Just like humans, cats can suffer from acid reflux, also known as gastroesophageal reflux disease or GERD.
Cat acid reflux isn’t a common occurance. Hopefully, for most cat owners this is something they will experience no more than once or twice a year. When it does happen, acid reflux in cats is usually caused by the occasional hairball or gastrointestinal irritation, but for some unfortunate cats (and their owners), this is a daily occurrence.
When we spoke to a vet, we heard that what always shocks them is the number of cat owners who come in and report that their cat vomits or regorges on a weekly or more frequent basis.
Cat owners whose cats suffer from acid reflux usually attribute it to “hairballs” or “eating too fast” and assume this is normal feline behavior. However, our vet always asks: if you were vomiting two or three times a week, would you still brush it off as “normal behavior.?
Another common misconception is that feline owners often assume that their cats suffer from acid reflux (also known as gastroesophageal reflux disease or GERD). In contrast to humans, where an estimated 7 million people in the United States have some symptoms of GERD, primary GERD is a rare cause of vomiting in cats and is almost always secondary to another problem.
So, even though cats show the signs of acid reflux, there is almost always an underlying reason why they’re vomiting… not just because they ate another meal of spicy fast food.
What is gastroesophageal in cats?
Acid reflux, gastroesophageal or GERD occurs when there is an uncontrolled backflow of gastric or intestinal fluids into the esophagus, which is the tube that connects the throat to the stomach.
The acid in the gastrointestinal fluids – which include stomach acid, pepsin, bile, and other components – can damage the mucosal lining of the esophagus and cause inflammation, a condition called esophagitis.
If you have ever experienced this yourself, you will easily agree that acid reflux is not pleasant for cats that experience it.
Symptoms of acid reflux in cats
Typically symptoms of acid reflux in cats are a history of frequent vomiting, salivation secondary to esophageal irritation, and a poor appetite.
Due to the esophageal irritation, cats may act pained when swallowing and will often avoid food.
Motility may be affected, and the cats can regurgitate food, fluids and mucous from acid reflux.
What causes acid reflux in cats
The first step in determining the cause of your cat’s acid reflux is to determine if your cat is vomiting or regorging.
Regorging in cats
Regurge is a passive process and is actually quite rare in cats. With regurgitation, food or water will spontaneously be brought up from the stomach — food will be undigested and there will be no bile (yellow-tinged fluid). The cat may gag after the event but will show no signs of distress prior to the regurge.
Most causes of regurgitation in cats are due to esophageal motility disorders, which are rare. In kittens, rare congenital abnormalities, such as hiatal hernias, lead to chronic regurgitation and gastroesophageal reflux of stomach acid. Regurgitation is also uncommon in older cats, with rare conditions such as feline dysautonomia or chronic esophagitis causing motility disorders of the esophagus.
Vomiting in cats
Vomiting in cats is much more common. This is an active process — the typical “ukkk, ukk, ukkk” sound and body positioning with abdominal contraction as the stomach expels its contents. Cats will usually show signs of nausea: lip licking, frequent swallowing, or salivation. Food may be present in various levels of digestion and bile (yellow-tinged digestive fluid) is present.
There are multiple reasons for vomiting in cats, and this often isn’t acid reflux. Yes, it may be a simple hairball, but hair is meant to pass through the GI tract. For cats that vomit hairballs more frequently than once or twice a year, there is typically an underlying gastrointestinal problem.
If you’re convinced that hairballs could be the cause, see the best remedy products and solutions for hairballs in cats.
In younger cats, foreign bodies (pieces of cat toys, string, dental floss, plastic bags/wrappers) are a frequent cause of the vomiting and may require surgery to put an end to the vomiting. Cats of any age can get a foreign body obstruction but most are younger (more playful) cats, though our vet once saw a 14-year-old cat that developed an intestinal obstruction from swallowing a whole almond.
Food allergies, intolerances, and IBD (inflammatory bowel disease) are frequent causes of vomiting in middle age cats (4 to 9 years old) and probably the number one reason for those “chronic hairball” vomiters. Unfortunately, as their underlying food intolerances are left untreated, the complications of inflammatory bowel disease will become obvious – constant vomiting and acid reflux (GERD), diarrhea, and weight loss.
Chronic pancreatitis is often related to food sensitivities and presents with a similar history and clinical signs as chronic esophagitis and reflux, except there is no regurge.
Gastrointestinal lymphoma, unfortunately, a common cancer in cats, can cause signs identical to IBD, acid reflux in cats, and pancreatitis. The sooner the diagnosis is obtained, the quicker specific treatment can be initiated.
