-feeding unrestrained VFSS protocols are recommended to allow physiologic assessment of swallowing disorders with no higher risk of aspiration than eating and drinking at home. Recognition of LES achalasia-like syndrome may lead to further study of directed treatments targeting the functional obstruction as has been carried out in humans and dogs.
猫巨食管症（ME）是一种罕见的食管动力障碍性疾病，可导致猫出现反流、体重减轻，有时甚至死亡。它继发于神经和神经肌肉疾病、食管机械性梗阻（如血管环异常、食管狭窄）以及上呼吸道梗阻等；若未发现病因，则被认为是特发性的。视频荧光吞咽造影检查（VFSS），尤其是采用无约束自由进食方案时，在对反流猫进行全面评估（包括确定ME的病因）方面未得到充分利用。在本病例报告中，一只3月龄未绝育的雄性家猫，自断奶起就有反流病史，且X线检查有ME的证据，其VFSS特征与食管下括约肌（LES）功能障碍相符，符合LES失弛缓症样综合征。使用西地那非进行药物治疗未能改善临床症状，且拒绝了采用Heller肌切开术和Dor胃底折叠术对LES失弛缓症进行手术矫正。由于护理人员因持续反流产生同情疲劳，最终选择了安乐死。
视频荧光造影记录LES功能障碍（即LES失弛缓症样综合征）可确定猫ME的一种新病因。建议采用无约束自由进食的VFSS方案，以便对吞咽障碍进行生理评估，其误吸风险不高于在家中进食和饮水。认识LES失弛缓症样综合征可能会促使针对功能性梗阻的定向治疗展开进一步研究，就像在人类和犬类中所进行的那样。
