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Ask the Vet: What Causes a Dog's Stomach to Flip?

Dog's Stomach

Exactly what causes a dog's stomach to flip remains unknown, but there are several predisposing factors. Stomach flip, also known as bloat, or in medical terms, gastric dilatation volvulus (GDV), is the expansion of the dog's stomach due to the accumulation of gas or fluid. This expansion of the dog's stomach may be then followed by a clock-wise rotation on its axis. Simply stated, gastric dilatation volvulus refers to a bloated stomach that then flips and ends up twisting upon itself. When a dog's stomach flips, this can be a potentially life-threatening condition that results in gastric obstruction, impaired blood supply to the abdominal organs, low blood pressure, arrhythmia, shock, and ultimately death.

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What causes a dog's stomach to flip and twist?

Air Potentially Causes a Dog's Stomach to Flip

As mentioned, what exactly causes a dog's stomach to flip is not determined. It is believed though that the syndrome has though several predisposing factors.

It is presumed that the gastric dilatation is a result of the dog’s impaired ability to eliminate swallowed air that has accumulated in the dog's stomach. Then, as the dilatation continues, the dog's expanded stomach may end up flipping and eventually twisting.

By analyzing the history of dogs that developed a flipped stomach, it can be concluded that rapid drinking and eating resulting in swallowed air, followed by intense exercise, is a common contributing factor.

 Predisposing Factors that Causes a Dog's Stomach to Flip

The risk of stomach flipping runs in certain dog families. Middle-sized, large and giant breeds with deep, narrow chests (dogs with high thoracic depth-to-width ratio which allows more space for the stomach to twist) are most at risk.

The breeds include, great danes, Saint Bernards, standard poodles, Akitas, great danes, Irish wolfhounds, Newfoundlands, Rottweilers, basset hounds, Irish setters, Gordon Setters, Weirmaraners, Doberman pinschers and old English sheepdogs.

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On top of breed, there are several other predisposing factors. Dogs older than 5 years of age are at much higher risk than younger dogs of the same breed, and, whether neutered or not, male dogs, are at slightly higher risk of developing bloat than females of the same breed.

Even personality traits may be a factor. There is a direct link between the dog’s temperament and its tendency to develop bloat. Relaxed, happy and calm dogs are at less risk, when compared to hyperactive and fearful dogs. Recently, it has been determined that stress is also a contributing factor.

"An analogy that has helped my clients understand this syndrome is that of a hammock. If a small stone is placed in the middle of a hammock and the hammock is given a push, nothing much will happen, but if a large rock is put into the hammock and the hammock is given a push, it may flip over on itself, twisting both ends of the hammock."~Dr. Bob

Diet Potentially Causes a Dog's Stomach to Flip

Any dietary changes can make dogs sick

Any dietary changes can make dogs sick

Several dietary factors may contribute to stomach flipping in dogs. Dogs who are fed once a day may be predisposed because as mentioned, rapid eating of large amount of foods predisposes them to bloat. While in the past it was recommended to raise a dog's food bowl to aid digestion, a study found that eating out of raised bowls is a predisposing factor for bloat.

Ingredient-wise, another study found that neither protein, nor soy, nor cereal, appearing as the first four ingredients in dry dog food appeared to cause bloat. Instead, dry foods containing an oil or fat ingredient (such as sunflower oil, or animal fat) among the first four ingredients, predisposed high-risk dogs to GDV. Possibly, this occurs because such ingredients delay emptying of the dog's stomach.

Typically, the first signs of bloat occur about two to three hours after the dog ingests a large meal. It's important to see the vet as early as possible upon seeing the first signs. Dogs who have failed to see the vet for more than five hours since the onset of symptoms have a poor prognosis.

What causes a dog's stomach to flip can be prevented. If your dog is predisposed to bloat, try feeding several small meals instead of a larger one. Limit water consumption for an hour before and after meals. Restrict exercise before and after meals, reduce stress and avoid elevated feeding bowls.

