Bilious Vomiting Syndrome In Dogs – Symptoms & Treatment

When your dog often throws up yellow/light or dark green liquid in early morning (or in the wee hours of the night ) but then gladly gulps the breakfast and gets on with her day, as if nothing had happened, then time has come to enlighten yourself with the term “bilious vomiting syndrome (BVS)”.

This is an idiopathic, possibly a primary hypomotility disorder. Billious Vomiting Syndrome is due to bile build-up of excess bile irritating the empty lining of the stomach.

This may sound terrible, but as a matter of fact, the worst thing about the ‘bilious vomiting syndrome’ is only the word ‘syndrome’.

When doctors and vets use the word syndrome, it usually means we have no idea what causes it. That indirectly says it’s an awful disorder. But not all, at least not ‘BVS’.

Billious Vomiting Syndrome - may have any number of causes, but fortunately, a number of solutions, too.

• Vomiting (frothy yellow/greenish fluid)
• Nausea (eg., drooling, smacking lips)
• Pale gums, sunken eyes
• Signs of dehydration
• Temporarily reduced appetite

BVS does seem to be more reported in younger dogs (otherwise completely healthy dogs) than older ones.

BVS is usually diagnosed based on:

• Your pup's medical history.
• A normal physical examination.
• Signs of chronic/regular vomiting in the morning.
• Absence of evidence of other causes.

Vets suggest two therapies for BVS:

Dietary - First, start with simple dietary changes. Late night dinner or feeding a bedtime snack or feeding denser food to decrease the time the stomach is empty during the night.

Medication:

A prokinetic agent: (e.g., cisapride, 0.1 mg/kg orally; metoclopramide, 0.2 to 0.4 mg/kg orally; erythromycin, 0.5 to 1 mg/kg orally).

H2 blockers: Pepcid, Zantac or Tagamet.

A gastric mucosal protectant: (e.g., antacid or H2-receptor antagonist, sucralfate).

Step 1 - Provide a bedtime snack to increase gastric motility.

Step 2 - Stimulate the stomach into continuous motility by dividing the dog's daily food quota into multiple small meals.

If these steps do not work out means, go to step 3.

Step 3: Consult your vet and give an acid-reducer like Proton-pump inhibitors (omeprazole, esomeprazole, pantoprazole, etc) or H2RAs such as (ranitidine or famotidine).

Above three steps did not yield any results mean, go to step 4.

Step 4: Try a 'prokinetic' medication.

Metoclopramide (Reglan), cisapride, Macrolide antibiotics, Ranitidine, nizatidine, or lidocaine.

If those four steps don't work, go to Step 5.

Step 5: Check with your vet about gastroprotectant (protects gastric mucosa from bile irritation).

Sucralfate (Carafate) is the most prescribed mucosal protectant.

The most common treatments that can prevent or reduce the BVS are:

1. Divide 3 meals into 5-6 mini-meals and introduction of a healthy late-night snacking right before sleep to decrease the night fasting period.
2. For meals later in-night, be careful with your food measurements and don't overindulge.
3. Some vets recommend feeding a little food in the morning (just like a trailer to breakfast).

There is no breed disposition

1. The most commonly cited theory: duodenal fluid refluxes into the stomach at nighttime (via the pyloric sphincter) and irritates the gastric wall. Decreased stomach motility causes the backwashing of fluid (containing bile) to cause the stomach mucosal lining irritation resulting in morning vomits. Vets sometimes call this 'reflux gastritis'.

2. We are familiar with acid reflux, in which acid-containing contents in the stomach backflows via the oesophageal sphincter (valve at the end) into the esophagus. This causes damage to the oesophageal mucosa and causes pain and heartburn. BVS is also the same process - sphincter level is one down.

3. Other causes of vomiting but this list is not meant to be all-inclusive:

• Addison's disease (adrenal insufficiency).
• Colitis.
• Cancer.
• Food allergy.
• GI foreign bodies.
• Gastritis.
• Giardia infection.
• Helicobacter infection.
• Hiatal hernia (stomach sneaks up into the diaphragm).
• Inflammatory bowel disease (IBD).
• Intestinal parasites.
• Liver failure.
• Physalopterosis (gastrointestinal infection caused by stomach worm).
• Pancreatitis.
• Stomach ulcer.

• More vomits resulting in dehydration.
• Your pet has vomited several times.
• Abnormal vomit, either blood, pink, dark brown, or black.
• You are concerned about diarrhea or appetence or abdominal pain.
• Chronic BVS results in lethargy and loss of appetite.

What feeding times are best?

1. Fix a particular type of feeding schedule in place. This is one of the most important ways to lower the frequency of your dog's bilious vomiting.
2. Increased frequency of feedings may also help. Frequent small meals will make your dog's stomach full and can help stop acid from irritating the stomach lining.
3. Don't overfeed the dogs; make sure you still give your pet the same amount of food overall.
4. Provide normal dog food before they go to bed and feed them after you wake up in the morning.

Best foods for BVS:

1. 75% of a Dogs food should be complete, wholesome food certified by the Association of American Feed Control Officials (AAFCO).
2. The remaining 25% of your dog's diet can be canned food or other foods
3. A small bedtime low-fat snack
4. Bland diet: boiled chicken, cooked rice, tofu, low-fat cottage cheese, boiled hamburger, canned tuna, etc.,

Bilious vomiting syndrome (BVS) is a condition traditionally connected with vomiting of bile in the morning; however, it is otherwise inadequately characterized.

The good news: BVS is considered a benign condition. Recovery once treated for the specific cause has a good prognosis. Although it is self-limiting, follow the treatment plan prepared by your vet for your pet's specific situation.