• Acute Gastric Dilatation-Volvulus in Dogs (Bloat)


    Malathi Raghavan, DVM, MS; Lawrence T. Glickman, VMD, DrPH; Nita W.Glickman, MS, MPH; Diana B. Schellenberg*,

    Конкурс! На самую лучшую фотографию Восточно Европейской Овчарки.-bloat-gifDietary risk factors for gastric dilatation-volvulus (GDV) in dogs were identified using a nested case-control study. Of 1991 dogs from 11 large- and giant-breeds in a previous prospective study of GDV, 106 dogs that developed GDV were selected as cases while 212 remaining dogs were randomly selected as controls. A complete profile of nutrient intake was constructed for each dog based on owner-reported information, published references and nutrient databases. Potential risk factors were examined for a significant relationship with GDV risk using unconditional logistic regression.

    The study confirmed previous reports of increased risks of GDV associated with increasing age, having a first-degree relative with GDV, and having a raised food bowl. New significant findings included a 2.7-fold (or 170%) increased risk of GDV in dogs that consumed dry foods containing fat among the first four ingredients.

    The risk of GDV was increased 4.2-fold (or 320%) in dogs that consumed dry foods containing citric acid that were also moistened prior to feeding by owners. Dry foods containing a rendered meat meal with bone among the first four ingredients significantly GDV risk by 53.0%.

    Approximately 30% of all cases of GDV in this study could be attributed to consumption of dry foods containing fat among their first four ingredients, while 32% could be attributed to consumption of owner-moistened dry foods that also contained citric acid. These findings can be used by owners to reduce their dogs' risk of GDV. This manuscript has been accepted for publication in the Journal of the Animal Hospital Association.

    Diet-Related Risk Factors for Gastric Dilatation-Volvulus in Dogs of High-Risk Breeds

    FINDINGS: VOLUME OF FOOD FED Malathi Raghavan, DVM, PhD Nita Glickman, MS, MPH George McCabe, PhDGary Lantz, DVMLawrence T. Glickman, VMD, DrPH

    From the Departments of Veterinary Pathobiology, (Raghavan, N. Glickman, L. Glickman), Veterinary Clinical Sciences (Lantz), and Statistics (McCabe),Purdue University West Lafayette, Indiana 47907-2027.

    A nested case-control study was conducted among 1634 dogs with complete diet information in a 5-year prospective study to determine diet-related risk factors for gastric dilatation-volvulus (GDV). Cases included 106 dogs that developed GDV; controls included 212 dogs without GDV that were frequency matched to cases by year of GDV onset.

    Proportionate energy consumed from major food types and from carbohydrates was determined. Dogs were categorized as consuming either a low volume or high volume of food based on the median number of cups of food fed per kg of body weight per meal. Dogs fed a larger volume of food per meal were at a significantly increased risk of GDV, regardless of the number of meals fed daily.

    For both large-and giant-breed dogs, the risk of GDV was highest for dogs fed a larger volume of food once daily.

    This is from 2002 and is still current:A Review S. Greene

    For over 30 years breeders and owners of Standard Poodles have been concerned about reducing their dogs' risk of bloat. Here's some generalized information to help you understand new information learned from a Purdue University Bloat (Gastric Dilation - Torsion Complex)

    The term "Bloat" refers to any of three conditions:

    Acute gastric dilation

    Bloat also known as the overfeeding or overeating syndrome, involves a swelling up of the stomach from gas, fluid or both (acute gastric dilation). Once distended, the stomach may twist abruptly on the long axis. If it does twist, but the twist is 180 degree or less, it is called a torsion. A twist greater than 180 degrees is called a volvulus.

    Signs and Symptoms of Non-Torsion Bloat - Acute Gastric Dilation The signs are excessive salivation and drooling, extreme restlessness, attempts to vomit or pass stool and evidence of abdominal pain - the dog whines and groans when you push on the stomach wall. The abdomen will be istended. If your dog can belch or vomit, quite likely the condition is not caused by a twist. You must take the dog to a veterinarian where a long rubber or plastic stomach tube will be passed into the stomach. If there is a rush of air from the tube, the swelling in the abdomen will subside and there is almost immediate relief.

