Mortality and morbidity due to gastric dilatation-volvulus syndrome in pedigree dogs in the UK

Abstract

To estimate breed-specific risk of death due to, and prevalence of, gastric dilatation-volvulus (GDV) in UK pedigree dogs.
Data were available on the reported cause of and age at death and occurrence of and age at diagnosis of disease from the 2004 purebred dog health survey. A total of 15,881 dogs of 165 breeds had died in the previous 10 years; GDV was the cause of death in 65 breeds. There were 36,006 live dogs of 169 breeds of which 48 breeds had experienced > or =1 episodes of GDV. Prevalence ratios were used to estimate breed-specific GDV mortality and morbidity risks.
Gastric dilatation-volvulus was the cause of death for 389 dogs, representing 2.5% (95% CI: 2.2-2.7) of all deaths reported and the median age at death was 7.92 years. There were 253 episodes in 238 live dogs. The median age at first diagnosis was five years. Breeds at greatest risk of GDV mortality were the bloodhound, Grand Bleu de Gascogne, German longhaired pointer and Neapolitan mastiff. Breeds at greatest risk of GDV morbidity were the Grand Bleu de Gascogne, bloodhound, otterhound, Irish setter and Weimaraner.
These results suggest that 16 breeds, mainly large/giant, are at increased risk of morbidity/mortality due to GDV.

Full text

PAPER
376 Journal of Small Animal Practice • Vol 51 • July 2010 • © 2010 British Small Animal Veterinary Association
Animal Health Trust, Lanwades Park, Kentford,
Newmarket, Suffolk, CB8 7UU
Current adderss for Vicki J. Adams is Veterinary
Epidemiologist, PO Box 80, Bury St Edmunds,
Suffolk, IP28 9BF
KATY M. EVANS AND VICKI J. ADAMS
Journal of Small Animal Practice (2010)
51, 376–381
DOI: 10.1111/j.1748-5827.2010.00949.x
Accepted: 18 March 2010
Mortality and morbidity due to gastric
dilatation-volvulus syndrome in
pedigree dogs in the UK
INTRODUCTION
Gastric dilatation (GD) and gastric dila-
tation-volvulus (GDV) syndromes are
acute, life-threatening conditions most
commonly affecting large and giant-breed
dogs (Ward and others 2003). They fea-
ture rapid accumulation of air in the
stomach, malposition of the stomach to a
varying degree, a rise in intragastric pres-
sure and frequently lead to the develop-
ment of cardiogenic shock (Glickman
and others 2000a). It is often impossible
to distinguish between GD and GDV on
clinical signs alone, but it is thought that
both conditions may be manifestations of
the same disease process (Glickman and
others 1998).
The exact cause is still not clearly under-
stood although several risk factors have
been identified (Monnet 2003). These
risk factors include being a purebred and
of a large or giant breed (especially one
with a deep and narrow thorax) and hav-
ing a first-degree relative that had GDV
(Glickman and others 1994). Glickman
reports that the relatively high case-fatality
rate of approximately 30%, together with
the high incidence of GDV in large and
giant breed dogs, results in GDV being
a leading cause of death for these breeds
in North America (Glickman and others
2000b).
The purpose of this study was to
describe the breed-specific risk of death
due to GDV and to estimate the preva-
lence of GDV in UK pedigree dogs.
There have been numerous retrospective
studies considering characteristics of dogs
that have developed GDV, and prospec-
tive studies of individuals of breeds con-
sidered to be at high risk of developing
GDV, but this is the first cross-sectional
study of a large sample of pedigree dogs
from which the proportion of cases of
morbidity in live dogs due to GDV is
reported.
METHODS
Data were available on the reported cause
of death and occurrence of disease from
the 2004 Kennel Club/British Small
Animal Veterinary Association Scientific
Committee Purebred dog health survey
(Adams and others 2010). This survey was
administered via breed club secretaries of
170 breeds of dogs recognised by The
Kennel Club (KC) in the UK. Owners
were asked to anonymously complete a
questionnaire for all dogs they owned of
the relevant breed, and return it in a pre-
paid reply envelope. The questionnaire
contained three sections pertaining to the
health status of all dogs including ques-
tions covering the body systems, breeding
OBJECTIVES: To estimate breed-specific risk of death due to, and prev-
alence of, gastric dilatation-volvulus (GDV) in UK pedigree dogs.
