A One Health Review of Aerodigestive Disease in Dogs

Megan Grobman, Carol Reinero

Background:
Aerodigestive disease (AeroD) refers to disorders involving both the respiratory and upper digestive tracts due to failures in airway protection during swallowing. In dogs, these disorders are underrecognized despite parallels with human medicine, where aspiration-associated respiratory syndromes (AARS) like asthma, chronic bronchitis, and idiopathic pulmonary fibrosis are increasingly linked to reflux and dysphagia. This review aims to define AeroD in dogs, outline contributing mechanisms and diagnostic strategies, and propose a One Health approach to understanding its relevance in both veterinary and human medicine.

Methods:
This is a narrative review synthesizing veterinary and human literature. The authors present anatomical and physiological insights into swallowing and respiration, classify AeroD into multiple syndromes (e.g., BOAS, GERD, megaesophagus), and evaluate current and emerging diagnostic modalities including videofluoroscopic swallow studies (VFSS), high-resolution manometry (HRM), scintigraphy, biomarker analysis, and acoustic cough monitoring. Emphasis is placed on translational relevance, diagnostic gaps, and the potential for canine models to inform human disease.

Results:
AeroD in dogs spans numerous conditions such as BOAS, esophageal dysmotility, reflux diseases, and idiopathic cough. VFSS emerged as the most sensitive diagnostic for detecting abnormal swallowing and reflux events. While thoracic radiographs and endoscopy are commonly used, they lack sensitivity, especially for non-acidic reflux. HRM and pH monitoring offer advanced insights but are limited by availability. Biomarkers and nuclear scintigraphy show promise for detecting subclinical aspiration and nonacidic reflux. Clinical signs are often non-specific and may involve respiratory, gastrointestinal, or neurological symptoms. Dogs with pharyngeal weakness, cricopharyngeal dysfunction, or sliding hiatal hernias are at high risk of AARS.

Limitations:
The review highlights a lack of standardized diagnostic protocols and prospective studies in veterinary medicine. Many tools require advanced training or are inaccessible in general practice. Data from canine studies often lack granularity compared to human literature, and certain reflux phenomena remain poorly characterized in dogs.

Conclusions:
Aerodigestive disorders are likely more common in dogs than currently diagnosed. A thorough, multimodal diagnostic approach, especially incorporating VFSS, is critical for accurate identification and management. Greater awareness and research are needed to refine diagnostics and therapies. Given the similarities in pathophysiology between species, dogs may serve as valuable models for human AeroD, emphasizing the need for a One Health framework to enhance understanding and treatment across disciplines.

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