French bulldog standing over food bowl looking at bowl dog not interested in food loss of appetite nausea vomiting throwing up puking bilious vomiting syndrome BVS

Is Your Dog Throwing Up Yellow Liquid? It Could Be Bilious Vomiting Syndrome In Dogs

Have you ever woken up to the sound of your dog throwing up? It's never fun, but it may be alarming if the vomit is foamy, frothy, and yellowish or greenish. This typically indicates bile, an acidic liquid made in the liver and stored in the gallbladder to aid with digestion. In general, throwing up bile isn't a cause for concern, especially if your dog is otherwise in good health, and it's the first thing in the morning, as it's often bilious vomiting syndrome (of course, it's always a good idea to consult with a vet).

We know BVS all too well because our older dog, Brody, has it. So, here's an overview of the condition, including symptoms, causes, diagnosis, treatment, and more.

What Is Bilious Vomiting Syndrome In Dogs?

Bilious vomiting syndrome (BVS), also known as reflux gastritis, is a typically non-life-threatening, non-transmissible condition in which dogs throw up clear fluid that may be foamy or yellowish/greenish from bile. The vomiting typically occurs on an empty stomach, usually in the morning or during an extended break between meals, and doesn't involve food or foreign materials. Usually, a dog will vomit one time or a few times in a row and be fine for the rest of the day. Unfortunately, bilious vomiting syndrome is almost always chronic, meaning it's a recurring condition that happens frequently. In fact, it may occur a few times a month or week, but sometimes it happens daily.

Symptoms of Bilious Vomiting Syndrome

The main symptom of bilious vomiting syndrome is frequent and recurring vomiting of clear, foamy, and/or yellow liquid - especially if a dog is otherwise healthy, able to keep food and water down, at a healthy weight, has normal energy levels, and experiences the vomiting on an empty stomach. The general symptoms include:

  • Clear, foamy, or yellow vomit
  • Vomiting on an empty stomach, such as early in the morning or late at night
  • Gurgling sounds in the abdomen
  • Nausea
  • Licking lips or smacking lips
  • Drooling or excessive saliva
  • Gagging
  • Temporary loss of appetite or disinterest in food when first offered, typically due to nausea

Pro Tip: If your dog shows these symptoms, talk to your vet because other conditions and illnesses can present similarly (such as blockages, parasites, and more). Also, go to the vet as soon as possible if vomiting is accompanied by lethargy, extended loss of appetite, vomiting blood or what looks like coffee grounds, diarrhea, and weight loss.

What Causes Bilious Vomiting Syndrome in Dogs?

Bilious vomiting is most often caused by an empty stomach and imbalances in stomach acid, such as the over-secretion of stomach acid and other fluids from the intestines - similarly to acid reflux in humans. Because the dog's stomach is empty, there isn't anything to absorb stomach acids and bile, which causes irritation, nausea and vomiting.

That being said, the exact underlying cause of the syndrome is unknown, though certain factors may contribute to the condition. For example, young and middle-aged neutered male mixed-breed dogs and mutts seem to be more commonly diagnosed with the condition. It may also be more common in older or senior dogs, overweight dogs, as well as dogs with food allergies, inflammatory bowel disease (IBD), Giardia, abnormal stomach motility (movement of food and fluid through the digestive tract), and delayed gastric emptying.

Pro Tip: Although BVS can be a symptom of IBD and gastroenteritis, it's important to remember that they are different conditions, and unlike BVS, the latter two are usually not caused by bile and acid entering an empty stomach.

How Bilious Vomiting Syndrome Is Diagnosed

BVS is diagnosed by vets through an evaluation of the dog and by ruling out other causes. They will assess your dog's current state of health, medical history and symptoms - including characteristics of the vomit (clarity, color, consistency, etc.), frequency, and timing of occurrences. Additionally, vets will often conduct tests to rule out other causes. These tests may include blood tests (e.g., complete blood count to check overall health and serum chemistry to assess organ function), fecal and urine tests, X-rays, ultrasounds, endoscopies, and biopsies.