    Signs and Symptoms of Torsion or Volvulus - A LIFE AND DEATH SITUATION

    The initial signs are those of acute gastric dilation, except the distress is more marked. The dog breathes rapidly, has cold and pale mouth membranes and may even collapse. The shock-like signs are caused by strangulation of the blood supply to the stomach and the spleen in torsion or volvulus, a tube cannot be passed into the stomach. The only treatment is IMMEDIATE surgery and you must rush the dog to closest veterinary surgeon.

    Preventing Bloat - The Purdue University Study

    Many measures have been recommended and tried, but-until recently there has been little scientific evidence that any worked. Now, thanks to the Purdue University Bloat Study that picture is starting to change. Supported by grants from the American Kennel Club's Canine Health Foundation, Morris Animal Foundation and 11 parent breed clubs, including the Poodle Club of America, this five-year prospective study is the first of its kind. And it is yielding information on what breeders and owners should and shouldn't do to reduce Standard Poodles risk of bloat.

    The Purdue researchers, led by veterinarian and epidemiologist Dr. Lawrence T. Glickman, have thus far issued two reports of their findings, both published in the peer-reviewed Journal of the American Veterinary Medical Association. The more recent of the two, which appeared in the November 15, 2000, issue of JAVMA, contains findings that should cause Standard Poodle breeders and owners to step back and re-think bloat prevention information.

    One of the more important findings was that there are significant differences between the "large breeds" studied (Akita, Bloodhound, Collie,Irish Setter, Rottweiler, Standard Poodle and Weimaraner) and the "giant breeds" studied (Great Dane, Irish Wolfhound, Newfoundland and Saint Bernard).

    The results reported here apply to the "large breeds" only, e.g. our Standard Poodles

    Old Thoughts: What We Used to Think About Bloat Over the years, breeders, owners and veterinarians have developed a body of lore about what causes bloat and how it can be prevented. Here are some of those things which we now know are correct, i.e. bloat is caused by too much exercise on a full stomach. Overloading the stomach. Swallowing air when eating. We used to think that bloat could be prevented or reduced by Wetting dry kibble so that it won't swell in the stomach. Raising the food dish above floor level. Weight, breed size, the ratio of the depth of the thorax to its width and stress were not significantly associated with the risk of bloat in large breed dogs. In addition, several measures that have long been recommended to reduce the risk of bloat were found to have no effect.

    Factors That Make Difference - These measures, long been thought to reduce the risk of bloat, were found to have no effect:

    Restricting exercise before or after eating
    Restricting water intake before and/or after meals
    Feeding two or more meals per day
    Moistening dry kibble before feeding

    Factors That DO Make A Difference

    These four (4) factors ARE associated with an increased risk of bloat in large breed dogs

    1)Raising the food dish more than doubled the risk for bloat
    2)Speed of eating -Dogs rated by their owners as very fast eaters had a 38% increased risk of bloat
    3)Age: The study found that risk increased by 20% with each year of age. Owners should be more alert to early signs of bloat as their dogs grow older.
    4)Family History: Having a first-degree relative (parent, sibling or offspring) that had bloated increased a dog's risk by 63%.


    The Purdue research team concluded these are the things you can do to prevent bloat:

    The strongest recommendation to prevent GVD (bloat) should be to not breed a dog that has a first degree relative that has had bloat. This places a special responsibility on an owner to inform the breeder should their dog bloat.

    1)Do not raise the feeding dish
    2)SLOW the dog's speed of eating.