METHODS: Data were available on the reported cause of and age at
death and occurrence of and age at diagnosis of disease from the
2004 purebred dog health survey. A total of 15,881 dogs of 165
breeds had died in the previous 10 years; GDV was the cause of
death in 65 breeds. There were 36,006 live dogs of 169 breeds of
which 48 breeds had experienced ê1 episodes of GDV. Prevalence
ratios were used to estimate breed-specific GDV mortality and mor-
bidity risks.
RESULTS: Gastric dilatation-volvulus was the cause of death for 389
dogs, representing 2.5% (95% CI: 2.2-2.7) of all deaths reported
and the median age at death was 7.92 years. There were 253
episodes in 238 live dogs. The median age at first diagnosis was
five years. Breeds at greatest risk of GDV mortality were the blood-
hound, Grand Bleu de Gascogne, German longhaired pointer and
Neapolitan mastiff. Breeds at greatest risk of GDV morbidity were
the Grand Bleu de Gascogne, bloodhound, otterhound, Irish setter
and Weimaraner.
CLINICAL SIGNIFICANCE: These results suggest that 16 breeds, mainly
large/giant, are at increased risk of morbidity/mortality due to
GDV.
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Journal of Small Animal Practice • Vol 51 • July 2010 • © 2010 British Small Animal Veterinary Association 377
GDV syndrome in pedigree dogs in UK
of females and occurrence of birth defects.
A fourth section dealt with dogs that had
died in the last 10 years. The question-
naire was designed and pre-tested in two
breeds, the Norfolk terrier and German
spitz. The questionnaire is available on the
Kennel Club website (The Kennel Club
2006).
The proportion of deaths due to GDV
was estimated as the number of deaths
due to GDV divided by the total num-
ber of deaths reported for that breed and
expressed as a percentage (Table 1). Breed-
specific prevalence of GDV morbidity
was estimated as the number of cases of
GDV for the breed divided by the total
number of live dogs of each breed and
expressed as a percentage (Table 2). The
association between exposure to a particu-
lar risk factor (in this case, breed) and the
occurrence of death or disease in a cross-
sectional study can be estimated using
two parameters: the prevalence ratio (PR)
and the odds ratio (OR). Although the
OR is often reported for cross-sectional
studies, it overestimates the value of the
association between the exposure factor
and cause of death or disease (especially
when the cause of death disease is not
rare). The PR is therefore the preferred
estimate and it is reported with 95% con-
fidence intervals (CIs). When the value
of PR is equal to 1, then it is said that
no association exists between occurrence
of exposure and the cause of death or
occurrence of disease. When the value of
the PR is greater than 1, then the expo-
sure is said to be positively associated
with the cause of death or occurrence of
disease and it is interpreted as a risk fac-
tor. Finally, when the value of the PR is
less than 1, then the exposure is said to
Table 1. For a total of 389 deaths due to gastric dilatation-volvulus (GDV), the number of deaths due to GDV, the total
number of deaths reported and the proportion of deaths due to GDV for each of 65 breeds that reported any deaths due
to GDV
Breed
Deaths due to
GDV Total deaths % Deaths Breed
Deaths due
to GDV
Total
deaths % Deaths
Akita 3 28 10·7 Hungarian wirehaired vizsla 1 15 6·7
Alaskan Malamute 1 14 7·1 Irish red & white setter 14 179 7·8
Anatolian/Karabash 1 23 4·4 Irish setter 24 451 5·3
Basset hound 12 142 8·5 Irish water spaniel 1 95 1·1
Bearded collie 1 278 0·4 Irish wolfhound 12 112 10·7
Bernese mountain dog 14 394 3·6 Italian greyhound 1 46 2·2
Bloodhound 25 82 30·5 Italian spinone 3 47 6·4
