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Can Cats Have Acid Reflux?

We’re all familiar with heartburn and probably know about acid reflux and GERD, but we don’t normally think of cats having it. The idea probably inspires you to ask, “Is cat acid reflux a thing?” Read all about it here.

Can Cats Get Acid Reflux?

Yes, cats can have acid reflux. In fact, it’s pretty common. It can happen to any cat, but it is more likely to occur in young and senior cats. Unfortunately, because they can’t talk to us, in human anyway, it’s hard for them to tell us they’re having heartburn or that their coughing or puking is from acid.

What is acid reflux in cats?

Feline acid reflux is very similar to acid reflux in humans. Like us, cats are supposed to have a high amount of stomach acid, but there is such a thing as too much. With acid reflux, the cat produces more stomach acid than normal and it weakens their esophageal sphincter muscle, or this muscle becomes weakened for another reason. Either way, stomach acid starts coming up into the cat’s esophagus and the esophagus is not equipped to handle stomach acid, burning and damaging the tissue. It’s called acid for a reason.

Acid reflux is often also called GERD or gastroesophageal reflux disease, a more descriptive and specific term. When it becomes severe enough to damage the esophagus, it becomes esophagitis.

Acid reflux and esophagitis in cats cause very serious problems:
  • pain
  • stress
  • difficulty swallowing
  • vomiting
  • scarring of the esophagus
  • infections
  • aspiration pneumonia, from food or liquid getting into their lungs

What causes acid reflux in cats?

Many factors can cause excess stomach acid and GERD in cats. We’ll list them in approximate order of likelihood.

Radiation therapy

If your cat has had radiation therapy around their neck, it can damage their esophagus or impair its function. You would, of course, know your cat had had this treatment and your vet should prepare you for potential problems.

Anesthesia

Temporary acid reflux can be caused by anesthesia if the anesthesia was improperly administered. This may cause your cat discomfort and stress for a short time but should not last long enough to cause serious damage. Should it impair their ability to eat or swallow, or seem to be causing them pain get them to a vet.

Medications

Some medications, such as clindamycin, doxycycline, tetracycline, and potassium chloride, can cause esophagitis, which means the cat suddenly gets a weakened esophageal sphincter and damage to their esophagus when the other causes were not present or sufficient to create a problem. This would occur while the cat was on medication, so you could suspect this as a cause.

Younger cats are more likely to develop acid reflux than adult cats because their esophageal sphincter muscle is not fully developed.

Senior cats may have an increased risk because they are more likely to need surgeries, treatments, and medications that may cause temporary acid reflux or esophageal sphincter damage.

Stress

Like humans, the cat body just doesn’t work right when they’re stressed. One of the ways this presents itself is that they can produce more stomach acid than their bodies can really handle. Too much stomach acid and gas can put excess pressure on the esophageal muscle and cause acid reflux.

Vomiting

If your cat throws up a lot from chronic hairballs or any other reason, all this vomiting can weaken the esophageal sphincter. You will certainly know if your cat has been puking enough to cause this problem. No one misses cat vomiting.

What goes in a kitty tummy impacts how well their tummy works and how much acid they produce. The exact cause may be different for each pet, but low-quality cat foods are the most common culprit.

Symptoms of acid reflux in cats

Acid reflux typically begins with having too much stomach acid and gastritis.

Cat excess stomach acid symptoms may include:
  • loss of appetite
  • gas
  • burping
  • occasional vomiting, especially within an hour of eating or when eating certain foods

Because your cat can’t tell you they are uncomfortable or what’s wrong, many cat owners don’t discover anything is wrong in its milder stages.

It becomes acid reflux, or GERD, when it starts entering the cat’s esophagus, hence the reflux part of the name.

Symptoms of GERD in cats may include:
  • frequent vomiting often within one hour after eating
  • vomiting up bile or nothing but acid
  • licking their paws in a manner not like grooming, in an attempt to self-soothe
  • licking their lips
  • persistent or unusual coughing
  • choking
  • difficulty swallowing, they may stretch their neck out to try to swallow or visibly appear to struggle with swallowing, or want to eat but stop when they try to swallow
  • excessive drooling
  • gulping
  • lethargy
  • a change in vocal pitch
  • difficulty breathing with pneumonia
  • fever, with infection from extreme esophagus damage or pneumonia

When to see a vet about acid reflux in cats

If you are lucky enough to catch it while the symptoms are still mild enough, not impairing their ability to eat, causing pain, etc., you might have time to try improving their diet or limiting their stress to see if it reduces their symptoms and prevents the problem from ever escalating. If the problem is not quickly resolved, get them to a vet shortly to ensure that it is indeed acid reflux and get expert advice on fixing your cat’s acid problem.