    A future report from the research team will provide data on dietary factors and how they may or may not be associated with bloat risk

    References: 1. http://www.vet.purdue.edu/epi/bloat.htm 2.Glickman LT, Glickman NW, Schellenberg, DB, et al. Non-dietary risk factors for gastric dilatation-volvulus in large and giant breed dogs. 3.Dog Owner's Home

    Veterinary Handbook, Delbert G. Carlson, DVM and James M. Giffin, MD




    By Patricia Long
    June, 1997
    Updated April, 2009
    Edited by Dr. Kathy Berge, DVM
    Websites to bookmark:

    Bloat Overview - Symptoms, Causes, Prevention, Links http://www.globalspan.net/bloat.htm
    MichVet.com http://www.michvet.com/library/surgery_gdv.asp
    Bloat first aid kit & demonstration http://www.kifka.com/Elektrik/BloatFirstAid.htm
    Contributors: Sherri Starbird; Berner-list: Susan Ablon, Marianne Becktel, Judy Benoit, Liz Bradbury, Cathy Burlile, Dr. Laurel Cain, DVM, Dino Candelaria, Gael Goldsack, Gisela Haas, Valorie Horney, Linda Klei, Bronnie Longhurst, the McHales, Christine Nielson, Marjorie Reho, Roscoe (with thanks to the newf-l), Frankie Rubel, Phil Shaffer, Debbie Tripp, Jerry Uhl
    Have you ever eaten too much at a family gathering? Remember that uncomfortable bloated feeling? All you did was sit down and relax for an hour or two, and you were ready for dessert. So why does everyone panic over bloat in their dogs?
    Gastric dilatation-volvulus is an acute, life-threatening situation.
    Gastric dilatation-volvulus requires immediate medical and surgical attention.


    Gastric dilatation means stomach distention or enlargement. This may or may not be accompanied by volvulus, or torsion, or twisting of the stomach on its long axis. Once the stomach twists, the stomach contents are trapped in place as the gas continues to build. As the stomach expands,it can press on major arteries and veins in the abdominal cavity, restricting blood flow and lowering blood pressure. Once this happens, the heart rate increases and the pulse becomes weak as the dog goes into shock. If the stomach swells enough, it can displace the spleen, cutting off circulation, and causing enlargement and even twisting of the spleen. With circulation for the stomach constricted, parts of the stomach wall can necrose, or die. All of this can happen over a period of hours, or even minutes. But once it starts, it needs immediate medical attention.
    Classic symptoms of bloat include pacing, difficulty walking, panting, discomfort, agitation, depression, drooling, foaming or frothing at the mouth, unproductive vomiting or retching, distention of the stomach. The swollen stomach may be grossly large, and hard (tympanic) to the touch. If the dog is going into shock, the gums will appear pale or grey, and when they are depressed with a finger, the color will be very slow to return; the heart rate will be fast, but the pulse will be weak. [Try looking at your healthy dog right now. Look at the color of the gums. Now you know their normal color. Press on the gum with your finger for a second. When you remove your finger, you will see a white mark where all the blood was pushed out of the capillaries. The speed with which the color returns shows a good blood pressure as the capillaries refill. Anytime the blood flow is compromised, the capillaries are the first to shut down. Now try to find the pulse. I just tried, and according to my findings, Maggie is dead. You can find the pulse by placing your finger on the femoral artery - high up on the inside of the back leg. I finally found Maggie's, but practice before you have to find it on a sick dog.]

    • Seek immediate veterinary assistance if your dog ...
      • ► attempts to vomit (usually unsuccessful); may occur every 2-30 minutes
      • ► is foaming or frothing at the mouth
      • ► is anxious and restless
      • ► is "hunched up" or "roached up" appearance
      • ► appears to have a bloated abdomen that may feel tight like a drum
      • ► has pale or off-color (bright red) gums
      • ► displays unproductive gagging
      • ► is whining
      • ► is pacing
      • ► is uncomfortable - won't sit or lie down, is panting excessively, or is standing spread-legged