Borzoi 8 87 9·2 Komondor 1 10 10·0
Bouvier des Flandres 1 39 2·6 Labrador retriever 3 574 0·5
Boxer 7 130 5·4 Large Munsterlander 3 69 4·4
Briard 1 71 1·4 Manchester terrier 1 32 3·1
Bulldog 2 180 1·1 Mastiff 13 80 16·3
Bullmastiff 7 96 7·3 Neapolitan mastiff 2 7 28·6
Chesapeake Bay retriever 2 45 4·4 Newfoundland 15 269 5·6
Chow chow 16 80 20·0 Norfolk terrier 1 189 0·5
Clumber spaniel 1 69 1·5 Old English sheepdog 5 65 7·7
Curly coated retriever 3 40 7·5 Otterhound 4 54 7·4
Dachshund (all) 2 245 0·8 Pointer 1 145 0·7
Dalmatian 7 199 3·5 Pyrenean sheepdog 1 66 1·5
Deerhound 20 287 7·0 Rhodesian ridgeback 8 183 4·4
Dobermann 3 100 3·0 Samoyed 6 223 2·7
English setter 5 384 1·3 Shar-Pei 2 60 3·3
English springer spaniel 1 90 1·1 Siberian husky 2 129 1·6
Flatcoated retriever 22 610 3·6 Soft coated wheaten terrier 2 111 1·8
French bulldog 1 71 1·4 St Bernard 8 53 15·1
German longhaired pointer 1 2 50·0 Standard poodle 7 118 5·9
German shorthaired pointer 1 159 0·6 Sussex spaniel 2 42 4·8
German wirehaired pointer 1 41 2·4 Weimaraner 28 242 11·6
Golden retriever 5 927 0·5 Welsh springer spaniel 2 157 1·3
Gordon setter 2 157 1·3 Pembroke Welsh corgi 1 116 0·9
Grand Bleu de Gascogne 3 6 50·0 West Highland white terrier 1 127 0·8
Great Dane 32 171 18·7 Whippet 1 486 0·2
Greyhound 2 69 2·9

K. M. Evans & V. J. Adams
378 Journal of Small Animal Practice • Vol 51 • July 2010 • © 2010 British Small Animal Veterinary Association
be negatively associated with the cause of
death or disease and it is interpreted as a
preventive factor. The breed-specific PRs
for GDV deaths were estimated as (the
number of dogs of the breed of interest
that died due to GDV divided by the total
number of dogs of the breed of interest
that died) divided by (the number of dogs
of the other breeds that died due to GDV
divided by the total number of dogs in the
survey that died) so that the total num-
ber of dogs included in the calculation
was 15,881 (Table 3, Fig 1). The breed-
specific PRs for morbidity due to GDV
were estimated as (the number of cases of
GDV reported in live dogs of the breed
of interest divided by the total number of
live dogs of the breed of interest) divided
by (the number of cases of GDV reported
in live dogs of the other breeds divided by
the total number of live dogs in the sur-
vey) such that the total number of dogs
included in the calculation was 36,006
(Table 4). The estimated PRs were con-
sidered to be statistically significant when
the P-value was less than the Bonferroni
corrected level of significance of 0·05/k
for multiple comparisons (where k is the
number of comparisons).
RESULTS
Data on cause of death and age at death
for dogs that had died in the last 10 years
were available for 15,881 dogs of 165
breeds. Data on the occurrence of disease
and age at diagnosis of one or more epi-
sodes of disease were available for 36,006
live dogs of 169 breeds. Unfortunately
there were no data on the German shep-
herd dog, which is consistently in the top
10 breeds registered with the UK Kennel
Club, because the British Association for
German shepherd dogs declined to take
part in the survey.
GDV was reported as the cause of
death for 389 dogs of 65 breeds, repre-
senting 2·5% (95% CI: 2·2 to 2·7) of all
deaths reported. The median age at death
due to GDV was 7 years and 11 months
(minimum 8 months, maximum 16 years
6 months). The two breeds that had the
most deaths due to GDV were the great
Dane (32 of 389=8%) and the Weima-
raner (28 of 389=7%, Table 1). The two
breeds with the greatest proportion of
deaths due to GDV were the Grand Bleu
de Gascogne and the German longhaired
pointer, although each of these breeds
had very few reported deaths in total.
