BLOAT AND TORSION IN BRIARDS
Most comhreMost comprehensive information on bloat in Briards

by Martine Huslig, MS
Board Certified Genetic Counselor
        Excerpt quoted from Dr. Larry Glickman

Bloat…is a word that strikes fear into the hearts  of many dog owners, especially those who have experienced it first hand. 

As a human genetic counselor---based on what I know about Briard pedigrees---there is little doubt in my mind that the early onset bloat that we see in Briards is genetic.  In many breeds bloat occurs randomly in dogs that are older.  In Briards--- what I believe to be familial bloat strikes dogs most typically between the ages of 2 years and 8 years (but as early as 6 months.)   Dogs with early onset bloat will often have a first degree relative who has bloated (parent, sibling or offspring.)  When I purchased my first Briard---her mother and grandmother had both torsioned.  By the time the litter was 2 years---2 of her littermates were dead due to bloat/torsion.  It did not seem controversial to me at the time to conclude that bloat was a genetic condition in Briards.  Since that time, the past 10 years, I have made the attempt to purchase and breed to dogs with little bloat in their families and have not had a Briard bloat or torsion (my first Briard was "tacked" and this is a procedure that I do recommend to pet dogs with close relatives who have bloated.)    My professional interpretation of the pedigrees is that the condition may be as simple as an autosomal dominant condition IN OUR BREED but ten years later I am still waiting for a research project into the genetics of bloat.  Identification of the genetic factor or factors that lead to bloat would allow breeders to continue with families of dogs while eliminating the gene/genes for bloat in the family.  The best research to date has been done by Dr. Larry Glickman and associates at Purdue but these are "epidemiological" and not genetic studies.  These studies DO confirm that a first degree relative with bloat is a primary risk factor for bloat.  To learn more go to  Purdue study at  http://www.vet.purdue.edu/epi/bloat.htm 

What is "bloat"?
So---for those who are learning--what is bloat?  The term bloat is often used to refer to an emergency medical condition called torsion.  The conditions are officially referred to as Gastric Dilitation and Volvulus.  Bloat and torsaion often go hand in hand.  The term Bloat (Dilatation) refers to gastric/stomach distension or when the stomach fills up with gas.  Torsion/volvulus refers to the twisting of the stomach that can occur with or sometimes without bloat.  Bloat alone can be a serious condition.  If the stomach fills up enough it can apply pressure to surrounding vessels and organs and pressure needs to be relieved by the passing of a "gastric tube."  Torsion is typically even more of an emergency.  In dogs the stomach normally hangs somewhat like a hammock and can "roll over" or "tort.  Torsion can be complete or partial.  Torsion cuts off blood flow/supply and animals can go into shock and death quickly.  The esophagus can be cut off because it is twisted.  Blood flow is diminished through the entire body and blood supply is cut off to the stomach and the spleen.  Blood pressure can drop, heart arrhythmias can occur due to the diminished blood flow.  The stomach lining begins to die and toxins build-up.  In some cases the torsion is not complete giving owners more time to seek emergency medical attention.   Some people will tack dogs that they feel to be at risk for GDV.  These dogs can still "bloat" and is some cases of spleen alone can torsion and if not diagnosed this can be equally life threatening.

Signs of GDV
Sometimes signs of distress are obvious, sometimes they are much more subtle.  Dogs may stand, sit, then pace and exhibit general signs of restlessness or discomfort.  They may try to vomit, but can’t or they may throw up a frothy or slimy liquid.  They settle for just a moment and then start again.  They may pant or salivate.  Many owners report a "far away look in their eyes."  It is important to note---they may not appear to be OBVIOUSLY in pain and their stomach generally is NOT tender to the touch.  In hours or immediately they may stand frozen, head down or exhibit signs of shock.  Their stomach may look like a balloon or be tight as a drum but this sign is not always present.  If the torsion is partial then they may be able to eat or drink so these are not reasons to rule out torsion,  Bloat is serious and life threatening.  It can and does kill and when suspected requires immediate medical attention.  More information on Bloat Symptoms

What to do?
If a dog has bloated/torsioned, it is important that they receive emergency veterinary care as soon as possible.   The condition can progress rapidly so it is usually not a time to hesitate.   The vet must pass a stomach tube to relieve the pressure, treat with fluids for possible shock emergency surgery is often indicated to untwist, reposition and "tack" or anchor the stomach into place.  In some cases when bloat/torsion has been detected early--the vet may question the owner's concerns.  Some vets may want to take a wait and see approach—but when actually torsion is present---every minute potentially counts.   Wait and see has resulted in the death of MANY Briards.  If you think that your dog might be bloating --insist on an X-ray.  A simple X-ray can tell if a dog has torsioned.  Sadly there are many tragic stories of people who took their dog to the vet in the middle of the night and right on time only to be sent home without an accurate diagnosis.   (See excerpt from Dr. Larry Glickman below.)  As a side note---when getting a new puppy/dog or when you move to a new area, it is best to identify your veterinary emergency options ahead of time.  Many vets no longer take emergencies.   Especially in a bigger cities—there are generally excellent emergency vets.  Some are better than others so you want to know where the best ER hospital is.  If the better one is farther away—it may be worth the extra time to get to the better vet because it is the experience, and judgment calls in such clinics that may make the difference in SAVING YOUR DOG’S LIFE in any emergency situation. 