Diagnosis of acid reflux in cats
Diagnostic testing of acid reflux or other conditions with symptoms similar to cat acid reflux can vary in its scope and cost for cats with chronic vomiting. The first step for many of these cats is not a laboratory test, but a simple diet change.
You could try a few things home to treat acid reflux in your cat, such as:
In a vomiting cat that is otherwise healthy, veterinarians often start with a trial of a limited ingredient diet (a single source diet combining one protein and one carbohydrate fiber that the cat has never eaten before, such as venison and pea) or a commercial hydrolyzed diet (a diet manufactured in a laboratory to break proteins down to a level the cat’s immune system can’t recognize as antigenic while still remaining nutritionally complete).
If no improvement is seen within 1-2 months of a strict diet trial, then food allergy is considered a less likely cause of the vomiting, and additional diagnostics are required.
Simple radiographs (X-rays) and a barium study (a radiopaque liquid that highlights the GI tract) can help delineate congenital abnormalities and foreign bodies. Ultrasound is a fantastic diagnostic tool for visualizing the feline gastrointestinal tract, pancreas and lymph nodes, but is still limited in its ability to provide a definitive diagnosis of conditions with symptoms similar to that of cat acid reflux.
Definitive diagnostic samples of the feline esophagus and gastrointestinal tract can only be obtained by endoscopy and endoscopic biopsy or surgical biopsy. Both procedures require the cat to be under general anesthesia.
In endoscopy, a camera is placed down the cat’s throat into the esophagus, then into the stomach, and then the intestines. Special grasping forceps can be used to take biopsy specimens to send to a pathologist to definitively diagnose the cause of the vomiting in your cat. The way to visualize the esophagus for a true diagnosis of GERD in cats can only be done with endoscopy (esophagoscopy). Most specialty practices offer endoscopic or laparoscopic biopsy, but this procedure is rarely available at most private vets due to the cost of the equipment.
Surgical biopsies of the cat’s stomach or intestines can be done by a general practitioner or surgeon, often as part of abdominal exploratory surgery. One must always balance the risk of more invasive procedures (reaction to general anesthesia, poor wound healing, and infection) with the benefits of the information obtained (biopsy samples to develop a specific treatment plan).
Treatment for cats with acid reflux
Treatment for any cat is always a challenge, as any cat owner can attest to.
For cats that suffer from severe reflux and esophagitis, advanced IBD, lymphoma, or pancreatitis, often times a feeding tube is placed temporarily to provide nutrition and medications which will bypass the oral cavity as these cats are often not eating well on their own.
Cats with acid reflux, GERD or esophagitis will benefit from esophageal and stomach protectants such as sucralfate – a tablet that dissolves in water and, given by mouth, will your coat your cat’s esophageal and stomach erosions.
Pepcid / Famotidine for the stomach
Famotidine, known most commonly as Pepcid, is used to lower the stomach acid in cats to promote healing of ulcers and erosions. Famotidine is an inexpensive OTC tablet but can be prescribed as a suspension by your veterinarian for owners struggling to give their cats a tablet.
Appetite stimulants, such as cyproheptadine or mirtazapine, can be prescribed by your veterinarian to encourage your cat to eat.
Reglan or metoclopramide for nausea and improved motility
For chronic regurgitation or vomiting in cats, metoclopramide, or Reglan are often prescribed to help increase intestinal motility, fight nausea, and close the lower esophageal sphincter to reduce reflux and vomiting in cats. This medication is by prescription and comes as either a liquid suspension or a small tablet and is only used when gastrointestinal obstruction and congenital conditions have been ruled out.
Steroids to reduce inflamation
Steroids are often used to decrease inflammation in the gastrointestinal tract of cats suffering from IBD or to induce remission in cats with lymphoma. This medication comes as a prescription tablet or cherry-flavored liquid, but can be compounded into a more-palatable flavored liquid or even a chew tablet treat for cats that are a challenge to medicate.
Antibiotics for inflammation
Metronidazole, or Flagyl, is an antibiotic that is frequently used to decrease intestinal inflammation and has the added benefit of controlling bacterial overgrowth in the intestines and Helicobacter in the stomach.
If all these medications sound overwhelming, you are right! An owner’s insightful history, combined with your veterinarian’s specific diagnostics, are the best tools to pinpoint the cause of your cat’s vomiting or regurgitation and minimize the number of treatments needed to help your feline friend overcome reflux.