How a Dog's Stomach Ends up Flipping

 The onset of bloat in dogs starts with the accumulation of gas in the stomach. As mentioned, the most common reason for the gaseous build-up in the stomach is swallowing air. Sometimes the condition may progress as simple gastric dilatation (bloat) without the volvulus (dog stomach flipping).

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In the cases of the stomach expanding without flipping, the condition has the potential to resolve on its own because the accumulated gas can be eliminated (burping, flatulence). However, if the stomach manages to flip, both the entrance and exit of the stomach become obstructed, therefore the possibility of gas elimination is disabled. When this happens, the gas is trapped in the stomach and the stomach continues to bloat (expand). This leads to a cascading chain of events.

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The bloated stomach starts putting pressure on the diaphragm, causing breathing difficulties in the affected dog. The bloated stomach also puts pressures on the large veins in the abdomen which are responsible for carrying blood back to the heart, therefore compromising the affected dog's blood circulation. As the pressure of the gas on the stomach wall increases, insufficient blood flow reaches the wall, resulting in tissue death.

Once vital tissues are deprived of blood and oxygen, then systemic shock sets in. Digestion stops and toxins accumulate in the blood which exacerbates the shock. As the dilatation progresses, the risk of the stomach wall rupturing increases.

 Symptoms of a Flipped Stomach in Dogs 

A flipped stomach in dogs usually manifests with abdominal enlargement, loss of appetite, drooling, elevated heart rate, restless pacing, breathing difficulties and pain. Affected dogs may try to vomit, retching repeatedly but being unable to vomit. The pain will often cause them to assume a hunched-up posture.

Because the abdomen is enlarged, often, when gently tapping it with fingers just behind the last ribs, produces a typical, hollow, drum-like sound. Labored breathing may also result from the enlarged stomach pressing on the diaphragm.

Depending on the condition’s stage, if the dog is already in a systemic shock state, he will show a weak pulse, increased heart rate and pale mucous membranes.

 At the Vet's Office 

life expectancy of addison disease in dogs

Bloat is considered to be one of the most serious non-traumatic conditions in dogs and it requires immediate veterinary attention. Every second counts! Early diagnosis and prompt aggressive medical supportive care combined with surgical intervention increase the affected dog's chances of survival.

Diagnosis of bloat in dogs is based on the dog's medical history, presenation of symptoms, physical examination findings and laboratory findings. However, since most of the symptoms are non-specific for bloat, definitive diagnosis mainly comes from abdominal x-rays.

If the dog is in shock, then shock treatment must be instituted immediately. This entails administration of IV fluids, antibiotics and pain medications.

It is crucial to reduce the pressure on the stomach wall and interior organs as soon as possible. Once the dog is stabilized and strong enough to undergo anesthesia, surgery is used to rotate the stomach back, securing it down into its regular position.

To eliminate the risk of future GDV episodes, the veterinarian may perform a preventative procedure known as gastropexy ( the surgical attachment of the stomach to the body wall) also known as "stomach tacking."

The prognosis of bloat in dogs depends on the overall severity of the condition, the degree of shock, the extent of cardiac issues, the level of tissue death and the length of surgery. Unfortunately, bloat is an acute condition with a high fatality rate even for dogs with uncomplicated conditions that receive immediate medical attention.

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  • Glickman L, Glickman N, Schellenberg D, Raghavan M, Lee T (2000). "Non-dietary risk factors for gastric dilatation-volvulus in large and giant breed dogs". J. Am. Vet. Med. Assoc. 217 (10): 1492–9.
  • DVM360: Gastric dilatation-volvulus: Controlling the crisis

About the Author

ivana crnec

Dr. Ivana Crnec is a graduate of the University Sv. Kliment Ohridski’s Faculty of Veterinary Medicine in Bitola, Republic of Macedonia. She is a certified nutritionist and is certified in HAACP food safety system implementation.

She currently practices as a veterinarian in Bitola and is completing her postgraduate studies in the Pathology of Domestic Carnivores at the Faculty of Veterinary Medicine in Zagreb, Croatia.

Ivana’s research has been published in international journals, and she regularly attends international veterinary conferences.

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