Prevention strategies for GDV/bloat in dogs

Re: Prevention strategies for GDV/bloat in dogs

John Flynn — Thu, 17 Oct 2013 21:02:44 GMT

[quote user="robloxley"]I accept though there are individual case reports of pexied dogs with recurrence of GDV[/quote]

I've seen one in a red setter 7 years later.

[quote user="robloxley"]prophylactic surgery[/quote]

Obviously controversial.

[quote user="robloxley"] though I don't think anyone would suggest not pexy-ing a GDV they operated upon?[/quote]

Agreed. And this has been my experience. But I wonder whether there's published data out there that would convince a skeptic? All I found was:

W.E. Wingfield, C.W. Betts, R.W. Greene. Operative techniques and recurrence rates associated with gastric volvulus in the dog. J Small Anim Pract, 16 (1975), pp. 427–432

cited as the source of the "80% recurrence without gastropexy" oft quoted.

Here's the source data:

1. Technique not available

4 successes
1 failure

2. Pyloric surgery

20 successes
5 failures

3. Gastrotomy

[table is blank on this line]

4. Gastrectomy

6 successes
0 failures

5. Gastropexy

27 sucesses
8 failures

6. Pharyngostomy tube

5 successes
1 failure

7. Splenectomy

15 successes
4 failures

8. Repositioning alone

1 sucess
4 failures

* "Success" = No surgical recurrences 5 months post-operatively.

Unless there's other data out there, then I wouldn't personally be able to think it enough evidence to convince a skeptic that gastropexy was necessary (though I personally gastropexy any GDV that I operate on and would encourage anyone asking to do the same and my case-load is hardly large enough to draw meaningful conclusions based purely on my own experience).

Re: Prevention strategies for GDV/bloat in dogs

John Flynn — Thu, 17 Oct 2013 20:41:00 GMT

[quote user="Niall Taylor"]I still can't find that paper on kibble size, annoyingly.[/quote]

Theyse LFH, van de Brom WE, van Sluijs FJ. Small size food particles and age as risk factors for gastric dilatation volvulus in Great Danes. Vet Rec 1998;48–50.

I think the Glickmans' papers (particularly the later ones) are more interesting reads though:

Glickman LT, Glickman NW, Perez CM, et al. Analysis of risk factors for gastric dilatation and dilatation-volvulus in dogs. J Am Vet Med Assoc1994;204:1465–1471.

Glickman LT, Glickman NW, Schellenberg DB, et al. Non-dietary risk factors for gastric dilatation-volvulus in large and giant breed dogs. J Am Vet Med Assoc 2000;217(10):1492–1499

Glickman LT, Emerick T, Glickman NW, et al. Radiological assessment of the relationship between thoracic conformation and the risk of gastric dilatation-volvulus in dogs. Vet Radiol Ultrasound 1996;37:174–180.

Glickman LT, Glickman NW, Schellenberg DB, et al. Multiple risk factors for the gastric dilatation-volvulus syndrome in dogs: a practitioner/owner case-control study. J Am Anim Hosp Assoc1997;33:197–204.

Glickman LT, Glickman NW, Schellenberg DB, et al. Incidence of and breed-related risk factors for gastric dilatation-volvulus in dogs. J Am Vet Med Assoc 2000;216(1):40–45.

Raghavan M, Glickman N, McCabe G, et al. Diet-related risk factors for gastric dilatation-volvulus in dogs of high-risk breeds. J Am Anim Hosp Assoc2004;30:192-203.

Raghavan M, Glickman NW, Glickman LT. The effect of ingredients in dry dog foods on the risk of gastric dilatation-volvulus in dogs.J Am Anim Hosp Assoc2006;42:28-36.

Re: Prevention strategies for GDV/bloat in dogs

Francisco Gomez — Thu, 17 Oct 2013 20:11:53 GMT

[quote user="Evelyn Barbour-Hill"]

61 dogs had gastropexies done. None of them suffered a gastric volvulus in their subsequent life. It's a little sweeping to conclude from that , that: "This study confirmed the efficacy of IG for the long-term prevention of GDV in dogs."

