Anyone who has lived with dogs has probably dealt with dog vomit. Our canine friends are built to vomit, probably because many of them will eat almost anything that they come across. Vomiting essentially lets dogs “change their minds” when they’ve eaten something potentially dangerous.

But regurgitation is very different from vomiting. Whatever the underlying cause, regurgitation is dangerous. Over time, dogs can become malnourished. Regurgitation can also lead to aspiration pneumonia, which happens when food is inhaled into the lungs.

Let’s look at what sets regurgitation apart from vomiting, why it’s important to know the difference, and why you should always take chronic regurgitation seriously.

Dog Regurgitation vs. Vomiting

Making the determination of regurgitation versus vomiting is very important because their causes and treatments are very different. Here’s what each looks like.

What Vomiting Looks Like

Vomit comes from either a dog’s stomach or the first part of the small intestine, and getting it up takes some work. Just before a dog vomits, you can see (and hear) them heaving and retching as their abdominal muscles contract and relax. They often feel nauseous before they vomit, so they may also drool and lick their lips, two signs of nausea in dogs.

What Regurgitation Looks Like

When dogs regurgitate, food comes up from the esophagus, and it doesn’t have to travel far or past any sphincters. Therefore, regurgitation often seems to happen out of the blue and without any effort. Dogs may simply lower their heads and open their mouths, and their last meal is on the floor.

What Came Up?

You can look at what your dog has brought up for clues. If you see bile—a yellow-tinged fluid—you’re definitely dealing with vomit, since bile is secreted into the small intestine. A lack of bile isn’t very helpful, though, since that can be true with both vomiting and regurgitation.

When dogs regurgitate, what comes out often looks a lot like what just went in: food (maybe chewed) mixed with a little saliva or mucus. Sometimes, regurgitated material even maintains the tube-like shape it had in the esophagus.

What Causes Dog Regurgitation?

Sometimes a dog will regurgitate or vomit simply because they’ve wolfed down a big meal too quickly. If your dog seems to otherwise feel fine, don’t panic. Just keep an eye on things and make an appointment with your veterinarian if problems continue.

On the other hand, repeated regurgitation is a symptom of some very serious health problems. We can divide them into two major categories:

1. Things That Block the Esophagus

• Foreign bodies – If a dog eats something that becomes stuck in their esophagus, it can block the passage of food and water, leading to regurgitation.
• Tumors – Benign or malignant tumors within or just outside the esophagus can narrow the passage through which food and water pass and cause regurgitation.
• Stricture – Esophageal diseases or injuries can lead to scarring and stricture (abnormal narrowing). Dogs are sometimes born with esophageal strictures, which may not become evident until they start eating solid food.
• Vascular ring anomaly – Puppies can be born with abnormal blood vessels that create a tight ring around the esophagus, which makes it difficult for food to pass. This can also be called a persistent right aortic arch.
• Hiatal hernias – Abdominal contents can move through an opening in the diaphragm and press on the esophagus. This may occur after trauma or as a congenital (birth) defect.
• Esophageal worms – In southern parts of the United States, Spirocerca lupi worms can be carried by beetles and other hosts. If a dog eats an infected host, they can also be infected by these worms that create nodules in the esophagus, causing regurgitation.

2. Things that Affect Esophageal Function

• Megaesophagus – The esophagus is normally a muscular tube that pushes food into the stomach. With megaesophagus, it becomes dilated and weak. Food just sits in the esophagus until it is regurgitated. Megaesophagus can be present at birth or develop later in life. It has many causes, including:
  • Myasthenia gravis – This abnormality in the transmission of nerve signals to muscles can lead to muscular weakness. Other diseases affecting nerves and muscles can look similar to myasthenia gravis.
  • Addison’s disease – The hormonal changes associated with Addison’s disease (also called hypoadrenocorticism) can affect esophageal muscles and lead to megaesophagus.
  • Esophagitis – Chronic or severe inflammation of the esophagus can damage esophageal muscles. This can be seen with gastroesophageal reflux disease (GERD) or anything else  that irritates the esophagus.
  • Exposure to some toxins – Lead, organophosphates, botulinum, and other toxins can lead to megaesophagus in dogs.
  • Hypothyroidism – Low thyroid hormone levels are thought to be associated with megaesophagus in some dogs, although a definitive connection hasn’t been established.
  • Idiopathic megaesophagus – Often, an underlying cause can’t be identified, and a dog will be diagnosed with idiopathic megaesophagus.
• Esophageal dysmotility disorder – Sometimes the structure of a dog’s esophagus looks normal (unlike with megaesophagus), but it still doesn’t work as it should. This may occur after esophageal inflammation or injury, but a cause may not be evident. Some puppies are born with esophageal dysmotility disorders.