If the cat’s acid reflux is limiting their appetite, causing vomiting, drooling, lethargy, difficulty swallowing, or causing even more severe symptoms like a change in vocal pitch or a fever, get them to a vet within 24 hours or take them for an emergency trip, depending on the severity of their symptoms. There is always a vet in your area available 24/7.

Diagnosing acid reflux in cats

There may not be any outward signs of acid reflux. Your vet will listen to you describe the cat’s symptoms, burping, difficulty swallowing, eating habits, etc., and take in what outward signs are visible.

If the onset is sudden, they may want to be sure the cat hasn’t swallowed a foreign object or something caustic.

Hiatal hernias, cancer of the esophagus, and other diseases of the mouth and throat can cause similar symptoms, so the vet will also want to rule these out.

The best way to definitively diagnose acid reflux in cats is an esophagoscopy where the vet runs a camera down the cat’s esophagus to visibly inspect it.

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X-rays and a complete blood count may also be run.

Treating acid reflux in cats

Acid reflux isn’t a disease that strikes a cat and can be eradicated like a cancer, it is a situation that arises from certain factors and can result again any time those factors are present. It can be chronic. To protect your cat, you have to diligently prevent those factors from rearing their head. This requires a long-term management plan and for you to be on the lookout for symptoms that the problem is recurring.

Antacid for cats

As far as medicine goes, your vet will probably prescribe a low dose antacid for cats to manage the acid levels in their stomach.

The word “antacid” may make you think of your medicine cabinet or the digestive aid aisle in the grocery store. But don’t get too excited. Human antacids have spotty records for helping with feline acid reflux.

Pepcid

It is possible for you to give your cat Pepcid, but you should only do so with the guidance of a vet because you have to be mindful of creating a situation where the cat doesn’t have enough stomach acid. This can cause serious issues that are as dangerous or even more so than the acid reflux. Long term or excessive Pepcid use can also damage the cat’s kidneys.

Pepto-Bismol

Do not give Pepto-Bismol to cats as the Bismuth subsalicylate that makes it work is dangerous to them.

Kaopectate

Kaopectate contains the same harmful substance as Pepto-Bismol as well as aspirin. Do not give this to your cat either.

With any human medication or treatment, it is best to ask your vet before trying it out. Many will say it is fine to give your cat Pepcid, and go ahead, but with the vet’s guidance.

A wise acid reflux treatment in cats will include diet management. They should be eating higher-quality cat foods and less human food. Avoid giving them high fat foods as fat weakens the esophageal sphincter muscle. Lower protein food may also be advisable as protein does increase stomach acid. Soft food like more wet foods or dry food moistened with water or a wet food may help as they are easier to digest.

Changing the amount of food and frequency of the food may be helpful as well. It is easier to digest food, and therefore less stomach acid is needed, to eat less food at a time. You might try feeding your cat less food more frequently so they get what they need without getting too full. This will require filling their bowl with less food to leave out or feeding them only on a schedule.

When you start reading the ingredients and nutritional lists of popular commercial cat foods, you may think it’d be easier to make your own cat food. It may be a good idea to go the homemade cat food route, if you can, provided you make the cat food to your vet’s specifications. It is common for people to think they’re creating a healthy cat food for their cat and really be messing up their nutritional balance. There’s a lot of complex planning in making a decent cat food that requires special knowledge of what cats at different ages need.

Food restriction

Some vets will tell you not to feed your cat for a period of time after the visit to give the cat time to empty the food that is already in their digestive system before adding more. They will probably tell you what foods to begin feeding your cat when it is time for eating to resume.

Esophageal sphincter muscle repair

With mild to moderate forms of acid reflux, the esophageal sphincter is usually able to strengthen itself when there is less acid to irritate it.

Some medications to strengthen the muscle can facilitate matters.

Severe GERD – esophagitis in cats

The most severe forms of acid reflux, where the esophagus has been badly damaged, occurs when it turns into esophagitis. This is when very serious conditions develop.

Carafate can line an ulcerated esophagus to protect it from further damage and promote healing.

Antibiotics may be given to prevent infections in damaged tissues of the esophagus, and pain medications may be given if the damage has progressed to a point where the cat’s discomfort and pain cannot be alleviated by simply reducing the acid content in their stomach.

More drastic treatments like a gastrostomy tube may be required to let the esophagus rest.

Preventing acid reflux in cats

Thankfully, there are some things you can do to make it unlikely that your cat will develop acid problems.