Data on sex and neuter status of dogs
which had died due to GDV were not
available.
GDV was reported as a cause of mor-
bidity for dogs of 44 breeds (Table 2).
There were 253 cases of GDV in 238 live
dogs of 44 breeds with 224 dogs reported
to have had one episode, 13 dogs had two
episodes and 1 dog had three episodes.
The prevalence of GDV morbidity was
0·7% (238 dogs affected out of 36,006
total live dogs). The median age at first
diagnosis of GDV was five years (mini-
mum three months, maximum 15 years 5
months, n=186 dogs with age reported).
Considering the 238 live dogs which were
reported to have suffered one or more epi-
sodes of GDV, 131 (55%) were female and
66 of these had been neutered. The 107
male dogs reported to have suffered one or
Table 2. Breed-specific prevalence of gastric dilatation-volvulus (GDV) morbidity for the 44 breeds which reported cases
Breed
Cases of
GDV
Total number
of live dogs Prevalence Breed Cases of GDV
Total number
of live dogs Prevalence
Afghan hound 2 193 1·0 Hovawart 1 49 2·0
Akita 3 87 3·5 Hungarian Vizsla 1 123 0·8
Alaskan Malamute 1 111 0·9 Irish red & white setter 10 337 3·0
Basset hound 6 226 2·7 Irish setter 49 680 7·2
Beagle 1 507 0·2 Irish wolfhound 2 123 1·6
Bernese mountain dog 10 629 1·6 Italian spinone 8 222 3·6
Bloodhound 16 112 14·3 Labrador retriever 3 1341 0·2
Borzoi 6 133 4·5 Large Munsterlander 1 180 0·6
Bracco Italiano 1 19 5·3 Leonberger 4 223 1·8
Bull terrier 1 293 0·3 Manchester terrier 1 117 0·9
Curly coated retriever 1 81 1·2 Newfoundland 10 506 2·0
Dalmatian 3 452 0·7 Norfolk terrier 1 458 0·2
Deerhound 14 442 3·2 Otterhound 5 56 9·0
Dobermann 1 129 0·8 Pekingese 1 174 0·6
English springer spaniel 1 258 0·4 Siberian husky 1 797 0·1
Flatcoated retriever 21 926 2·3 Soft coated wheaten terrier 1 505 0·2
Giant Schnauzer 2 113 1·8 St Bernard 4 87 4·6
Golden retriever 3 1717 0·2 Standard poodle 7 255 3·1
Gordon setter 4 293 1·4 Sussex spaniel 2 121 1·7
Grand Bleu de Gascogne 3 14 21·4 Tibetan spaniel 2 379 0·5
Great Dane 5 225 2·2 Weimeraner 28 558 5·0
Greyhound 1 113 0·9 Whippet 2 1214 0·2

Journal of Small Animal Practice • Vol 51 • July 2010 • © 2010 British Small Animal Veterinary Association 379
GDV syndrome in pedigree dogs in UK
Table 3. Prevalence ratios (PRs) for gastric dilatation-volvulus (GDV) deaths in 23 breeds selected from Table 1 with three
or more deaths due to GDV and more than 7% of deaths in that breed due to GDV
Breed
Number deaths due
to GDVs
Total number of
deaths PR
95% Confidence
interval
P-value (significance
<0·002)*
Akita 3 28 4·4 1·5 to 12·9 0·03
Basset hound 12 142 3·5 2·0 to 6·1 <0·0001
Bloodhound 25 82 13·2 9·4 to 18·6 <0·0001
Borzoi 8 87 3·8 2·0 to 7·4 0·0002
Boxer 7 130 2·2 1·1 to 4·6 0·06
Bullmastiff 7 96 3·0 1·5 to 6·2 0·006
Chow chow 16 80 8·5 5·4 to 13·3 <0·0001
Curly coated retriever 3 40 3·1 1·0 to 9·2 0·12
Deerhound 20 287 3·0 2·0 to 4·6 <0·0001
German longhaired pointer 1 2 20·5 9·2 to 46·1 0·04
Grand Bleu de Gascogne 3 6 20·6 5·1 to 82·1 <0·0001
Great Dane 32 171 8·2 5·9 to 11·4 <0·0001
Irish red & white setter 14 179 3·3 2·0 to 5·5 <0·0001
Irish setter 24 451 2·3 1·5 to 3·4 0·0001
Irish wolfhound 12 112 4·5 2·6 to 7·7 <0·0001
Mastiff 13 80 6·8 4·1 to 11·3 <0·0001
Neapolitan mastiff 2 7 11·7 3·6 to 38·0 0·0012
Newfoundland 15 269 2·3 1·4 to 3·8 0·0016
Old English sheepdog 5 65 3·2 1·4 to 7·4 0·02
Otterhound 4 54 3·1 1·2 to 7·9 0·06
St Bernard 8 53 6·3 3·3 to 12·0 <0·0001
Standard poodle 7 118 2·5 1·2 to 5·1 0·03
Weimaraner 28 242 5·0 3·5 to 7·3 <0·0001
Example calculation of PR: (3 of 28)/(389 to 3 of 15881 to 28) = 4·4.