Dog Breeds Predisposed to Issues That Cause Regurgitation

Any dog can develop regurgitation, but some underlying health problems that can lead to it are more common in certain breeds. For example, Wirehaired Fox Terriers and Miniature Schnauzers are genetically predisposed to megaesophagus, but it is also frequently diagnosed in German Shepherds, Shar Peis, and mixed breed dogs. Brachycephalic dogs (those with flat faces, like Pugs and Bulldogs) are at increased risk for several types of esophageal disease, which can lead to regurgitation.

How Do Vets Find the Cause of Dog Regurgitation?

Veterinarians will start diagnosing the cause of regurgitation by asking a lot of questions and performing a full physical examination. This will help them confirm that a dog is indeed regurgitating, rather than vomiting, and identify any clues to potential causes.

Next, the veterinarian will probably ask to take x-rays of the dog’s chest and neck. The x-rays may identify a megaesophagus, foreign body, tumor, or aspiration pneumonia. Your dog may be given a contrast agent, like barium, to better outline their esophagus, but this should be done with caution because barium is dangerous if it gets in the lungs.

Veterinarians can also use an endoscope to examine the inside of your dog’s esophagus, which can help diagnose esophagitis and esophageal tumors.

Laboratory testing may be needed to get a feel for your dog’s overall health and identify underlying conditions. Special tests may include:

• Acetylcholine receptor antibody testing for myasthenia gravis
• An ACTH stimulation test for Addison’s disease
• Measuring lead levels in the blood
• Measuring thyroid hormone levels

Dog Regurgitation Treatment

Whenever possible, treatment for dog regurgitation is focused on the underlying problem.

For example:

• Esophageal foreign bodies can sometimes be removed using an endoscope.
• Surgery can correct vascular ring anomalies, remove tumors, or correct strictures.
• Myasthenia gravis, Addison’s disease, GERD, and hypothyroidism can all be managed with medications.

When a dog has idiopathic megaesophagus or an esophageal motility disorder, or when the underlying problem can’t be fully resolved, supportive and symptomatic care are also necessary. Options include:

• Vertical feedings with the use of a Bailey chair. Dogs should remain upright for at least 15 minutes after eating so the food can get into the stomach. Water should also be given in the Bailey chair.
• Change the consistency of the food. Some dogs do better with gruel and others with meatballs. Feed a high-quality, nutrient-dense food to reduce the overall amount.
• Feed small, frequent meals to avoid overloading the esophagus.
• A veterinarian can place a feeding tube directly into the dog’s stomach so that food, water, and medicine can be given while bypassing the esophagus.
• Medications to reduce stomach acidity, help empty the stomach, and protect the lining of the esophagus may be beneficial. If aspiration pneumonia develops, antibiotics and other treatments will be needed.
• Use a slanted dog bed that keeps a dog’s head higher than their abdomen while they sleep.

How to Prevent Regurgitation in Dogs

What if you’ve ruled out all the scary stuff and you’re just left with a chow hound who is regurgitating (or vomiting) because they eat too fast?

Thankfully, that’s a relatively easy fix. First, feed smaller, more frequent meals. For example, if you currently feed your dog twice a day, switch to three times a day with an appropriate reduction in meal size.

Slow feeder bowls, or even just a large rock placed in their current bowl, can also help. But as always, if your dog continues to have problems, talk to your veterinarian.

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