GI Flashcards
Factors associated with development of post-operative reflux in horses with large colon volvulus and
- POR is a negative prognostic indicator for survival (26x less likely)
- all horses with POR had >270o LCV
- Retained in mv model: pre-surgical PCV, DSI on TAUS and diarrhoea.
Use of multiple admission variables better predicts intestinal strangulation in horses with colic than peritoneal or the ratio of peritoneal:blood L-lactate concentration
Predictive Models:
Multivariable models incorporating multiple clinical variables were more effective in predicting intestinal strangulation (SO) than individual peritoneal fluid or blood L-lactate values.
Two models were developed:
-SO Model 1 (minimum database): Based on admission data ; Age, marked pain, rectal temperature, small intestine distention, blood glucose levels.
-SO Model 2 (with peritoneal fluid analysis): Marked pain, rectal temperature, serosanguineous peritoneal fluid, peritoneal-blood L-lactate difference.
Peritoneal fluid color remains a key indicator but is more reliable when combined with other markers (e.g., L-lactate).
SO Model 1 offers a quick screening tool, whereas SO Model 2 can refine surgical recommendations once peritoneal fluid data are available.
Retrospective evaluation of the effects of a singleintraoperative dose of dexamethasone in horses undergoingexploratory laparotomy for small intestinal lesions(2008–2019): 240 cases
- a single intraoperative dose of dexam-ethasone was not associated with the odds of POR, incisional infection,or short-term survival after small intestinal surgery
- underpowered and did not include prokinetics in analysis
- POR: 29%. NSD between dex and non dex groups. RF: PCV >40% at 24 hours post op, anastomosis, WCC >10 at admission, prokinetics not evaluated. ?? was dex prophylactic or therapeutic
- incisional infection: 19%, NSD dex, RF: repeat laparotomy, incisional discharge at time of hospital discharge.
Equine inflammatory response to abdominal surgery in the absence of gastrointestinal disease
Surgical manipulation (SI decompression) increased SAA- peaked at 72 hours at mean 587ug/ml. Higher in horses with post op complications. No difference in obese, but obese horses had higher TGs.
No difference in peritoneal SAA, but peritoneal lactate and WCC signifcantly increased
Small intestinal intussusception in horses: Multicentre retrospective report on 26 cases (2009-2020)
-26 cases identified over an 11-year period from three veterinary clinics.
-median age of affected horses was 9 months. mature horses also presented
-Predisposing Factors: Diarrhoea and General Anaesthesia, Parascaris equorum, Other Factors
-Ultrasonography was useful in diagnosing intussusception in 54% of cases,
- Jejunojejunal intussusceptions were the most common.
-Manual reduction was performed in nine cases, while R&A was necessary in eight cases. There was no significant difference in short-term survival between the two methods.
- The postoperative complication rate was high (47%), including ileus, diarrhoea, and colic. Horses with longer involved segments, higher lactate levels, and pre-admission reflux had a poorer prognosis.
-Short-term Survival: Short-term survival to discharge was 53%. Horses that survived to discharge had significantly shorter SI intussusception segments compared to those that did not survive.
-Long-term Survival: Long-term survival was high (92%) for horses that were discharged, with rare complications reported within the first year after discharge.
Prevalence of salmonella faecal shedding in at-risk hospitalised cases in an equine hospital in New Zealand: A pilot study
-NZ referral hospital incidence 10.7%
-Presenting complaints: dxa, colic, pyrexia
-2/14 cultures positibe, 1/19 PCR positive. One case had four negative cultures before a positive culture was obtained following sample enrichment on a previous sample. One horse tested positive on faecal culture after a previous negative faecal PCR
Effect of moving from being extensively managed out in pasture into training on the incidence of equine gastric ulcer syndrome in Icelandic horses
Feral horses-> training reduced EGSD. Sex and being fed forage 3x/d associated with improved score. No measures associated with glandular improvement.