[/quote]

It sounds just like 'I vaccinated 61 dogs with a homeopathic distemper vaccine. None of them had suffered distemper in their subsequent life'.

... and now you ask me, they didn't suffer from alcoholism and gambling either, so it must protect against that too...

Re: Prevention strategies for GDV/bloat in dogs

Evelyn Barbour-Hill — Thu, 17 Oct 2013 20:06:41 GMT

61 dogs had gastropexies done. None of them suffered a gastric volvulus in the subsequent follow-up period (which varied from dog to dog, with a maximum of 2511 days and a minimum of a mere 49 days). It's a little sweeping to conclude from that , that: "This study confirmed the efficacy of IG for the long-term prevention of GDV in dogs."

Re: Prevention strategies for GDV/bloat in dogs

Rob Loxley — Thu, 17 Oct 2013 19:39:51 GMT

[quote user="Bob Russell"]I am not sure a single survey of 60 odd dogs can be taken as 'gospel'[/quote]

Indeed, but what evidence do you want to use, if you discount the evidence available? I'd put it above singe case reports of recurrence of GDV in pexied dogs.

[quote user="Bob Russell"]Not saying it should not be done but a pexy is not a 'no risk' procedure in itself.[/quote]

Indeed - see the rest of my post

Re: Prevention strategies for GDV/bloat in dogs

Bob Russell — Thu, 17 Oct 2013 17:07:02 GMT

I am not sure a single survey of 60 odd dogs can be taken as 'gospel'. I doubt such a small study in man would lead to such a major procedure becoming acceptable routinely!

Not saying it should not be done but a pexy is not a 'no risk' procedure in itself.

Re: Prevention strategies for GDV/bloat in dogs

Anthony Dennison — Thu, 17 Oct 2013 14:33:34 GMT

[quote user="Evelyn Barbour-Hill"]It's my suspicion that after three or four years the stomach will not be significantly "fixed" at all and it might even be hard to trace the original pexy at post mortem – perhaps a little scarring or a pathetic strand of tissue.[/quote]

In my final year an Irish Setter was referred to the Surgery department at Bristol, suffering what seemed to be GDV despite having a pexy 2 or 3 years previously. Pexy was still well in place, they'd just sutured the wrong part of the stomach to the body wall. It was still pretty well attached at that point, only way of breaking it down was electrocautery.

Re: Prevention strategies for GDV/bloat in dogs

Rob Loxley — Thu, 17 Oct 2013 13:50:43 GMT

the evidence for the efficacy of gastropexy is there eg. http://www.ncbi.nlm.nih.gov/pubmed/23535748 in a decent number of cases studied over a decent number of years
I accept though there are individual case reports of pexied dogs with recurrence of GDV, and so we should (as ever) be discussing the pros/cons of prophylactic surgery, though I don't think anyone would suggest not pexy-ing a GDV they operated upon?

Re: Prevention strategies for GDV/bloat in dogs

Evelyn Barbour-Hill — Thu, 17 Oct 2013 12:27:44 GMT

[quote user="Niall Taylor"]

[quote user="Evelyn Barbour-Hill"]You could (has anybody, ever?) but it would not answer the question.[/quote]

True, but maybe you're asking the wrong question

[/quote]

I'm asking the question the answer to which I am interested in!

It's my suspicion that after three or four years the stomach will not be significantly "fixed" at all and it might even be hard to trace the original pexy at post mortem – perhaps a little scarring or a pathetic strand of tissue.

Re: Prevention strategies for GDV/bloat in dogs

Braden Collins — Thu, 17 Oct 2013 10:43:45 GMT

I read a paper a few years ago that indicated that the complication rate from prophylactic pexys was high enough that they were not clinically justified. This was around the time laprascopic pexys were starting to be done so I believe the study was done on dogs having a normal laparotomy. Laprascopic pexys may have a lower complication rate so that may be a different story. Sorry but don't have a reference.

Re: Prevention strategies for GDV/bloat in dogs

Niall Taylor — Thu, 17 Oct 2013 08:59:12 GMT

[quote user="Evelyn Barbour-Hill"]You could (has anybody, ever?) but it would not answer the question.[/quote]

True, but maybe you're asking the wrong question

Surely the relevant outcome measure would be how prophylactic pexying affected the GDV rate in matched populations? Or even more broadly, survival times and GI problems generally, post-op. That way the potential negative consequences of prophylactic pexying might be taken into account.

