our 6 year old beagle has been diagnosed with chronic acid reflux after a year of intermittent regurgitation, the GP vet wants to start with a feeding tube trial and the GI specialist is recommending a hydrolyzed diet plus prokinetics, and i cannot tell which path actually addresses the underlying problem

Hazel is a 6 year old beagle, we got her at 9 weeks from a working line breeder, no medical history of note until about 14 months ago when she started doing this thing where she would regurgitate small amounts of undigested food maybe once every two weeks, almost always within an hour of eating, usually at night. We did the obvious troubleshooting first, slowed down her eating with a puzzle feeder, raised her food bowl, switched from twice a day feeding to three smaller meals, tried a couple of different kibbles, and for a while the frequency dropped and we thought we had managed it. Then around 8 months ago the episodes started getting more frequent and more uncomfortable, she would do this lip smacking thing for 20 minutes before regurgitating, sometimes the regurgitated food had a yellow bile component, and she started avoiding her food bowl at certain times of day. We finally got referred to a GI specialist and did a full workup.

What the workup found. Endoscopy showed lower esophageal sphincter dysfunction with mild esophagitis, the stomach itself looked normal, biopsies came back showing low grade lymphocytic plasmacytic infiltrate in the antrum which the specialist said is consistent with chronic mild gastritis but not the primary issue. The fluoroscopy swallow study was the most informative piece, showed delayed gastric emptying (food sitting in the stomach significantly longer than normal) plus episodes of gastroesophageal reflux during the study itself. So the diagnosis ended up being chronic acid reflux with concurrent delayed gastric motility and a sphincter that is not closing fully. The specialist said this is more common in beagles than the literature reflects and that we caught it before it became severe.

Where the two vets disagree. Our regular vet, who has known Hazel since she was a puppy and who we trust, thinks we should do a 4 to 6 week feeding tube trial to give the esophagus time to fully heal from the chronic inflammation, then reintroduce oral feeding with strict positioning protocols. She has seen this work well for chronic esophagitis cases and she thinks the inflammation is the thing that needs to be addressed first before any dietary change will actually stick. The GI specialist who did the workup thinks the feeding tube is overkill for the severity of esophagitis we are seeing on scope, and is recommending a hydrolyzed protein diet (something like Royal Canin HP or Hills Z/D) combined with a prokinetic (metoclopramide or cisapride) to address the motility piece, plus omeprazole for acid suppression, all started together. She thinks the diet is the load bearing intervention and the meds are the bridge while the diet does its work.

The honest questions i am sitting with. one, the feeding tube trial seems aggressive given that the esophagitis is mild on scope, but our GP vet has been right about Hazel before and she is not someone who jumps to invasive options without reason. two, the hydrolyzed diet approach makes intuitive sense but i dont fully understand why a hydrolyzed protein would address a motility and sphincter problem, that seems more like a food allergy intervention. three, the prokinetic question, my reading suggests cisapride is much more effective than metoclopramide but it is harder to get and more expensive, is that the actual experience or is the metoclopramide adequate in most cases. four, the long term picture, is this a condition that goes into remission with the right protocol or is this lifelong management with a lot of trial and error. five, the food choice itself, even if we go with the GI specialist plan, the hydrolyzed prescription diets are expensive and Hazel has never been picky but i am nervous about switching her to a chicken based hydrolyzed food when her current rotation has been mostly fish and lamb. would really value hearing from vets who do this regularly and owners who have lived through a similar diagnosis