If you have a large breed dog, you probably have heard of a "twisted stomach". This is called gastric dilatation-volvulus, or GDV for short. GDV in dogs is a life-threatening condition that very quickly turns into an emergency situation. The stomach fills with gas and twists, cutting off important blood supplies to the stomach, spleen and pancreas. In this article, I will review what exactly GDV is, the symptoms and treatments, as well as how you can help prevent this from occurring in your dog.

What is GDV in dogs?

GDV, or gastric dilatation-volvulus, has also been called gastric torsion or twisted bloat and is a true medical emergency.

The stomach first fills with gas and distends, and then twists on its long axis, and we call this volvulus. As the spleen and pancreas are very closely related, anatomically, the twist also incorporates these organs, cutting off their blood supply. This eventually leads to circulatory shock, which is life-threatening.

Additionally, with GDV in dogs, the large caudal vena cava (a large blood vessel bringing blood back to the heart) is compromised. This results in blood being backed up in the spleen, kidneys, and intestines, as well as a reduction in blood flow back to the heart.

Organs that have a compromised blood supply can become impaired, leading to organ death.

What causes GDV in dogs?

We don't completely understand the exact cause of GDV in dogs. There are some factors that have been identified that can increase the risk in your dog.

Here is what we know about the known risk factors of a dog developing GDV:

  • Underweight or lean body condition
  • Age (middle-aged to older)
  • Inflammatory bowel disease
  • Gastric foreign body
  • Weather extremes (too hot, too cold, large drops in temperature over a short period, thunderstorms)
  • Feeding small kibble
  • Rapid eating
  • Excessive air/gas in the digestive system
  • Elevating the food bowl (potentially inducing aerophagia)
  • Overeating
  • Water restriction after eating
  • Increased exercise or activity immediately after eating
  • Anesthesia
  • Large breed dogs (especially Great Danes)
  • Stressful event(s)

As you can probably tell, there is no single cause for the development of GDV in dogs. Rather, the causes are multifactorial.

What are the clinical signs of GDV?

The most common symptom of GDV in dogs that I have seen is unproductive retching. This basically is attempting to vomit with nothing coming up. Other symptoms can include:

  • Distended abdomen
  • Abdominal pain
  • Restlessness
  • Pacing
  • Panting
  • Respiratory distress
  • Excessive drooling or salivation
  • Cardiac arrhythmia (irregular heart rate)
  • Tachycardia (elevated heart rate)

If your dog is showing any of these GDV symptoms, please see your veterinarian immediately. If it is after hours, please see your local emergency animal hospital or veterinarian. GDV is very serious and can quickly progress to a life-threatening condition.

How is GDV diagnosed?

GDV is diagnosed based on the clinical signs, physical exam and X-rays. Radiographically, GDV has a very characteristic appearance, making it easy to diagnose. As the stomach fills with gas and subsequently twists, this leads to a specific shape we call the "Popeyes arm" or "double bubble".

GDV in dogs
An X-ray of a dog with GDV. The large black tubular structure is the twisted stomach.

In some cases, GDV can be diagnosed with an abdominal ultrasound, but it can be difficult because there is excessive gas in the stomach, which makes the ultrasound more difficult to interpret.

What is the treatment for GDV in dogs?

The treatment for GDV in dogs is two-pronged. The first is hospitalization and stabilization, the second is surgery. Yes, GDV can only be treated surgically.

With the first goal of GDV treatment, we need to stabilize the dog's vital signs and decompress the stomach. During hospitalization, we attach an IV fluid line to deliver critical fluids and stabilize blood pressure. Oxygen supplementation is also often implemented at this time. We can then decompress the stomach either through passing a stomach tube or trocharization (a needle is introduced externally to evacuate the gas).

Because the twisting of the stomach can obstruct blood supply to major organs, surgical intervention is very important and an absolute requirement for treatment. Simply decompressing the stomach and thinking all is well is wrong.

There are conflicting studies evaluating the timing of surgery. One study showed no difference in survival rates with waiting at least 5 hours after medical stabilization. Another study showed an increase in risk by waiting more than 3 hours to perform the surgery.

GDV surgery requires a complete abdominal approach and evaluation. The GDV is treated and prevented by performing a gastropexy. This is where the stomach is sutured to the body wall to prevent it from twisting in the future. A gastropexy will not prevent uncomplicated bloat, but will prevent the more life-threatening stage, when it twists.

After GDV surgery, your dog will be monitored closely for a few days. Most dogs recover well from GDV surgery and can regain their normal activities within a few weeks.

What is the prognosis for dogs with GDV?

Mortality rates of GDV in dogs range from 10-45%. Dogs that have significant damage to the stomach or spleen have increased mortality rates, regardless of whether surgery was performed or not.

How can GDV be prevented?

Performing a prophylactic gastropexy (suturing the stomach to the body wall) can reduce the risk of GDV. A good time to perform this would be at the same time as a spay or neuter procedure, so you can share the same anesthetic.

Interestingly, a study revealed that performing a prophylactic gastropexy reduced mortality in Great Danes by 30-fold.

Please review the list of risk factors I explained above and implement strategies to avoid these.

In closing, GDV (Gastric Dilatation Volvulus) is a medical emergency in dogs. If you have a large breed dog and there are signs of discomfort, unrest, or unproductive vomiting, please see your veterinarian ASAP. The prognosis is typically better the sooner medical treatment can be started. To prevent GDV in your high-risk dog, consider having a prophylactic gastropexy performed at the same time as the spay or neuter.