Gastric Disease in Horses Flashcards
Name some disorders of the equine stomach
- EGSD – squamous disease in adults
- EGGD – glandular gastric disease in adults
- Gastric disease in foals – important but not that common
- Gastric rupture – primarily adults but not always
- Gastric impaction - primarily adults but not always
- Habronemiasis – main parasitic disease in the stomach
- Gasterophilus – just educate owners it’s a pointless disease to treat for
- Gastric neoplasia
What is the pathology of ESGD (equine squamous gastric disease)?
- EQUINE SQUAMOUS DISEASE
- Acid dependent disease
- Equine stomach split into 2. One part (above margo line??) doesn’t have same protective things to protect against acid – when acid splashes off onto the surface of the squamous region. Anything that REDUCES GASTRIC PH will have an impact on this disease – especially if its low for a longer period of time.
With equine squamous gastric disease (ESGD), what is there an imbalance between?
Imbalance between:
–Mucosal aggressive factors
- HCl
- Pepsin
- Bile acids
- Other organic acids
–Mucosal protective factors absent in squamous region
- Bicarbonate
- Mucus
Name some mucosal aggressive factors
- HCl
- Pepsin
- Bile acids
- Other organic acids
Name some mucosal protective factors absent in squamous region
- Bicarbonate
- Mucus
What plays a very important role in enhancing blood flow and promoting the secretion of the mucus-bicarbonate layer?
PGE2
What happens if mucosal blood is affected?
- PGE2 plays a very important role in enhancing blood flow and promoting the secretion of the mucus-bicarbonate layer
- THUS ANYTHING that affects mucosal blood flow WILL predispose animals to the development of gastric disease
What stimulates the production of surface PL’s, enhance mucosal repair and control [Na] within cells preventing cell swelling and death?
PG’s also stimulate production of surface PL’s, enhance mucosal repair and control [Na] within cells preventing cell swelling and death
In foals and adults, what are some things that can cause a reduction in gastric blood flow?
•Need at least disruption of mucosal protective factors which often relates to a reduction in gastric blood flow – lots of things that can disrupt blood flow but no evidence to suggest the likely causation
–Stress
–NSAIDs
–Furosemide
–Hypovolaemia – colic, D+, sepsis
–Anorexia, no feeding or intermittent feeding – boidy not going to send blood to gastric mucosa as not stimulated – no gastrin being produced from those methods of masticating and development of salivary production
–Ileus
What are some things that are likely to cause ESGD in adult horses?
- Squamous region less protected than the glandular region
- Likely prolonged exposure to HCl, pepsin and VFA’s
- Gastric pH likely important in this form of disease
- Lower pH if not buffered with food
–Ileus (inc also in bile acids in stomach)
- More carbohydrates in diet – more likely to have more VFA’s in stomach – dissociated at low pH – more likely to cause disease
- Stress – impact on gastrin production and will ultimately the amount of acid that is in the stomach
-Buffering with food, primarily fibre
Which horses is ESGD (squamous ulceration) more common in?
- Complex and multifactorial
- 60-95% prevalence – depends on population!
- Often thought of as a disease of the performance horse, but common in brood mares also
–Race horses have more carbs and less fibre in their diets
What are the clinical signs of ESGD in adult horses?
- In 95% cases (not always this high) this causes NO DISEASE
- Most of the disease proposed to be caused by this condition is drug company driven – drugs to treat this are very expensive!! Need to work out which horses needs treating and which ones have clinical signs
- Many horses with grade 2 (3) ulcers or less, are unlikely to have clinical signs
- Rarely MAY cause (if grade 3 or above)
–….. May have mild acute or recurrent colic
–decreased appetite and then weight loss/ reduction in body condition BUT NOT IN THE FACE OF A NORMAL APPETITE
–poor performance – unwilling to move forward**
–attitude changes – behaviour changes e.g. girthing pain, colt backed**
–** - most likely clinical signs, can be really tricky to differentiate from other causes of poor performance or having a bad attitude!