* Bonferroni corrected level of significance for multiple comparisons: alpha=0·05/k where k=number of comparisons, in this case 0·05 of 23=0·002.
more episodes of GDV showed a less even
distribution of neuter status, with only
36 of them having been neutered. The
four breeds with the highest prevalence of
GDV were the Grand Bleu de Gascogne,
bloodhound, otterhound and Irish setter
(Table 2).
The breeds which appeared to be at
most risk of dying due to GDV were the
bloodhound, Grand Bleu de Gascogne,
German longhaired pointer and Neapoli-
tan mastiff (Table 3). As mentioned earlier,
very few deaths were reported in the Grand
Bleu de Gascogne and German longhaired
pointer, and the P-values greater than
0·002 and the wide confidence limits for
the PRs in these two breeds reflect this. The
Grand Bleu de Gascogne and bloodhound
also appeared to be at the highest risk of
morbidity due to GDV. In contrast to the
other breeds at most risk of dying due to
GDV, the breeds at most risk of morbid-
ity due to GDV were the otterhound, Irish
setter and Weimaraner (Table 4). All the
breeds which appeared to be at increased
risk of morbidity or mortality due to GDV
were large or giant breeds except the basset
hound and chow chow.
DISCUSSION
A retrospective study by Glickman and
others (1994) which is widely referred to
on health information websites aimed at
dog breeders/owners reported ORs which
show the probability of a dog of a par-
ticular breed having been admitted to one
of 12 state veterinary institutions in the
USA with GDV compared to the prob-
ability of a German shepherd dog having
been admitted to the same institutions
with GDV (Glickman and others 1994).
They reported that six breeds were at sig-
nificantly increased risk and these were the
great Dane (OR=10·0), Weimaraner (4·6),
St Bernard (4·2), Gordon setter (4·1), Irish
setter (3·5) and standard poodle (2·9). The
PRs estimated in this study suggest that 23
breeds were at significantly increased risk
of death due to GDV compared to dogs of
other breeds. These include five of the six
breeds reported by Glickman and others
(1994), although the Gordon setter was
not at significantly greater risk. It is unfor-
tunate that there were no data for German
shepherd dogs in this study. Because the
study by Glickman and others was a
case-control study the authors could only
report ORs (Petrie and Watson 2006). As
this study was cross-sectional and several
of the breed-specific prevalences/propor-
tions were such that GDV could not be
considered to be rare, we chose to report
PRs in order to avoid overestimating the
risk. Care must be taken when interpret-
ing these data to consider how the risks
were estimated and also the width of the
95% CIs for the reported risks. One can
put more weight on a PR with relatively
narrow 95% CIs such as the bloodhound
than one with relatively wide 95% CIs

K. M. Evans & V. J. Adams
380 Journal of Small Animal Practice • Vol 51 • July 2010 • © 2010 British Small Animal Veterinary Association
Table 4. Prevalence ratios (PRs) for gastric dilatation-volvulus (GDV) morbidity
in four breeds selected from Table 2 with three or more cases of GDV and more
than 7% of dogs affected by GDV in that breed
Breed Number of GDVs
Number of
live dogs PR
95% Confidence
intervals
P-value (signifi-
cance <0·0125)*
Grande Bleu de
Gascogne
3 14 31·1 11·32 to 85·45 <0·0001
Bloodhound 16 112 21·8 13·62 to 34·95 <0·0001
Otterhound 5 56 13·1 5·601 to 30·40 <0·0001
Irish setter 49 680 12·6 9·31 to 17·06 <0·0001
Example calculation of PR: (16 of 112)/(251 to 16 of 36006 to 112)=21·8.