You can prevent your cat from developing acid reflux by:
  • feeding them high-quality cat food
  • not letting them eat huge amounts of food at one time
  • limiting their intake of table scraps
  • treating chronic stress
  • being mindful of times of acute stress
  • getting your cat to the vet and/or lowering the factors that cause acid reflux if they start having symptoms of acid reflux after surgery or when taking a medication

Should your cat develop acid reflux, the sooner you discover it and get the cat treatment, the less severe their case will be. Many cats can just undergo a little medication and diet change and be good as new.

How CBD Oil Might Help with Acid Reflux in Cats

You might find it useful to know about CBD oil when dealing with acid reflux in cats.

CBD oil is praised as a natural and effective means to help address:
  • nausea
  • vomiting
  • lack of appetite
  • lethargy
  • pain
  • anxiety

Medications your cat may have to take to address their acid reflux can have side effects that make it impossible or unnecessarily unpleasant to take the medication. CBD oil may alleviate these side effects so the cat can continue to use an otherwise effective treatment.

It also shows promise as an acid-inhibitor because there is a CB-receptor connected to the stomach. People are recommending it to humans for this purpose, so if your cat can’t take other antacids, you might want to try CBD oil.

“CB-receptor?” you ask. Scientists have discovered that humans and cats, as well as many other animals, have an endocannabinoid system in their bodies that regulates many bodily functions. This system creates cannabinoids, receptors all over the body tie it into major organs, and this process plays a part in the body’s homeostasis. External cannabinoids like cannabidiol, what CBD stands for, interact in the body like the body’s own cannabinoids, making up for deficiencies and giving a boost in times of need.

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“Cannabid­—,” you ask. Yes, you read that right, but it comes from hemp not marijuana, so there is no THC to contend with. The health benefits people put to medical marijuana are also present in hemp, because of cannabidiol. In fact, CBD oil from hemp provides longer-lasting, more reliable results than those made with marijuana because it contains more cannabidiol and virtually no THC while marijuana is mainly THC.

CBD oil is considered safe and side effect free. It is possible if the cat consumes a large enough amount of cannabidiol that they may experience a decrease in appetite, diarrhea, or sedation. You should tell the vet you are giving the cat CBD oil before they administer any treatments or prescri

be any medications as it does impact how the liver absorbs medications, making doses not work as expected. There is also conflicting information regarding whether cannabidiol has a positive or negative, (like acetaminophen or alcohol in humans) effect on the liver. You could discuss risks versus benefits with your vet.You could discuss using CBD oil with your vet if you are concerned about traditional treatments, your cat doesn’t respond well to a prescribed treatment, or your cat can’t even take traditional treatments. It has not been approved by the FDA at this time because there simply haven’t been enough tests and trials to make its effectiveness a guarantee, but it is so promising and such a gentle way to address many illnesses that more and more vets are coming on board. It can be a miraculous help for cats who can’t find relief in other ways.

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Vaping-associated esophagitis

Vaping, or e-cigarettes, heat nicotine and other chemicals to create a vapor that is inhaled. The practice has gained rapid popularity with 41 million people globally reporting regular or occasional use. Although tobacco smoking is well-known to increase esophageal acid exposure by augmenting the number of reflux events, the effects of vaping on the gastrointestinal tract have not yet been elucidated. Our objective is to report a case of severe esophagitis associated with vaping, which is the first in the literature to our knowledge.

Case presentation

A 25-year-old male with a history of well-controlled gastro-esophageal reflux disease presented to the emergency room for evaluation of one week of severe odynophagia. He had been treated with a proton-pump inhibitor for several years with good effect. Approximately two months prior to presentation, he started vaping tetrahydrocannabinol and nicotine with recent heavy daily use. He denied any alcohol or non-steroidal anti-inflammatory drug use. We performed esophagogastroduodenoscopy that revealed Los Angeles Grade C esophagitis (involving ≥ 1 mucosal breaks continuous between tops of ≥ 2 mucosal folds, < 75% circumferential). Histopathological analysis of esophageal biopsies demonstrated granulation tissue with acute and chronic inflammation. Periodic acid-Schiff-diastase staining was negative and immunohistochemical stains for herpes simplex virus and cytomegalovirus were negative. There was no evidence of eosinophilic esophagitis. We treated him with intravenous PPI and analgesics until he was able to tolerate oral intake. He was counseled extensively on vaping cessation and reported complete resolution of symptoms after 2 months.

Conclusion

This patient’s presentation illustrates a serious gastrointestinal consequence of vaping, the long-term consequences of which warrant additional studies. Like smoking, the mechanism of injury in vaping may be, at least in part, due to the effects of nicotine. As prevalence of vaping continues to rise, clinicians should be aware of this complication and carefully solicit a patient’s vaping history as a simple denial of “smoking” can be misleading.