    In theory, the treatment for bloat is simple. Treat the shock with IV fluids, decompress the stomach, and if the stomach has twisted, get it back into position. In reality, it gets more complicated. An x-ray will usually show if the stomach has rotated or not. If a tube can be put down the throat into the stomach, this is what is preferred. The stomach contents are emptied and the stomach is rinsed with water or a saline solution. If the dog cannot be tubed [the danger with entubation is that it can rupture the lower esophagus], then another possible procedure is trocarization, or inserting a large bore needle directly into the stomach wall. [The danger with this procedure is peritonitis from stomach contents leaking into the abdominal cavity and causing infection. For an untrained person, the danger is that the needle will be put into an enlarged spleen instead of the stomach, or the wall of the stomach will rupture because the stomach wall has stretched too thin.] Once enough gas has been released by the trocar, the dog can sometimes be tubed to further decompress and empty the stomach. The other procedure is to make an incision in the stomach wall in order to empty the stomach.
    Surgery may be required to reposition the stomach, and if part of the stomach wall has necrosed, that part will have to be removed (resected). If the spleen has sustained enough damage, it will have to be removed. Once the dog has bloated, there is an extremely high probability that he will bloat again. To prevent the stomach from twisting, and to significantly reduce the probability of bloat recurring, the stomach should be tacked in place (gastropexy). Some dogs with a high degree of risk can have a gastropexy done before the dog ever bloats. The easiest form of this is a laparoscopic gastropexy. Using a laparascope to see, small incisions are made, and the stomach is tacked at each incision site. Done on an outpatient basis, it could cost under $400 (US). When surgery is required for bloat, it typically costs about $1200 (US) if there are no complications. With complications, stomach resection, splenectomy, the cost can reach $5000 (US).


    An recent study conducted at Purdue University by Dr. Glickman, provides current information about the risk factors and probability of bloat. Dr. Glickman's extensive research focused primarily on study of Irish Setters.

    • ► NOTE ► The dogs who are at greatest risk of bloat are the large, deep chested breeds.
      The greater the chest depth/width ratio, the greater the risk of bloat.
    • ► NOTE ► Happy dogs are less likely to bloat.

      • ► Factors linked to an increased risk are:
        • history of belching and flatus (gas),
        • aggression toward people or other dogs,
        • fast eating,
        • fewer meals per day,
        • less canned food,
        • less table scraps,
        • fewer snacks,
        • raising the food bowl INCREASES the risk of bloat - the higher the dish, the greater the risk.

          • ► Factors with NO correlation to risk are:
            • dry food,
            • dry food moistened with water,
            • supplements, vitamins,
            • multiple animal households,
            • pre-existing disease,
            • drug treatment,
            • vaccines

    Some of the common precipitating factors are: stressful event, change in feeding time, bigger meal than usual.

    Most cases of bloat occur between 6pm and midnight - 59.3% of the cases studied by Dr. Glickman occurred during that time period.
    The gastropexy greatly reduced the risk of recurrence of bloat, from 4% per month to 0.3% per month.
    In Dr. Glickman's study of 1934 dogs with GDV, he reports a death rate of 28.6% from gastric dilatation, and 33.3% from gastric dilatation-volvulus, and a lifetime recurrence rate of 80%, dropping to 3-5% with gastropexy.


    One of the keys to helping a dog survive bloat is to know your dog. If he's not acting normal and you suspect bloat, go to the vet and have it checked. If your vet isn't sure, but you are, insist on having x-rays taken. Many of the cases of bloat presented here followed surgery - stress. Always watch a dog carefully for the first 24 hours following any surgical procedure. If the dog has to remain at the vet's clinic, ensure that the dog will be monitored regularly around the clock. Otherwise, consider Dr. Laurel Cain's advice and move the dog to an emergency clinic where he will receive careful monitoring.
    Once a dog has bloated, there is a good chance that he will bloat again.

    • ► Avoid vigorous exercise for one hour before and two hours after eating.
    • ► Always watch for signs of bloat, especially after any type of stress.
    • ► Feed your dog at least twice a day.
      I found that mixing in a couple of large spoons of canned food with the dry helped to slow Vesta and Maggie when they eat.
    • ► And keep those guys happy!