I agree that it seems a rather drastic step to do a gastropexy in a healthy gut - it's something we have discussed with the vets here but never actually put a policy in place.

Cheers,

Niall

Re: Prevention strategies for GDV/bloat in dogs

Evelyn Barbour-Hill — Thu, 17 Oct 2013 01:00:29 GMT

[quote user="robloxley"]

[quote user="Evelyn Barbour-Hill"]

I'd be interested to know how many of those gastropexies are still pexed, as it were, three or four years later. I'm not sure how one could ever find out, unless you did systematic post-mortem examination of every operated dog.

[/quote]

You can compare the GDV recurrence rate between patients that were pexied at time of surgery and those that weren't?

[/quote]

You could (has anybody, ever?) but it would not answer the question.

Re: Prevention strategies for GDV/bloat in dogs

Rob Loxley — Wed, 16 Oct 2013 23:27:18 GMT

[quote user="Evelyn Barbour-Hill"]

[/quote]

You can compare the GDV recurrence rate between patients that were pexied at time of surgery and those that weren't?

Re: Prevention strategies for GDV/bloat in dogs

Evelyn Barbour-Hill — Wed, 16 Oct 2013 16:09:43 GMT

Re: Prevention strategies for GDV/bloat in dogs

Rob Loxley — Wed, 16 Oct 2013 13:47:30 GMT

[quote user="Utlendigur"]But gastropexy won't prevent bloat - just volvulus.[/quote]

Fair, but its the V that kills them...

Re: Prevention strategies for GDV/bloat in dogs

Utlendigur — Wed, 16 Oct 2013 13:42:13 GMT

But gastropexy won't prevent bloat - just volvulus.

Nb have you ever noticed that owners who want you to do gastropexys ( or "just stitch her stomach while you're in there) at spaying are usually having the neutering done on a charity voucher

Re: Prevention strategies for GDV/bloat in dogs

karen jones — Wed, 16 Oct 2013 13:37:17 GMT

One of our vets has just been on emergency surgery course with cpd solutions. The vet on that said they were offering prophylactic stomach anchoring ops at neutering in breeds at risk.

Re: Prevention strategies for GDV/bloat in dogs

Niall Taylor — Wed, 16 Oct 2013 09:23:58 GMT

[quote user="Andrew Kent"]This is the paper most people refer to:

Non-dietary risk factors for gastric dilatation-volvulus in large and giant breed dogs

[/quote]

Thanks Andy and others. My concern with papers like this is obviously large breed dogs are a/ prone to gdv and b/ have owners who like to use raised feeding. So is this cause and effect or it is selection bias? I was always taught that raised feeding reduced the risk of GDV

I still can't find that paper on kibble size, annoyingly.

Niall

Re: Prevention strategies for GDV/bloat in dogs

Utlendigur — Tue, 15 Oct 2013 14:49:59 GMT

[quote user="bob lehner"]

[quote user="Anthony Dennison"]

These are also really good as an aid for weight loss as well, one of my nurses loves them.

[/quote]

Very interesting - I didn't realise that people used them as well. I'll pass it on to a couple of chubby VNs I know.

[/quote]

Reminds me of a practice website I saw recently that said something like "Our large and friendly staff are always here to help"

Re: Prevention strategies for GDV/bloat in dogs

Anthony Dennison — Tue, 15 Oct 2013 13:59:52 GMT

[quote user="bob lehner"]

[quote user="Anthony Dennison"]

These are also really good as an aid for weight loss as well, one of my nurses loves them.

[/quote]

Very interesting - I didn't realise that people used them as well. I'll pass it on to a couple of chubby VNs I know.

[/quote]

Oh dear. Bad grammar gets you nowhere! I'll try again, my nurse loves recommending them for use with dogs trying to lose weight.

Re: Prevention strategies for GDV/bloat in dogs

bob lehner — Mon, 14 Oct 2013 18:24:34 GMT

[quote user="Anthony Dennison"]

These are also really good as an aid for weight loss as well, one of my nurses loves them.