In general, BVS is diagnosed based on a history of recurring or chronic vomiting, especially in the morning or on an empty stomach, along with normal physical examinations, and by ruling out other potential causes (such as parasites, pancreatitis, or blockage). Other causes of a dog vomiting yellow that need to be ruled out include, but are not limited to:

  • Inflammatory bowel disease (IBD)
  • Pancreatitis
  • Intestinal parasites
  • Gastritis
  • Foreign bodies in the stomach and intestines, especially slow-moving ones
  • Food allergies
  • Ulcers
  • Bacterial infections, such as Helicobacter
  • Addison's disease
  • Cancer
  • Hernia where the stomach moves up into the chest
  • Physalopterosis (a stomach worm from eating crickets, often found in the Midwest)
  • Slow-moving intestinal foreign bodies

Pro Tip: Providing photos or videos of the vomit can be helpful for vets when diagnosing the cause of vomiting.

How to Treat Bilious Vomiting Syndrome And Prevent Bilious Vomiting In Dogs

The goal of treating BVS is to reduce the factors that instigate vomiting, particularly addressing the issues of an empty stomach, excessive stomach acid and irregular stomach motility. For instance, smaller and more frequent feedings can help limit the amount of time a dog's stomach remains empty.

Pro Tip: When dividing your dog's food into smaller and more frequent meals, be careful not to increase the total amount of food you feed your dog. Doing so could lead to high caloric intake and weight gain, which can worsen BVS and result in other health issues.

Home Remedies For Bilious Vomiting Syndrome In Dogs

Before turning to medication, treatment typically starts with diet changes and other home remedies. These can include:

  • Feeding smaller, more frequent meals, particularly one late at night right before bed. Also, sometimes a small meal first thing in the morning before a larger one can help.
  • Switching to a food designed for ensitive stomachs.
  • Using foods with ingredients that stay in the stomach longer, such as protein. Some options include high-protein dog foods or homemade dog homemade dog food that provides more tailored ingredients. It's important to note that homemade dog food often does not provide enough of the essential nutrients and nutritional value for dogs.
  • Eliminating foods that cause allergies or sensitivities.
  • Supplements, like probiotics, to improve gut health.
  • Increasing hydration to prevent dehydration, clear acid from the esophagus and back into the stomach, regulate bowel movements, improve digestion and gut motility, and temporarily raise stomach pH.
  • Reducing an overweight dog's weight through diet and exercise.
  • Adding herbs that are safe for dogs to consume and combat nausea, such as:
    • Ginger (in small amounts and not for dogs with bleeding disorders, on NSAIDs, or going into surgery)
    • Licorice root (avoid in dogs with high blood pressure, heart conditions, and kidney issues)
    • Fennel
    • Slippery elm
    • Marshmallow root (avoid in dogs with diabetes)

Pro Tip: If you aren't working from home or around during the day to ensure your dog gets smaller more frequent meals, you can hire a pet sitter or dog walker, take them to doggy daycare or dog boarding facilities for the day, or buy an auto-feeder.

Medication Treatment Of BVS In Dogs

If diet changes don't seem to be helping, the next treatment typically involves medication that works in your dog's body to reduce the stomach's acidity, protects the stomach lining, and improves gut motility. Some medication treatment options include:

  • Over-the-counter medicines, such as H2 blockers and antacids (Pepcid, Omeprazole, Tagamet, Zantac, etc.).
  • Prescription medications such as metoclopramide, prokinetics (to help with gut motility), and Sucralfate (a short-term medicine that coats the irritated and inflamed stomach or esophagus).
  • Medicine to treat underlying causes - like Giardia with anti-parasitic medication or IBD with high-quality diets free of allergens (such as hypoallergenic dog food and hydrolyzed hypoallergenic food).

Pro Tip: It's always recommended that you consult with your vet before giving your dog herbs, supplements, and medications - especially ones designed for humans. This way, you can ensure that it works well with your dog's medical history and current medications, as well as get the right dosing for your dog's size and weight.

Prognosis For Dogs With Bilious Vomiting Syndrome

BVS is not typically life-threatening or serious, so the prognosis is very good. Most dogs respond well to home remedies and treatment, with some experiencing very infrequent episodes or even a complete resolution of BVS. However, for dogs that do not respond well or seem to worsen, it's important to revisit your vet, as there may be an underlying issue that requires further evaluation and treatment.
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