    Berner-Garde Database records accessed on April 12, 2009 lists 127 records found Diagnosis = GASTRIC DILATATION (BLOAT) & 106 records found Diagnosis = GASTRIC DILATATION / VOLVULUS (BLOAT / TORSION)
    Sherri Starbird's Flash showed well enough on Saturday May 12, 2007 to get an Award of Merit at the National Specialty; but Sherri knew he was off. She thought he might just need to poop. He relaxed, he settled in, but by dinner time he was gagging up white foam and they rushed him to the ER. He was in full torsion and had immediate surgery to reposition the stomach and tack it to prevent further rotation. The surgery went well. However, over the following days he continued to fail, as his sodium level rose along with the temperature. Not only is there a risk of cardiac issues after the surgery, but sodium can elevate dangerously, and treatment has to be aggressive ? a line into the jugular and a urinary catheter. Flash didn?t make it, his temperature soared along with the sodium levels - a rare but very dangerous side effect of bloat. [Dr Simmons told her that approx. 20-30 percent of bloat cases don't make it, that it is a very life-threatening event, and not always in predictable ways. (This in part due to the cells in the blood/fluids that die during the torsion - when circulation is cut off.) Once the torsion is released, he said those now necrotic cells are released in the dog?s system, and it is unpredictable where the "poisonous" stuff ends up and causes damage. In Flash's case, they may have ended up in the hypothalamus causing inability to regulate the body electrolytes and temperature, or caused that chain-reaction which damaged the brain regulatory center (hypothalamus).]


