Bloat: the emergency that kills in hours
4 min read · Updated
Gastric dilatation-volvulus is the reason so many of the breed profiles on this site end with the words learn the signs of bloat. It takes a healthy dog and kills it the same day, it is commonest in the deep-chested breeds people most want to own, and the single thing that changes the outcome is how quickly the dog reaches a surgeon.
What actually happens
Two things go wrong, usually together. The stomach fills with gas and fluid and distends — that is the dilatation. Then it rotates on its own axis, which is the volvulus, and the rotation seals both ends so nothing can escape in either direction.
From that point it is a circulatory emergency rather than a digestive one. The swollen stomach presses on the major veins returning blood to the heart, so blood pressure falls. The stomach wall's own blood supply is twisted shut, so the tissue begins to die. The spleen, attached to the stomach, is often dragged round with it. A dog can go from apparently normal to shock in under two hours.
Untreated it is essentially always fatal. With prompt surgery, survival is good — figures in the region of eighty per cent are commonly reported — and almost all of the difference between those two outcomes is time.
The signs, in the order you will notice them
Unproductive retching is the classic one. The dog tries repeatedly to vomit and brings up nothing, or only white foam. This is the sign that should move you, and it is the one most often waited out.
Restlessness and pacing. A dog that cannot settle, gets up, turns round, lies down and immediately gets up again, often in the evening after a meal.
A swollen or hard abdomen, usually just behind the ribs. In a deep-chested dog it may not be obvious from the side — feel rather than look.
Drooling more than usual, and repeated swallowing.
A hunched posture, or the front end down and the back end up.
Pale or tacky gums, rapid shallow breathing, weakness, collapse. These are late, and by the time they appear the dog is in shock.
What to do
Go to a vet immediately. Not in the morning, not after seeing whether it settles — immediately, including at two in the morning, and including if you are not sure.
Phone ahead while someone else gets the dog into the car. A practice that knows a suspected GDV is arriving can have a theatre and a team ready, and that call can save the better part of an hour.
Do not try to relieve it yourself, do not give anything by mouth, and do not spend time looking for a second opinion online.
The cost of being wrong in the cautious direction is a consultation fee. The cost of being wrong in the other direction is the dog. Every emergency vet would rather see ten dogs that turned out to have eaten something disagreeable than miss one GDV.
Which dogs are at risk
The strongest predictor is chest shape: deep and narrow, rather than broad. The Great Dane has the highest lifetime risk of any breed, frequently put near one in four.
The list of at-risk breeds is long and includes the Standard Poodle, Weimaraner, Irish and Gordon Setter, Bloodhound, Saint Bernard, Newfoundland, German Shepherd, Boxer, Dobermann, Rottweiler, Akita, Greyhound, Basset Hound and most of the large livestock guardians — Akbash, Anatolian, Boerboel, Kangal, Caucasian and Central Asian Shepherds. The Greater Swiss Mountain Dog is prone to splenic torsion as well, which presents similarly.
Risk rises with age. It is higher in dogs with a close relative that has bloated, which is why it is worth asking a breeder. Being underweight raises it; so does eating one large meal a day, eating fast, and being an anxious or excitable dog.
What reduces the risk
Feed two or three smaller meals rather than one large one, and use a slow-feeder bowl for a dog that inhales its food.
Raised bowls have been widely recommended and the evidence points the other way — the large prospective study at Purdue found raised feeding was associated with increased risk in large and giant breeds. Feed at floor level unless a vet has advised otherwise for another reason.
Avoid hard exercise immediately before and after eating, though the evidence here is weaker than the folklore suggests.
For high-risk breeds, prophylactic gastropexy is the intervention that actually works. The stomach is tacked to the abdominal wall so that it cannot rotate; dilatation can still occur, but the lethal part largely cannot. It is commonly done at the same time as neutering, or laparoscopically, and for a Great Dane or a similar breed it is worth discussing with a vet before it is needed rather than after.