What are some clinical signs of grade 3+ ulcers with ESGD in adult horses?
–May have mild acute or recurrent colic
–decreased appetite and then weight loss/ reduction in body condition BUT NOT IN THE FACE OF A NORMAL APPETITE
–poor performance – unwilling to move forward**
–attitude changes – behaviour changes e.g. girthing pain, colt backed**
–** - most likely clinical signs, can be really tricky to differentiate from other causes of poor performance or having a bad attitude!
What is the diagnosis for ESGD?
Gastroscopy
What is the treatment for ESGD?
•Omeprazole – a proton- pump inhibitor
–Licensed for the horse (SID)
–Expensive although getting cheaper – many insurance companies won’t pay for this unless definitively diagnosed. £350 – 500 per month for treatment but a months treatment will fix 90% of these horses.a
–Prophylactic and therapeutic doses licensed – may not be appropriate to use prophylactically
•Ranitidine – H2-blocker – some work done on it, but almost no one uses it
–More effective in rested than competing horses – doesn’t work in working horses really
–Not licensed, slightly cheaper but needs giving TID (3xdaily)
How does omeprazole work for the treatment of ESGD?
Cost?
•Omeprazole – a proton- pump inhibitor
–Licensed for the horse (SID)
–Expensive although getting cheaper – many insurance companies won’t pay for this unless definitively diagnosed. £350 – 500 per month for treatment but a months treatment will fix 90% of these horses.a
–Prophylactic and therapeutic doses licensed – may not be appropriate to use prophylactically
How does ranitidine work for the treatment of ESGD?
License?
•Ranitidine – H2-blocker – some work done on it, but almost no one uses it
–More effective in rested than competing horses – doesn’t work in working horses really
–Not licensed, slightly cheaper but needs giving TID (3xdaily)
How can you prevent ESGD?
- About manipulation and management of the diet. 75% of horses probably don’t need what they got given in a bucket – hay or haylage would reduce the prevalence of this disease. Little and often feeds is better (closer to wild)
- Dietary management if possible
–Small feeds little and often
–Frequently not possible
–More fibre in diet
–Small feeds prior to exercise as the work can increase risk of acid splash into squamous mucosa
- Low dose omeprazole – licensed for this purpose – anecdotally this is become less common
- Pectin-lethicin compounds – dietetics – shown to have some efficacy
–Also found in sugar beet – high in pectin, has some evidence to show its effective as a preventative
How can you use dietary management to prevent ESGD?
•Dietary management if possible
–Small feeds little and often
–Frequently not possible
–More fibre in diet
–Small feeds prior to exercise as the work can increase risk of acid splash into squamous mucosa
What drugs/medications can you use to prevent ESGD?
- Low dose omeprazole – licensed for this purpose – anecdotally this is become less common
- Pectin-lethicin compounds – dietetics – shown to have some efficacy
–Also found in sugar beet – high in pectin, has some evidence to show its effective as a preventative
Describe this
Shows image of squamous and glandular mucosa – line is the middle is margo plicatus . If we see lesions, will see them just running in squamous mucosa just above the margo line
Describe grades 1-4 on squamous ulceration (from the EGUS council)
1- mildest, mucosa still intact but hyperkeratinisation on the surface – variation of normal sometimes, unlikely to have clinical signs
2- multiple small multifocal lesions that are ulcers. Can be extensive, sometimes don’t cause CS’s – if a lot, more likely to treat
3 – more larger and extensive that might be deeper, some might bleed – much more likely to have CS’s
4 – deep craters, often very large and end up having to heal in a way a skin wounds would – contract and granulate – much longer to do this!
What is the difference between these 2 pictures?
Left – normal
Right – horse that was confirmed to have habronemiasis
What is this?
Gastric squamous cell carcinoma
Looks like very deep ulcer, but doesn’t have other changes to mucosa you would expect to disease
