Also known as Bloat, Twisted Stomach, Gastric Dilatation-Volvulus or GDV, this condition is one of the most serious emergencies in small animal practice, and it can make all the difference to the outcome if it is recognised immediately.
There are two parts to this condition, the bloat and the torsion. Bloat is when the dog’s stomach fills up with gas, fluid, froth or a mixture of all of these, to a far greater size than normal. Torsion (volvulus) is when the whole stomach twists inside the abdomen so that it is closed off at both its entrance and its exit, just like a sausage which is twisted closed at both ends.
They may both occur together, or one may lead to the other. If bloat occurs first, the enlarged stomach is at greater risk of torsion. If torsion occurs first, bloating will definitely result. No food can leave the stomach, so it ferments, and no gas can be belched up.
The effect of the swollen stomach is that it presses on all of the other vital organs close to it. The breathing will become difficult and if the large blood vessels within the abdomen get squeezed so much that they cannot allow blood flow, then other organs will begin to shut down. The stomach wall and the spleen can become necrotic or dead due to loss of blood flow, and this releases toxins into the bloodstream. It is very painful, and if not corrected, the dog will die.
The reasons for this condition occurring are not fully understood, but there are some well known and definite risk factors. The condition happens mainly in larger breeds, particularly those with a deep-chested shape like Great Danes, German Shepherds, Setters, Wolfhounds and Boxers, but these are not the only breeds affected. It also happens more (but not exclusively) in dogs over 7 years of age, and it is more common in males than in females. The risks increase if the stomach is very full, either with food or with water, so a dog which is fed once daily and eats very quickly, or gets access to the food store and gorges itself, would be at higher risk. Exercising after eating or after a big drink also increases the risk.
The onset of a gastric torsion is usually very rapid. The dog can appear quite normal one minute but once symptoms start they very quickly get worse. The most common symptoms are some or all of:
- Restlessness, anxiety
- Discomfort, followed by worsening pain
- Arched back, reluctance to lie down
- Drooling saliva or froth
- Attempts to vomit (retching) with little being brought up
- Swollen abdomen, often feels hard and if tapped feels like a balloon
- Rapid breathing
- Pale coloured gums and tongue
- Shock, possible death
It is vital to get veterinary attention as soon as possible if you suspect bloat or torsion. Always phone your surgery or your emergency service first as it will save valuable time if you go to the right place where the staff are prepared for your arrival.
Occasionally, there can be a slower onset. This may mean that the stomach has bloated without twisting, but there is still a high risk of torsion occurring so advice should be sought from your surgery.
Diagnosis & Treatment
Diagnosing the condition can be very straightforward if a dog is showing all of the classic symptoms. X-rays may be needed to confirm it. Blood tests will probably be taken to find out how serious the changes in the blood are, because changes in the circulating levels of salts in the blood can be life-threatening. These will be treated with intravenous fluids given quickly and at high volumes. A stomach tube may be passed, but this will not be successful if the stomach has twisted because the tube will not be able to get through the obstructed entrance. The vet may decide to decompress the stomach (let some gas out) by inserting a needle into the dog’s side. The order in which these procedures may be carried out will depend on just how ill the dog is.
A surgical operation will be needed to untwist the stomach, to check for damage to the organs and to try to prevent it from happening again. Some will need immediate surgery and others will need to be stabilised first to improve their chances of survival. Some dogs have to have part of the stomach or the spleen removed if the damage has been severe. The surgery is very high risk especially if the dog is already in shock because of the effects on the circulation and breathing.
When successful surgery is carried out, with the stomach and spleen returned to their normal position or repaired if damaged, it is common to perform a procedure to try to stop the condition occurring again, known as a gastropexy. There are different ways of doing this, but the aim is to anchor the stomach to the abdominal wall so that it is unable to twist. It could still bloat, but hopefully the consequences would not be so serious.
The survival rate following this condition varies a lot, but sadly, many dogs die each year from gastric torsion. The survival rate is better in younger dogs and if immediate treatment is given.
- Be aware of the signs to look out for
- Feed larger dogs two or three smaller meals a day
- Do not allow your dog to exercise after eating or after a big drink
- Try to discourage rapid eating by separating competitive dogs at feeding time
- Try a specially shaped feeding bowl designed to slow eating down
- The effects of type of food and feeding from a raised bowl are under constant review and more research will show whether these are significant or not
I suspect that most vets never forget the first case of gastric torsion that they see. Mine was in a Great Dane, which I worked on all night with the help of two nurses. That one was fortunate and survived. It was a great moment for all of us when it left the surgery mid-morning the next day. The nurses jokingly told me that there was another one on the way in but I didn’t believe them, at least, not until I saw it walk in, arriving just as the first one left. Since then I have treated many dogs with gastric torsion and it is always memorable and always a challenge.
My own boxer Martha died of this condition last year despite very prompt attention and all preventative measures being in place. Sadly, her age was against her and our only consolation is that her suffering was very short-lived.
If you are concerned about your dog’s health, talk to your vet or use our interactive Dog Symptom Guide to help decide what to do next.