[/quote]

Very interesting - I didn't realise that people used them as well. I'll pass it on to a couple of chubby VNs I know.

Re: Prevention strategies for GDV/bloat in dogs

Andrew Kent — Mon, 14 Oct 2013 18:07:27 GMT

This is the paper most people refer to:

Non-dietary risk factors for gastric dilatation-volvulus in large and giant breed dogs

Lawrence T. Glickman, VMD, DrPH Nita W. Glickman, MS, MPH Diana B. Schellenberg, MS Malathi Raghavan, DVM, MS Tana Lee, BA Department of Veterinary Pathobiology, School of Veterinary Medicine, Purdue University, West Lafayette, IN 47907-1243. (Glickman, Schellenberg, Raghavan, Lee); Center for the Human Animal Bond, School of Veterinary Medicine, Purdue University, West Lafayette, IN 47907-1243. (Glickman) Objective—To identify non-dietary risk factors for gastric dilatation-volvulus (GDV) in large breed and giant breed dogs.

Design—Prospective cohort study.

Animals—1,637 dogs ≥ 6 months old of the following breeds: Akita, Bloodhound, Collie, Great Dane, Irish Setter, Irish Wolfhound, Newfoundland, Rottweiler, Saint Bernard, Standard Poodle, and Weimaraner.

Procedure—Owners of dogs that did not have a history of GDV were recruited at dog shows, and the dog's length and height and the depth and width of its thorax and abdomen were measured. Information concerning the dog's medical history, genetic background, personality, and diet was obtained from the owners, and owners were contacted by mail and telephone at approximately 1-year intervals to determine whether dogs had developed GDV or died. Incidence of GDV, calculated on the basis of dogyears at risk for dogs that were or were not exposed to potential risk factors, was used to calculate the relative risk of GDV.

Results and Clinical Relevance—Cumulative incidence of GDV during the study was 6% for large breed and giant breed dogs. Factors significantly associated with an increased risk of GDV were increasing age, having a first-degree relative with a history of GDV, having a faster speed of eating, and having a raised feeding bowl. Approximately 20 and 52% of cases of GDV among the large breed and giant breed dogs, respectively, were attributed to having a raised feed bowl. (J Am Vet Med Assoc 2000;217:1492–1499)

Re: Prevention strategies for GDV/bloat in dogs

Anthony Dennison — Mon, 14 Oct 2013 17:27:46 GMT

[quote user="bob lehner"]He recommended using a special feeding bowl designed to prevent the dog eating too fast - a number of these are marketed - they have raised knobbles in them so the dog has to chase the food around and can only take small mouthfulls (google 'anti-bloat feeding bowl'). [/quote]

These are also really good as an aid for weight loss as well, one of my nurses loves them.

At University (2012 grad.) we were taught the benefits of raised feeding too. Kibble size is a factor - the bigger the kibble the longer time spent chewing, slowing down gobbling rate.

Re: Prevention strategies for GDV/bloat in dogs

John Flynn — Mon, 14 Oct 2013 17:16:44 GMT

[quote user="Niall Taylor"]a paper I seem to recall about large kibble size being a protective factor. [/quote]

I thought it was the other way round...?

[quote user="Niall Taylor"]postural/elevated feeding can predispose dogs to the condition[/quote]

That is my understanding. There were various papers by the Glickmans over a decade ago on risk factors and I think this was one of the "statistaically significant" ones they found.

I've always just accepted the quoted risk factors, never looked at the actual studies in detail.

I tend to direct owners to: http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=672 for a list.

Re: Prevention strategies for GDV/bloat in dogs

bob lehner — Mon, 14 Oct 2013 15:10:24 GMT

I watched a good webinar on gdv a while back - can't remember who it was by, but was a reasonably well-known name. He recommended using a special feeding bowl designed to prevent the dog eating too fast - a number of these are marketed - they have raised knobbles in them so the dog has to chase the food around and can only take small mouthfulls (google 'anti-bloat feeding bowl').

He also said don't let the dog fall asleep too soon after eating, as they can't burp whilst asleep and so more likely to get gas build up - gentle exercise post feeding was better.