(Gastric Dilation Volvulus Syndrome)
Gastric Dilatation Volvulus Syndrome (GDV), sometimes called “Bloat”, is an emergency medical condition in dogs where the stomach fills with gas (dilatation) and rotates on itself (volvulus). .
What are some of the symptoms common to a pet with GVD/Bloat?
The typical presentation for dogs with GDV is a large, deep-chested dog with a sudden onset of abdominal distention, panting, restlessness, drooling, and repeated retching as if to vomit with no material produced. While the underlying cause of GDV is unknown, there have been several consistent risk factors reported in the literature.
What makes GVD/Bloat such a serious condition?
This twisted stomach traps gas and material inside and continues to expand quickly over time. The massively enlarged stomach compresses vital blood vessels within the abdomen, preventing normal blood flow to the organs. This leads to a combination of several life-threatening issues at once in the patient, and is 100% fatal without rapid emergency treatment and surgery. With aggressive treatment, mortality rates have been reported to be between 10 and 33%.
What are some of the risk factors identified with GVD?
Large of giant breed dogs with a deep chest make up almost all cases of GDV
German Shepherds, Great Danes, Standard Poodles, Labradors, and Doberman Pinschers are commonly affected breeds
Purebred dogs reported to develop GDV >8x that of mixed-breed dogs
If a dog has a close relative (mom,dad, or sibling) with a history of GDV, they are at a higher risk for GDV themselves.
Risk for GDV increases with age, but older dogs have the same chance of survival as younger dogs with urgent treatment and surgery
Dogs with an anxious or aggressive personality are at a higher risk for GDV
Dogs with a previous splenectomy are likely at a higher risk for developing GDV
Dogs fed one large meal per day are at a higher risk than those fed multiple smaller meals per day and a varied diet.
Dogs that eat very rapidly are at a higher risk for developing GDV
How is a GDV/Bloat dianosed?
Physical exam - A diagnosis of GDV can often be made on physical examination with a consistent history
Abdominal X-rays - The diagnosis of GDV is confirmed on abdominal x-rays
Blood work - this information helps to understand how the body systems are affected, and helps to guide the emergency treatment plan and anesthesia selection for surgery.
EKG - this test looks for an abnormal heartbeat which can be caused by GDV that needs treatment before anesthesia and surgery
How is GDV/Bloat treated?
Emergency Medical Treatment
Patients with GDV require immediate emergency medical treatment and should be brought in for veterinary care as soon as possible. The goal of emergency medical treatment is to stabilize the patient in preparation for anesthesia and surgery to correct the GDV. Emergency treatment involves decompression of the stomach with a tube or catheter to initially decrease the size of the stomach and improve blood flow to the organs. Aggressive fluid therapy is also started to rehydrate the patient, dilute a build-up of toxins in the bloodstream, and improve blood pressure and heart function. Cardiac arrhythmias (abnormal heartbeats) detected on EKG are addressed with IV medications to normalize the rhythm. Blood values are checked initially and then repeated during the course of emergency treatment to monitor the response to treatment and make changes as needed. Surgery is performed as soon as the patient is stabilized for anesthesia, typically within 1-2 hours of starting emergency treatment. Patients often cannot be completely stabilized until after surgery.
Surgery for Bloat/GVD
After emergency medical treatment to stabilize the patient, surgery is required to treat GDV. The goal of surgical treatment is to untwist the stomach and replace it in its normal location. In order to prevent the stomach from twisting again a surgical procedure called Gastropexy is performed. The Gastropexy procedure involves tacking the stomach to the internal body wall to hold it in its normal location. Over time, scar tissue develops and creates a permanent adhesion between the stomach and internal body wall, which prevents the stomach from twisting again. In severe cases, and when emergency treatment is delayed, parts of the stomach may become necrotic (dead) and require surgical removal. Sometimes, the spleen is also damaged and needs to be removed. The stomach, spleen, and all other organs are carefully evaluated at the time of surgery to determine any additional treatment is necessary. In the most severe cases, or when emergency treatment is delayed, the entire stomach can become necrotic (dead), in which case, euthanasia is the only option to prevent additional suffering.
With prompt, early intervention of GDV this outcome is far less likely. Because of how destructive GDV is, mortality rates range between 10-33% even with appropriate treatment. If resection of part of the stomach and/or spleen is required, mortality rate is typically on the higher end of that range whereas uncomplicated GDV cases are on the lower end. Without surgical treatment, GDV is 100% fatal. After surgery, most GDV patients require hospitalization and supportive care for 12-48 hours depending on the severity of the case.
The gastropexy procedure can also be performed as a prophylactic (preventative) measure against GDV in dogs at a high risk for GDV development. We recommend prophylactic gastropexy in large and giant breeds that have additional risk factors for development (see above). Roughly 25% of large and giant purebred dogs develop GDV in their lifetime. Great Danes and German Shepherd Dogs are greatly overrepresented in the GDV literature and should be strongly considered for prophylactic gastropexy.
For more information about this condition, visit ACVS.org.