7.1.2: Gastric disease - diagnosis, treatment and management

Question 1

1

Answer 1

Dorsal squamous fundus

Question 2

2

Answer 2

Greater curvature

Question 3

3

Answer 3

Margo plicatus

Question 4

4

Answer 4

Lesser curvature

Question 5

5

Answer 5

Cardia

Question 6

6

Answer 6

Ventral glandular fundus

Question 7

7

Answer 7

Antrum

Question 8

8

Answer 8

Pylorus

Question 9

Risk factors for gastric disease

Answer 9

• Lack of access to forage
• Lack of access to water
• High carbohydrate diets -> these have acidifying effects on gastric juices
• High stress environments/individuals
• Other focuses of pain (sometimes can’t resolve gastric disease until pain from elsewhere in the body is controlled)

Question 10

Clinical signs of gastric disease

Answer 10

• Colic signs (particularly after eating)
• Weight loss
• Bucking/rearing under saddle
• Resentment of girthing and leg aid
• Poor performance
• Changes in temperament

Question 11

Preparation of a patient for gastroscopy

Answer 11

• Withhold food for at least 12hrs; some centres say longer (need empty stomach to properly assess)
• Water should be removed ~4hrs before
• Use a grazing muzzle for horses liable to eat their own bedding/faeces in order to prevent this happening

Question 12

What would you use to sedate a horse for gastroscopy?

Answer 12

Detomidine + butorphanol

Question 13

How do you grade squamous ulceration visualised on gastroscopy?

Answer 13

• Grade 0 - epithelium intact, no appearance of hyperkeratosis
• Grade I - the mucosa is intact but there are areas of hyperkeratotis
• Grade II - small single or multifocal lesions
• Grade III - large single or extensive superficial lesions
• Grade IV - extensive lesions with areas of apparent deep ulceration

Question 14

Which grade of squamous ulceration is shown here?

Answer 14

Grade 0

Question 15

Which grade of squamous ulceration is shown here?

Answer 15

Grade IV

Question 16

How do we describe glandular disease lesions?

Answer 16

• Mild/moderate/severe
• Focal/multifocal/diffuse
• Raised/flat/depressed
• Hyperaemic/haemorrhagic/fibrinosuppurative

Any combination is possible. Some centres also use diagrams to note the appearance of lesions.

Numerical grading systems are no longer used for glandular disease.

Question 17

First line treatment of gastric disease

Answer 17

• Oral omeprazole -> for squamous ulceration. Licensed and effective. Better bioavailability if horse starved beforehand.
• Misoprostol -> for glandular disease
• Not uncommon to see combination therapy
• ± oral sucralfate as an adjunct to the above

Question 18

Which of the following is considered easier to treat?
a) glandular disease
b) squamous ulceration

Answer 18

b) squamous ulceration - typically takes 3 weeks to treat compared to 3 months for glandular disease

Question 19

1

Answer 19

Question 20

2

Answer 20

Question 21

3

Answer 21

Question 22

4

Answer 22

Question 23

How does oral sucralfate help with the treatment of gastric disease?

Answer 23

Oral sucralfate coats the stomach and helps to bolster the mucus barroer while we are treating the lesions with other drugs.

Question 24

How often should you endoscope a horse with gastric disease to monitor treatment progress?

Answer 24

Every 4 weeks

Question 25

**True/false:** once a horse has had one episode of glandular disease, they should forever be managed accordingly as they are at a high risk of recurrence.

Answer 25

**True** ## Footnote These horses are like laminitic ponies - highly predisposed to recurrence.

Question 26

Husbandry changes you would implement for long-term management of gastric diseases

Answer 26

* Feed roughage al lib throughout the day * Reducing stressful stimuli where at all possible * Elimination of carbohydrates from the horse's diet; replace with oils if calories needed * Feed supplements: there is evidence for pectin and lecithin to bolster the mucus barrier * Can use oral omeprazole long-term at 1 mg/kg^ daily; ideally target this to high risk periods e.g. moving yards, competitions -> check competition rules to check if this is allowed ## Footnote (^this is 1/4 of the therapeutic dose)