What more do we know?
The Clinical Epidemiology at Purdue University did a prospective study starting in 1994.  Members of the research staff traveled to dog shows around the country and asked owners of 7 large breeds (Akita, Bloodhound, Collie, Irish Setter, Rottweiler, Standard Poodle, Weimaraner) and for four giant breeds (Great Dane, Irish Wolfhound, Newfoundland, Saint Bernard) to participate.  The owners filled out a detailed questionnaire.  A total of 1920 dogs who had not previously bloated were collected.

These are the best and only significant SCIENTIFIC studies on the potential causes. Although they may not be the definitive last word on Bloat—they are better than any information on Bloat to date.  There is no scientific evidence to support limited exercise before and after meals, wetting food etc. as decreasing the risk of bloat.  These "preventative measure" were looked at and did not appear to influence the incidence of Bloat..  These studies show that raised food bowls and wetting certain foods actually significantly increase the risk of Bloat.  (These have all been “traditional” methods to try to combat the occurrence of GDV.)

Quoted from the Purdue website:

"Most of the popular methods currently recommended to prevent GDV did not appear to be effective, and one of these, raising the feed bowl, may actually be detrimental in the breeds studied."

The studies report an increased risks of GDV associated with
1) increasing age
2) having a first-degree relative with GDV
3) having a faster speed of eating
4) dog eating a "large" volume of food per meal--especially one time a day
5) having a raised food bowl
6) consumption of dry foods containing fat among the first four ingredients
7) consumption of 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 decreased GDV risk by 53.0%.

Dogs described as "happy" had a decreased risk of bloat. 

Stomach Tacking
Prophylactic gastropexy (or stomach tacking) has been shown to be effective at preventing bloat.  Although most likely not 100% effective this procedure appears to dramatically decrease the risk for related death and is now available laproscopically (probably less "cost effective" but less invasive for the dog.)   Many people choose or recommend this procedure in at risk breeds or to dogs who have a perceived increased risk of bloat/torsion.  If there is a significant "family history"--this is a reasonable procedure to consider for pet dogs.  Many will say that "breeding dogs" should not be tacked.  The reason for this is presumably the assumption that the condition has a genetic component. Since many dogs do not bloat until they are past or well into reproductive age---an individual dog bloating is not necessarily the best criteria to use in accessing the likelihood that they will produce the condition in their offspring.   Additionally---dogs who bloat in their second decade (10 and over) in many cases may not have a genetic propensity to bloat.  Eliminating the prophylactic tacking of breeding potential dogs is only helpful if dogs in such families are not bred until after the age of bloat in the family (which in Briards can be over 6 years of age)---since this may not be feasible especially in females, then other methods may need to be considered if the desire is to decrease the likelihood of bloat/torsion in future generations.  Breeding "away" form a heritable condition involves replacing "at risk" dogs in the breeding program with lower risk dogs.  In any case, a research project that identifies the genes that cause disease is the best way to eliminate a problem in a breed---ESPECIALLY late onset dominant types of conditions.

More on the possible "Inheritance of Bloat" and Canine Genetics
From http://www.poodlehealthregistry.org/docs/Standard/PHR_Standard_Bloat.html "The late John Armstrong, PhD, professor of genetics at the University of Ottawa, believed that much of the bloat seen in Standard Poodles was caused by a dominant gene and that 50% of standards who had one parent who had bloated would themselves bloat. Dr. Armstrong put up a bloat pedigree analysis of Wycliffe dogs at http://www.canine-genetics.com/pedigree.htm
http://www.canine-genetics.com/bloat2.htm  I came to my conclusions about Briards independent of my discovery of Dr. Armstrong's work.  Hopefully one day a genetic study will allow us to identify such a marker linked to bloat.  In the meantime---the incidence of the disease can be decreased by breeding dogs at a lower risk in place of dogs at higher risk (ie dogs who have bloated or have produced offspring who have bloated--in the case of a late onset dominant condition---a dog with a parent/sibling and an offspring who has bloated can be considered "affected" even without a diagnosis of the condition themselves.)  Also see  Breeding healthier dogs---a genetic primer.

Genetics and diversity/Genetics for breeders etc...

A Message to Dog Owners from the Director of the Purdue Bloat Research Program

Excerpt from Bloat Notes, January 1997

Several times a week I receive a phone call from someone whose dog has died of bloat. Usually my role is to provide a sympathetic ear and assure the callers that there was nothing they could have changed to prevent the incident. Our current knowledge of bloat does not allow us to identify specific events that trigger an acute episode in susceptible dogs, although some form of "stress" was probably involved. One of our long-term research objectives is to better define what constitutes stress for dogs and to measure their physiological response to it. However, the primary goal of the research is to determine why some dogs are more susceptible to bloat than others, i.e., what are the risk factors for bloat. This has led to studies of the physical conformation of dogs, their diet, vaccination histories, and even to new ways to evaluate a dogís temperament and personality.