* Bonferroni corrected level of significance for multiple comparisons: alpha=0·05/k where k=number of comparisons, in this
case 0·05 of 4=0·0125.
such as the Grand Bleu de Gascogne in
the present study.
A retrospective study at Pennsylvania
Veterinary Hospital of 295 cases of GDV
affecting dogs of 35 breeds reported a
breed predisposition in German shepherd
dogs (21% of GDV cases), great Danes
(14%), large mixed breed dogs (10%)
and standard poodles (5·1%) (Brockman
and others 1995). Our results agree with
this study in that both great Danes and
standard poodles were at increased risk of
morbidity and mortality due to GDV.
A total of four breeds were at signifi-
cantly increased risk of morbidity due to
GDV compared to dogs of other breeds.
Of the two breeds that appeared to be at
significantly increased risk of morbidity or
mortality due to GDV which are not large
or giant breeds, the basset hound has been
suggested to be at increased risk by other
authors (Burrows and Ignaszewski 1990,
Glickman and others 1994) but the chow
chow has not been mentioned in this con-
text prior to this study.
Rawlings and others (2002) suggest
that several years without any signs of
gastrointestinal tract problems in a dog
that may be susceptible to GDV does not
guarantee that this dog will not develop
GDV as shown by the acute onset of
GDV unexpectedly in middle-aged or
older dogs (Rawlings and others 2002).
The median age at first diagnosis of five
years in this study, and more strikingly the
maximum reported age of 15 years and 5
months at first diagnosis, appears to sup-
port this suggestion. As this study was an
anonymous cross-sectional study, it was
impossible to tell whether the live dogs
which had been reported to have had one
or more episodes of GDV had subsequent
episodes or have even died due to GDV
since the survey. It was also not possible to
differentiate between cases of GD without
volvulus and cases of GDV.
Much has been written about possible
risk factors for GDV apart from those
associated with breeding. These include
dietary factors such as feeding a large
volume of food at each meal (Raghavan
and others 2004), small particle size of
food (Theyse and others 1998), feeding
a single food type and the occurrence of
aerophagia (Elwood 1998). Other non-
dietary risk factors include increasing
age (Glickman and others 1994) and
recent kenneling or a car journey (Elwood
FIG 1. Total number of deaths due to GDV for 23 breeds of dog with three or more deaths due to GDV and more than 7% of deaths in that breed due
to GDV

Journal of Small Animal Practice • Vol 51 • July 2010 • © 2010 British Small Animal Veterinary Association 381
GDV syndrome in pedigree dogs in UK
1998). Many other potential risk factors
have been suggested in the results of some
studies while being considered to be of
little importance from the results of other
studies. Falling into this category are gen-
der and neuter status, having a low body
condition score, temperament, speed of
eating, frequency of feeding and height
of food bowl (Glickman and others 1994,
1997, 2000a,b).
The results of this study suggest that in
the UK 16 breeds of dog are at increased
risk of morbidity or mortality due to
GDV. All but two of these are large or
giant breeds – the basset hound and chow
chow being the exceptions. The breeds at
highest risk are the bloodhound, Grand
Bleu de Gascogne, German longhaired
pointer, Neapolitan mastiff, otterhound
and Irish setter, although there were rela-
tively few cases of deaths or morbidity due
to any causes reported for the Grand Bleu
de Gascogne and the German longhaired
pointer. Cases of morbidity due to GDV
were quite evenly distributed between
males and females, and among the males
more cases occurred in dogs which had
not been neutered, but these data were not
available for deaths.
Acknowledgements
The authors would like to thank the
Kennel Club Charitable Trust for funding
this study.
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