    There have been many stories on the Berner-L from people whose dogs have bloated. Marianne Becktel and Marjorie Reho advocate giving the dog Mylanta II or Maalox before taking the dog to the vet.
    From best case to worst case, here are the List examples:
    - several people report their dogs have a gulping episode, but after an hour of this, it goes away with no other symptoms.
    - pre-bloat behavior (pacing, discomfort) was noticed by Gisela Haas (Chuckie), Judy Benoit (Sarah), Liz Bradbury (Boots), and Pat Long (Vesta).
    - Susan Ablon's Granville bloated 5 hours after eating, the vet successfully tubed him to decompress the stomach, there was no torsion or surgery. He bloated again at age 8.5, it's thought to have been triggered by the GI ulcer caused by all the medications he was taking.
    - Linda Klei had just moved, her other dog was being kept at her Mom's house while undergoing chemotherapy, and on her first day at work, 9 year old Dutchie bloated after eating a lot of cedar chips and part of a blanket. Although she was about 180 degrees torsed, Dutchie was successfully tubed.
    - Cathy Burlile's Cailler bloated when he was 4 years old, she feeds him 4 times a day, and he is now 9.5 years old. He had had minor surgery 36 hours prior to bloating.
    - Judy Benoit's Sarah had a root canal, came home and curled up in the yard. When she came inside, she couldn't get comfortable. It was bloat. Sarah's sire and one littermate died of bloat.
    - Valerie Horney's Booker was smiling and wagging, but his stomach looked distended. She had to insist on getting an x-ray because the vet didn't think it was bloat. It was, and Booker was already partially torsed. After surgery, he was raring to go!
    - Phil Shaffer's Boris had shoulder surgery, bloated 24 hours later, but never did have any of the classic symptoms.
    - Jerry Uhl's 10 year old Harbo bloated immediately after coming home from the place where he was boarded for 4 days. He successfully survived the surgery and lived another 2 years until his death from old age at 12.
    - Debbie Tripp's Kim bloated right after checking into the Specialty. Kim had all the classic symptoms, it was bloat with torsion. With quick action on Debbie's part, plenty of luck, and a lot of good medical help, 10.5 year old Kim survived the bloat and the surgery. It is believed that Debbie survived the Specialty!
    - Frankie Rubel's Matt bloated at 1:30am. Having previously lost a dog to bloat, Frankie's son recognized the symptoms. Quick action and surgery helped Matt pull through successfully. The procedure cost $2108 at U of P Vet Hospital. Matt's sire is Cathy Burlile's Cailler.
    - The McHale's Quincy bloated at 7 months. Six weeks later, he bloated again. They then had the gastropexy done, but just one week after the vet gave the go ahead for Quincy to receive normal activity, Quincy contracted Parvo which he was unable to survive. His immune system was probably seriously compromised from all the stress.
    - Marge Reho's Anneke had surgery to correct and ear-flap hematoma, and went into cardiac arrest from an allergy to the anesthetic (before the days of isoflurene). She was put on heart medication which is no longer on the market, because it produces stomach problems. The first time Anneke bloated, she was successfully tubed. The second time she bloated, Marge was able to fix the situation with almost half a bottle of Maalox. The last time, Anneke was given some ice cream in celebration of her 6th birthday. Anneke bloated, the stomach torsed completely, she was unable to be tubed, and because of the allergy to anesthesia, surgery would have been immediately fatal. The stomach did not twist back on its own, and Anneke did not survive. The vet felt that the cold food was the immediate trigger for the bloat.
    - Bev Barney fed her 10 month old bitch one morning, crated her that night, and she was already bloating the next morning when the crate was opened. The bitch died on the way to the vet.
    - Cathy Burlile lost her Dallas to bloat when he was 2 years old. He showed all the classic symptoms, and survived the surgery only to die of complications following the procedure (DIC, disseminated intravascular coagulation).
    - Marge Reho's Heike underwent an emergency spay, bloated that night at the vet's clinic, and was dead the next morning when they opened at 6am.
    - Dino Candelaria's Diver started to show classic early signs of bloat, and when she called the vet he agreed. He told her to take her to the emergency clinic for overnight observation, but to first perform a "full nelson bloat joggle" (Dino's term!). She put her arms behind Diver's front legs, then under and up in front and then up and over behind the neck (a full nelson on a person). Dino picked Diver up and joggled her up and down to allow the weight of the food to help straighten the stomach. It allowed Diver to start belching, and by the time Diver reached the emergency clinic, there was no gas in the stomach, and the stomach had not twisted. Diver stayed overnight for monitoring, but no surgery was required. Dino stresses that the bloat joggle should not be used instead of going to the vet, but only as the first line of defense.
    Some of the other contributions to the list include:
    - Christine Nielson's friend's dog who had his teeth cleaned Friday, bloated on Saturday and tubed successfully, bloated again on Sunday and was again successfully tubed.
    - Gael Goldsack knew of an 18 month old irish wolfhound who died of bloat after eating too much bread, which was felt by the owner to have fermented, causing gas (gas in the stomach of dogs with GDV has been shown to be primarily air, not gas produced by bacterial fermentation. - paraphrase from Small Animal Clinical Nutrition as per Cathy Burlile).
    - Roscoe posted all the newf-L posts about bloat, one of which linked bloat in her dog to a soy based diet (although no study has ever been done which links soy to bloat); another related the story of a newf on a natural diet who bloated.
    - Bronnie Longhurst knew a Saint Bernard on the BARF diet who bloated.
    - Cathy Burlile knew someone with a GSD who used Gas-X successfully on the first 2 occurrences of bloat, but the third time there was full torsion that required immediate surgery.
    As you can see from this collection, there are many different symptoms, and many different outcomes.
    Website: Bloat references http://www.dogfencediy.com/library/c...t-information/
    Report to Morris Animal Foundation, 1/10/93, Combined Final Report/Progress Report For Phase I, Dr. Glickman, DVM, 1/10/93.
    Multiple Risk Factors for the Gastric Dilatation-Volvulus Syndrome in Dogs: A Practitioner/Owner Case-Control Study, Dr. Glickman, DVM, et al, Journal of the American Animal Hospital Association, May/June 1997 Vol 33 No 3, pp 197-204.
    U.C. Davis Book of Dogs, edited by Mordecai Siegal, 1st edition, 1995.
    Saunders Manual of Small Animal Practice, Stephen J. Birchard, DVM, Robert G. Sherding, DVM, W. B. Saunders, 1st edition, 1994.
    Essentials of Small Animal Internal Medicine, Richard W. Nelson, DVM, C. Guillermo Couto, DVM, Mosby Year Book, 1992.
    The Merck Veterinary Manual, Merck & Co., 7th edition, 1991.