The overall bloat fatality rate approaches 30% for dogs with a dilated, rotated stomach. Approximately half of the dogs that die with a rotated stomach will do so before veterinary medical or surgical treatment is obtained. Dogs may be found dead or die on the way to the hospital, or may be euthanized by the veterinarian because of their poor prognosis or the owner's financial considerations. In contrast, dogs properly treated have [greater than] 80% probability of surviving a bloat episode and then leading a normal life. Veterinarians over the past 2 decades have reduced dramatically the postoperative fatality rate from gastric dilatation-volvulus (GDV) from [greater than]50% to [less than]20% by using improved therapy for shock, safer anesthetic agents, and better surgical techniques.

Too often, however, owners of dogs that died of bloat tell me that they had recognized that the dog had a serious problem and rushed the dog to a veterinarian, only to be told that it was probably only a "belly ache," or that the dog's stomach was dilated, but not rotated. Sometimes the veterinarian recognized dilatation, but not a rotation (volvulus, torsion), passed a stomach tube to relieve the pressure, and sent the dog home. Or the dog was diagnosed as having dilatation and rotation, and a stomach tube was passed to relieve the pressure, but surgery (gastropexy) to permanently correct the rotation was delayed, either because the dog was thought to be too ill to withstand the surgery, or the veterinarian was not adequately equipped or prepared at the time to perform the operation. The latter may occur if the veterinarian is in the midst of busy office hours or if -- especially at night -- there is insufficient technical help available to properly perform the surgery, which requires careful administration of anesthesia, appropriate fluid therapy, and close monitoring of the dog's vital signs.

Numerous clinical reports from Europe and the United States show that gastropexy to prevent gastric rotation should be performed as soon as possible following stomach decompression on all dogs with gastric dilatation, whether or not the stomach is thought to be rotated at the time. The recurrence rate of gastric volvulus in dogs treated for bloat conservatively, i.e., without surgery, approaches 100%, whereas the recurrence rate following gastropexy is [less than]5%. The stomach of a dog that has had a gastropexy can still dilate, but it is unlikely to rotate, so if dilatation does occur after gastropexy, it can probably be treated conservatively.

What does all this mean to you? If your dog suddenly develops a distended abdomen, appears uncomfortable, and gets progressively worse, rush the dog to a veterinarian, preferably one equipped to do emergency surgery. Gastric distention is a life-threatening condition, even if the stomach has not rotated. Immediate decompression is required to relieve pressure on blood vessels and to restore circulation to the heart, because shock can occur within minutes of the first clinical signs. Fluid therapy is indicated to treat shock, and drugs may be needed if the heart rhythm is irregular. This should be followed as soon as possible by surgery to reposition and immobilize (gastropexy) the stomach before it is irreversibly damaged. The best indicators of how well the dog will do postoperatively are its physical condition (state of shock) prior to surgery and the appearance of the stomach during surgery (since dead or dying stomach tissue implies a very poor prognosis). Intensive monitoring is usually required for several days postoperatively in case complications occur.

If you suspect your dog has bloat, but the veterinarian dismisses it as a minor problem, inquire about radiographs to rule out GDV. If dilatation with or without volvulus is diagnosed and the stomach is decompressed, either by passing a stomach tube or by piercing the stomach with a large needle (trochar) passed through the body wall, the dog should be considered as a candidate for immediate surgery, unless its condition is too unstable to tolerate anesthesia. If the veterinarian recommends that surgery be delayed for any other reason, seek a second opinion immediately. Delay in surgery will increase the chance of the stomach rotating if it hasn't already, or will decrease the chance of the dog surviving if rotation has occurred.

Following is an excerpt of a letter that illustrates some of these points. "I noticed Kelly [an Irish Setter] attempting to vomit with nothing coming up. Grass? Chicken bone? I watched her and we continued to walk. She was happy and greeted people, wagging her tail, ... and had fun. We went home and Kelly went upstairs where she attempted to vomit several times. I immediately called my vet. Kelly and I arrived at the veterinarian's office within five minutes of the phone call. I told the veterinarian that Kelly had vomited two or three times with nothing coming up. I said that she looked a little broad around the ribs. The veterinarian did a physical examination and concluded that Kelly's problem was just a "stomach ache." ... I was directed to give her Pepto Bismol®. I took Kelly home and she lay down on the bed. About 45 minutes later she went out to the back yard. When I went out 10 minutes later, I found her bloated up. I grabbed her, took her back to the veterinary hospital, but she died on the operating table." (Comment: There is no guarantee that if radiographs had been taken during the first veterinary visit, Kelly's outcome would have been different. However, radiographs might have confirmed the presence of gastric dilatation or volvulus, and thus the need for immediate gastric decompression and surgery.) Be prepared -- Teamwork between you and your veterinarian is your dog's best hope when it comes to bloat.

For more information on the early signs of bloat, talk with your veterinarian. Ask what treatment he/she recommends for bloat, and if their hospital has a 24-hour emergency service.

--Larry Glickman, VMD, DrPh