Incidence 72%-> 25% after 8 weeks
Long-chain polyunsaturated fatty acid supplementation increases levels in red blood cells and reduces the prevalence and severity of squamous gastric ulcers in exercised Thoroughbreds
Fish oil based long chain PUFa diet with high amoutns of GLA (gamma-linolenic acid) associated with squamous improvement in racehorses in training. SC PUFAs did not. LC PUFAs appear to have a role in ulcer healing.
Clinical efficacy, safety and pharmacokinetics of a novel long-acting intramuscular omeprazole in performance horses with gastric ulcers
USA LA omeprazole (IM) at 5mg/kg
-ESGD Improvement: By Day 14, 78% of horses showed improvement in ESGD scores, with 22% achieving complete healing. No further significant improvedment by 28d-> 2 weeks may be enough
-EGGD Healing: n=6, 5 healed. The small sample size for EGGD limits the interpretation of these results.
-healing rate for ESGD in this study was lower than previously reported rates for other long-acting omeprazole formulations. Differences in formulations, horse populations, and management practices may account for these variations.
- Injection site reactions increased with each dose, with 8% of horses reacting after the first dose and 48% after the fourth dose. Reactions included edema, heat, and pain, with more severe reactions following the third and fourth doses.
- No significant systemic adverse effects were noted.
-Serum Concentrations: The mean maximum concentration (Cmax) of omeprazole was 46.2 ng/ml, occurring at six hours post-injection. Serum concentrations remained above 4.3 ng/ml for seven days =target
-Comparison with Oral Formulations: The long-acting intramuscular formulation bypasses the variability in bioavailability seen with oral dosing, providing more consistent serum concentrations.
Strongyle egg reappearance periods following moxidectin treatment in horses in Southeast England
A shortened egg re-emergence period demonstrated for moxidectin and cyathostomes (all strongyles)- 6weeks-16 weeks. Previously reported in literture as 12-16 weeks.
Gives weight to performing routine FECRT and re-emergence tests for monitoring.
Horses under routine management- Bell equine
Strongyloides westeri infection on a Thoroughbred breeding farm in Ireland (2014–2019): Prevalence, risk factors and peripartum ivermectin
S. westeri, foal, anthelmintic
Dietary and management factors influence the equine gastric microbiome
Horses on grass hay only highest diverstiy > alfalfa only > both. No sweet feed> those that did.
Sweet feed reduced intrasample dissimilarity and reduced diversity.
Horses with turnout- more diversity,
Show horses vs racing- more diverse.
Bray curtis index= difference in species composition
Jaccard index= similarity/ diversity
Dominant phyla in the equine gastric microbiome were Proteobacteria, Firmicutes, Actinobacteriota, and Bacteroidota. The dominant genera included Actinobacillus, Cutibacterium, Staphylococcus, and Streptococcus.
Correlation of epiploic foramen length to height, weight, breed, gender and age in horses
No correlation was found between height and EF length, which contrasts with previous studies that suggested a greater risk of epiploic foramen entrapment (EFE) in taller horses.
The study sample mostly comprised Quarter Horses, which may explain the difference in findings compared to studies with Thoroughbreds.
The study did not find a correlation between weight and EF length, differing from previous research that used different methodologies to measure EF size.
The study did not find a correlation between age and EF length, supporting previous findings that right hepatic lobe atrophy in older horses does not increase EF length.
The study supports the theory that increased intra-abdominal pressure is a significant factor in EFE occurrence, rather than EF length.
Trends in the management of horses referred for evaluation of colic: 2004–2017
Fewer horses undergoing colic surgery and increased costs. Financial crisis had impact. Influence of insurance varies by region
The effect of porcine hydrolysed collagen on gastric ulcer scores, gastric juice pH, gastrin and amino acid concentrations in horses
- non glandular ulcer number (NGN): decreased with omeprazole. By the end of the recovery phase, on Day 56, mean NGN scores were significantly lower in the PHC-treated horses, when compared to untreated controls
-non glandular severity: reduced by omeprazole. No tx effect of collagen - no effect on glandular
- collagen had a synergistic effect on increasing gastric pH, with omeprazole
- collagen non effect on gastrin concentration, ompeprazole increased
- will not replace pharmacology but may have synergistic effect. But: n=10 and no power calc.
