Gastric disease Flashcards
Diagnosis, treatment & management
Clinical signs of gastric dz
- Colic signs (particularly after eating)
- Weight loss
- Bucking/rearing under saddle
- Resentment of girthing and leg aid
- Poor performance
- Changes in temperament
Risk factors of gastric dz
- Lack of access to forage
- Lack of access to water
- High carbohydrate diets
– acidifying effect on gastric juices - High stress environments/individuals
- Other focuses of pain?
– In cases on unresolved gastric dz we will often look for other sources of pain as we often can’t resolve gastric dz until the other stressor has been resolved
A lot of these risk factors relate solely to squamous dz
Gastroscopy - patient prep
- Horses must have food withheld for at least 12 hours
- Water removed ~4 hours before?
- Grazing muzzle for horses which eat bedding
Restraint for gastroscopy
Chemical restraint:
* Sedation with an alpha-2 agonist and an opiate
* Detomidine
* Butorphanol
Physical restraint:
* At least three personnel
* One person to restrain the horse
* One person to pass the endoscope
* One person to control the endoscope
Nose twitching
* Useful additional restraint in some cases
* Often only required for the first 20s as you
pass through nasal passages
Squamous ulceration - Grade 0
- the epithelium is intact and there’s no appearance of hyperkeratosis
Squamous ulceration - Grade I
- the mucosa is intact, but there are areas of hyperkeratosis
Squamous ulceration - Grade II
- small, single or multifocal lesions
Squamous ulceration - Grade III
- large single or extensive superficial lesions
Squamous ulceration - Grade IV
- extensive lesions with areas of apparent deep ulceration
How to describe lesions of glandular dz
- Mild/moderate/severe
- Focal/multifocal/diffuse
- Raised/flat/depressed
- Hyperaemic?
- Haemorrhagic?
- Fibrinosupprative?
1st line tx of gastric disease
Squamous ulceration:
- oral omeprazole (4mg/kg)
Glandular dz:
- oral misoprostal (5mcg/kg)
– not licensed in horses but licensed in humans
Both/either:
- long acting injectable omeprazole (4mg/kg 1x weekly IM)
± oral sucralfate (10-40mg/kg)
– never use as a monotherapy
– coats the stomach and helps to bolster mucus barrier whilst we’re treating the lesions
Which horses is omeprazole not suitable for? Why?
- horses that don’t starve well
- bioavailability of oral omeprazole is much better on an empty
Glandular dz 2nd line
Defining treatment failure is difficult:
* Most glandular cases will not be resolved in four weeks
Option 1: Continue on current therapy for another period of time or reduce interval
Option 2: Long active, injectable omeprazole (4mg/kg once a week IM) <–> oral misoprostol (5mcg/kg)
Option 3: Further diagnostics: transendoscopic mucosal biopsies
Option 4: Switch to corticosteroids – dexamethasone or prednisolone
Glandular disease: management and maintenance
Husbandry and management changes:
* Feed roughage ad lib, especially during the day
* Reduce stressful stimuli
* Eliminate carbohydrates from the horses diet
* Replace with oils in cases where calories are needed
Feed supplements:
* Limited evidence for many – buffers of little use clinically
* Growing evidence for the use of pectin and lecithin
– theory they bolster the mucus barrier
– expensive
* Consider sugar beet pulp as a source of pectin
Maintenance medication:
* Oral omeprazole licensed for long term use at 1mg/kg orally once daily
* Can be targeted to high risk periods
* Consider competition legality – prohibited by the BHA
Do CS seem to correlate to the severity of dz seen in the stomach?
- no