Background

Vaping, or e-cigarettes, heat nicotine and other chemicals to create a vapor that is inhaled. The practice has gained rapid popularity with 41 million people globally reporting regular or occasional use [1]. Although tobacco smoking is well-known to increase esophageal acid exposure by augmenting the number of reflux events [5], the effects of vaping on the gastrointestinal tract have not yet been elucidated. Our objectives are to report a case of severe esophagitis associated with vaping, which is the first in the literature to our knowledge.

Case presentation

A 25-year-old male with a history of well-controlled gastro-esophageal reflux disease (GERD) presented to the emergency room for evaluation of one week of severe odynophagia and inability to tolerate po. He had been treated with a proton-pump inhibitor (PPI) for several years with good effect. Approximately 2 months prior to presentation, he started vaping tetrahydrocannabinol (THC) and nicotine with recent heavy daily use. He denied any alcohol or NSAID intake. On physical exam, the patient was non-toxic appearing with a soft abdomen.

We performed esophagogastroduodenoscopy that revealed Los Angeles Grade C esophagitis (involving ≥ 1 mucosal breaks continuous between tops of ≥ 2 mucosal folds, < 75% circumferential) (Fig. 1). Histopathological analysis of esophageal biopsies demonstrated granulation tissue with acute and chronic inflammation (Fig. 2). Periodic acid-Schiff-diastase staining was negative and immunohistochemical stains for herpes simplex virus and cytomegalovirus were negative. There was no evidence of eosinophilic esophagitis. He was diagnosed with esophagitis secondary to vaping. We treated him with intravenous 40 mg twice daily PPI and analgesics until he was able to tolerate oral intake. He was counseled extensively on vaping cessation. The patient reported complete resolution of symptoms after 2 months of PPI therapy and vaping cessation.

Images of the esophagus during esophagogastroduodenoscopy. Images of the patient’s esophagus obtained during esophagogastroduodenoscopy demonstrating severe bridging mucosal breaks less than 75% of the circumference, consistent with Grade C esophagitis per the Los Angeles Criteria for erosive esophagitis

Histological image of the distal esophageal biopsy specimen. Hematoxylin and eosin stain of the patient’s distal esophageal mucosal biopsy specimen demonstrating granulation tissue with acute on chronic inflammation. Photograph provided by Dr. Vikram Deshpande (Massachusetts General Hospital)

Discussion and conclusion

The emerging consequences of vaping have garnered significant public health attention in the product’s largest markets, the United States, the United Kingdom and France, which spend a combined $10 billion yearly on vaping products [1]. In addition to well-publicized lung injury, vaping is also associated with increased cardiovascular disease [2] and the development of oral ulceration [3].

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The temporality of his commencing vaping with his symptoms strongly suggested a relationship, supported by the endoscopic appearance, histopathologic analysis, and exclusion of other etiologies. Cigarette smoking classically increases the risk of Barrett’s esophagus and malignancy, which it does synergistically with GERD [4]. Indeed cigarette smoking increases the odds of gastro-esophageal reflux symptoms [5] and greatly increases acid exposure time on ambulatory pH monitoring [6]—effects which are largely attributed to nicotine. Similarly, the mechanism of injury in vaping may be, at least in part, due to the effects of nicotine when present in the vaping substrate. Interestingly, like nicotine [7], THC (and namely, activation of cannabinoid receptors 1 and 2) has also been shown to play in important role in the regulation of transient lower esophageal sphincter relaxations, as well as lower esophageal pressure [8, 9], further supporting vaping as the trigger of our patient’s presentation. Vaping poses particular challenges given the risk of unknown chemicals and toxins entering the substrate due to inconsistent regulations. However, independent of the substrate itself, direct mucosal injury as another mechanism of injury has been proposed secondary to the by-products of vaporized additives, which result in oxidative stress and DNA damage [10].

This patient’s presentation illustrates a serious gastrointestinal consequence of vaping, the long-term consequences of which warrant additional studies. As prevalence of vaping continues to rise, clinicians should be aware of this complication and carefully solicit a patient’s vaping history as a simple denial of “smoking” can be misleading.

Availability of data and materials

Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

Abbreviations

Gastroesophageal reflux disease

Non-steroidal anti-inflammatory drug

References

Jones L. Vaping: how popular are e-cigarettes? BBC News, BBC, 14 Sept. 2019, www.bbc.com/news/business-44295336.