Acute abdominal dehiscence following laparotomy: A multicentre, international retrospective study
-AAD occurred due to tearing of sutures through the linea alba or rupture of the body wall adjacent to the suture line in 46 horses (73%). Suture line only failed in 6%
- occurred at a median of 5 days postoperatively
-Only 24% had poor Sx recovery
- broodmares accounted for 25% of the cases (n = 16). Particularly <36h pp and late gestation
-Surgical site infection developed prior to AAD in 28 horses (44%)
- Surgical repair was performed in 27 horses (43%), 10 (16%) were treated conservatively and 26 (41%) were euthanised immediately.
-Repair was most frequently performed using suture (n = 14), wire (n = 5) or a combination (n = 5).
- Overall survival to hospital discharge was 38% (24/63). Where surgical repair was performed, 15 horses (56%) survived to hospital discharge; 9 horses (90%, those without evisceration) managed conservatively survived to hospital discharge.
-The only variables with a significant association with survival to hospital discharge were lowest arterial pH under general anaesthesia (P = .04) and peripheral blood lactate concentration 24 hours after surgery (P = .01)
Scoping review: Occurrence and definitions of postoperative
complications in equine colic surgery
Definitions of the same complications varied widely, with no consensus on terminology or criteria in the literature.
Some complications lacked any reported definition, while others had multiple conflicting definitions across studies.
The lack of standardization complicates interpretation, potentially leading to overestimation or underestimation of surgical risks.
Approximately 40% of studies did not include long-term follow-up data
Prevalence of and risk factors associated with Salmonella shedding among equids presented to a veterinary teaching hospital for colic (2013–2018)
- prevalence of 3.5%. 1585 horses sampled
-Compared to the general colic population, Equids shedding Salmonella were more likely to present in July and present with a history of fever, increased lactate and/or neutropenia - not associated with survival to discharge. But were 4.2x more likley to develop a complication and was associated with longer hospitalisation.
- Hospitalised equids shedding Salmonella were more likely to be febrile and 10 times more likely to develop reflux compared to colic controls.
- median cultures submitted in the salmonella group 7!
-Reflux was identified as a stronger indicator than diarrhea
-no association with colic surgery in this population
A comprehensive and comparative proteomic analysis of horse serum proteins in colitis
–On day 1 of treatment, eight proteins in the colitis group were upregulated (P < .05, more than a twofold change) compared with the healthy group. Among the eight proteins, biliverdin reductase B was significantly upregulated (P < .05) in the non-survivor group (n = 5) compared with the survivor group (n = 7).
-On the last day of the treatment, haemoglobin subunit alpha, clusterin, glyceraldehyde-3-phosphate dehydrogenase, lipopolysaccharide-binding protein, and biliverdin reductase B showed significant increases (P < .05) in the non-survivor group
-A significant difference was observed for lipopolysaccharide-binding protein (P < .01) between the colitis group and the healthy group whilst there was no significant difference observed for lysozyme.
-The upregulation of proteins like haemoglobin subunit alpha and biliverdin reductase B indicates increased hemolysis during colitis.
-proteins such as GAPDH and carbonic anhydrase 1, associated with cytosolic leakage, suggest cellular damage in colitis.
- Lipopolysaccharide-binding protein (LBP) and clusterin reflect inflammatory responses and oxidative stress, respectively
Larval cyathostominosis: Clinicopathological data and treatment outcomes of hospitalised horses
- median age 2 years-mostly presented winter and spring
- 55% were nonsurvivors
-Faecal shedding of Salmonella spp. occurred in four cases. Median FWEC 50epg. Most had moderate tapeworm infection intensity. - Anthelmintic treatment was administered in 25/35 cases (71%), of which 22 also received corticosteroids (89%). Mostly moxidectin.
