Gastric Dilatation and Volvulus Syndrome (GDV)

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GDV is a medical emergency, and treatment should begin as soon as possible. The sooner the dog is treated, the greater its chance of survival.

Treatment is usually begun even before the test results (e.g., x-rays, an ECG, blood tests) are available. Treatment includes the following:

• Intravenous antibiotics (e.g., cefazolin sodium, cefoxitin sodium) to protect against gastrointestinal infection that can lead to endotoxemia (bacterial poisoning of the body which causes illness and shock)
• Intravenous corticosteroids (e.g., dexamethasone sodium phosphate or prednisone sodium succinate) to treat shock
• H2-receptor antagonists to prevent gastric ulceration, a potential postoperative complication

Medical Decompression
In cases of simple dilatation, the dog is sedated and a tube is passed through its mouth and into its stomach to remove built-up gas and fluid. This procedure is known as medical decompression. After the buildup is removed, warm-water stomach lavage is performed to wash out accumulated food and gastric juices.

Surgery
If the stomach is twisted, it may be impossible to pass a tube through the esophagus and into the stomach, and the dog will need surgery. Whether dogs with GDV require emergency surgery or not, prophylactic surgery is recommended to avoid recurrence. Surgery involves the following:

• Decompressing the stomach by inserting a large needle or trochar (a surgical instrument used for removing fluids from cavities) into the stomach cavity

• Moving the stomach back to its normal location

• Suturing the stomach to the body wall (usually part of the rib cage) so it can't twist again (gastropexy or anchoring surgery)

• Removing parts of the stomach that have been destroyed due to the lack of blood flow

• Removing the spleen if it has been compromised (splenectomy)

Complications
GDV surgery is not always successful. Potential complications include the following:

• Arrhythmias (irregular heartbeat) due to the decreased blood flow back to the heart
• Belching
• Death
• Disseminated intravascular coagulation (DIC), a blood clotting disorder that leads to diffuse bleeding, pain, and seizures
• Intermittent vomiting
• Postoperative gastric ulceration, open sores on the mucous membrane of the stomach caused by accumulated gastric juices (Gastric ulcers may occur—usually within 5 to 7 days following surgery—and may rupture, causing septic peritonitis, an infection and inflammation of the peritoneum, the membrane that lines the abdomen.)
• Recurrence of gastric dilatation

Post-surgical care
Post-surgical care involves the following:

• Antibiotics, if necessary
• Continued IV fluid therapy, if necessary
• Electrocardiograph monitoring and treatment for arrhythmias, if they occur
• Monitoring the dog's cardiorespiratory function for at least 24 hours
• Monitoring the dog's blood pressure and perfusion (passage of blood through the blood vessels) for at least 24 hours

Prevention
The risk of bloat can be reduced in the following ways:

• Eating small portions throughout the day (especially important for large, deep-chested dogs)
• Not breeding dogs with a family history of GDV
• Surgically "stapling" the dog's stomach to the inner abdominal wall (gastropexy) to prevent twisting
• Waiting 1 to 2 hours after eating before exercising (especially important for large, deep-chested dogs)

Prognosis
Without prompt medical attention, bloat can cause death. Death can occur even after treatment; the prognosis depends on the dog's condition during and after the surgery. The more time that passes from the onset of symptoms to the initiation of treatment, the worse the prognosis. Dogs that require removal of part of the stomach (partial gastrectomy) have a decreased chance of survival. Dogs that recover well 7 days after surgery have a very good chance of survival.

Recurrences are common, especially in dogs that do not undergo gastropexies. As many as 80% of all dogs that don't have gastropexies suffer recurrences, compared to 3% to 5% of dogs that do have gastropexies.

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