Osei AD, Mirbolouk M, Orimoloye OA, Dzaye O, Uddin SMI, Benjamin EJ, Hall ME, DeFilippis AP, Stokes A, Bhatnagar A, Nasir K, Blaha MJ. Association between e-cigarette use and cardiovascular disease among never and current combustible-cigarette smokers. Am J Med. 2019;132(8):949-954.e2.

Ali NS, Billings ML, Tollefson MM, Davis DMR, Hand JL. Oral erosions associated with surreptitious marijuana vaping in an adolescent boy. Pediatr Dermatol. 2020;37(2):347–9.

Cook MB, Shaheen NJ, Anderson LA, Giffen C, Chow WH, Vaughan TL, Whiteman DC, Corley DA. Cigarette smoking increases risk of Barrett’s esophagus: an analysis of the Barrett’s and Esophageal Adenocarcinoma Consortium. Gastroenterology. 2012;142(4):744–53.

Eusebi LH, Ratnakumaran R, Yuan Y, Solaymani-Dodaran M, Bazzoli F, Ford AC. Global prevalence of, and risk factors for, gastro-oesophageal reflux symptoms: a meta-analysis. Gut. 2018;67(3):430–40.

Kadakia SC, Kikendall JW, Maydonovitch C, Johnson LF. Effect of cigarette smoking on gastroesophageal reflux measured by 24-h ambulatory esophageal pH monitoring. Am J Gastroenterol. 1995;90(10):1785–90.

Kahrilas PJ, Gupta RR. Mechanisms of acid reflux associated with cigarette smoking. Gut. 1990;31(1):4–10.

Beaumont H, Jensen J, Carlsson A, Ruth M, Lehmann A, Boeckxstaens G. Effect of delta9-tetrahydrocannabinol, a cannabinoid receptor agonist, on the triggering of transient lower oesophageal sphincter relaxations in dogs and humans. Br J Pharmacol. 2009;156(1):153–62.

Izzo AA, Camilleri M. Emerging role of cannabinoids in gastrointestinal and liver diseases: basic and clinical aspects. Gut. 2008;57(8):1140–55.

Sundar IK, Javed F, Romanos GE, Rahman I. E-cigarettes and flavorings induce inflammatory and pro-senescence responses in oral epithelial cells and periodontal fibroblasts. Oncotarget. 2016;7:77196–204.

CBD oil and Acid Reflux/”GERD”

If you’ve dealt with Acid Reflux before then you know how painful and annoying it can be. You can’t eat certain foods, drink certain drinks, or even lay down to sleep in some cases. You sit down to have a nice dinner, a glass of wine, and then just a little while after you finish your meal, that burning sensation starts in the back of your throat. You didn’t realize your food had a tiny bit of garlic in it, Now you’ve got to worry about hours of pain and discomfort. You don’t even know why this happens to you.

So first, what is acid reflux? Acid reflux is when the contents of the stomach enter the esophagus.. Stomach acid, half digested foods, and other digestive enzymes move into the throat, causing pain and damage to the sensitive flesh in the esophagus. There are actually many things that can cause this reaction.

Too little stomach acid in the stomach can cause the lower esophageal sphincter to relax, allowing the back flow of digestive juices. Many times not having enough stomach acid is caused by taking too much anti acid medication. This can also cause slow digestion and a buildup of bad bacteria within the stomach. This can further complicate the ability to digest food efficiently as well as cause complications with the immune system. Stomach issues can be a root cause for many other health issues that arise. Slow digestion can cause food to actually spoil while still within the stomach, helping to breed more bad bacteria.

So, sometimes grabbing those acid pills isn’t really the best solution. While it may provide temporary relief, it might be helping cause more issues in the long run. Before I ever took CBD oil I found that ingesting a tablespoon of apple cider vinegar helped my digestion and limited acid reflux greatly.

CBD has undoubtedly helped my acid reflux more than anything. It has helped improve my digestion and limit my lower esophageal sphincter motility. Going from having to sleep upright every night to laying down at night is one of the best things that happened after taking CBD oil.

If you struggle with acid reflux or “GERD” I believe that taking CBD oil will greatly improve your quality of life. Adding in apple cider vinegar once a day can also greatly improve digestive health and promote adequate acid levels within the stomach. You may read that and think it can’t be true. Try it. Mix a little Apple cider vinegar in a cup of water and see how you feel an hour or so later.

It can be a real struggle getting through life when you have to deal with any digestive related issues. Maybe people don’t understand just how debilitating it can become. If you struggle with acid or any related issues then CBD may be right for you. In my last post I discussed how CBD interacts with the body. I would suggest checking that out. CBD interacts with the endocannabinoid receptors in the digestive system.