-Recumbency prior to admission (p = 0.037) and administration of isotonic fluid therapy (p = 0.027) were associated with nonsurvival.
-lower TP (p = 0.006) and higher SAA (p = 0.050) concentrations at admission as well as lower last recorded TP (p = 0.002) and lower last recorded albumin concentrations (p = 0.028) were associated with nonsurvival
-horses continued to be hypoproteinaemic.
-Cyathostomins were identified in the faeces of 30 horses at ante-mortem (79%)
Effect of omeprazole and sucralfate on gastrointestinal injury in a fasting/NSAID model
‘-post-treatment EGGD scores higher for horses receiving sucralfate (median 3; IQR 2.25,3) than omeprazole (1; 1,1).
-The effect of treatment on ESGD scores just achieved significance (P = .05), with post-treatment ESGD scores higher for sucralfate (4; 3,4) than omeprazole (2; 2,3).
-RDC thickness increased in sucralfate group but not omeprazole group.
-suggesting that gastric acid suppression plays a protective role against NSAID-induced glandular gastric lesions.
- Omeprazole-treated horses did not show this colonic thickening, suggesting a protective effect against NSAID-associated colitis.
Effects of Age, Disease, and Anastomosis on Short- and Long-Term Survival After Surgical Correction of Small Intestinal Strangulating Diseases in Horses
-This study followed horses for the longest interval post-surgery compared to previous research, emphasizing its importance in understanding the long-term effects of surgical correction for small intestinal strangulation.
-Older horses (≥16 years) exhibited shorter long-term survival times compared to younger horses (72 vs 121 months), but this was attributed to their naturally limited remaining lifespan rather than a direct effect of surgery.
-Horses treated with jejunocecostomy (JC) had shorter survival times compared to those undergoing jejunojejunostomy (JJ) or no resection (NR).
-NR had the most favorable outcomes, suggesting that early intervention to avoid resection may improve survival.
-Epiploic foramen entrapment (EFE) and strangulating lipoma (LIP) cases had similar long-term survival despite EFE horses being younger. This finding challenges assumptions about better outcomes for younger horses.
-Horses with miscellaneous diseases (MIS) had the longest survival times, likely due to fewer severe ischemic injuries and a higher proportion of NR cases.
Five- versus seven-day dosing intervals of extended-release injectable omeprazole
n=82
GGD Healing:
Administering extended-release injectable omeprazole (ERIO) at 5-day intervals resulted in significantly higher healing rates (93%) compared to 7-day intervals (69%).
Improved outcomes suggest that the 5-day regimen mitigates the period of suboptimal acid suppression observed between Days 4 and 7 in the weekly schedule.
ESGD Healing:
Healing rates for equine squamous gastric disease were slightly higher in the 5-day group (97%) compared to the 7-day group (82%), but the difference was not statistically significant (p = 0.07).
Both regimens demonstrated high healing rates for ESGD.
4 Injection site reactions (2 in neck, 1 abscess).
Previous papers: Median intraday pH peaked 3 days after administration and then declined gradually to Day 7. Between Days 4 and 7, acid suppression was suboptimal in some horses.
Serum amyloid A and plasma fibrinogen concentrations in horses following emergency exploratory celiotomy
- 300 horses, 52.0% developed post-operative complications and 83.7% survived to discharge, with significantly reduced chance of survival in horses that developed post-operative complications (P<0.01).
-Post-operative complications; associated with strangulating lesions, and higher [fibrinogen] at admission - survival to discharge; associated with lower [SAA] at 5 days post-operatively (peaked at day 2-3 then gradually increased)
-No complications: SAA peaked day 2, fibrinogen day 4 - Complications: SAA peaked day 4 with a more marked increase, fibrinogen continued to increase throughout study period.
-Nonsurvivors showed an erratic and persistently elevated SAA trend, unlike survivors who exhibited a peak followed by a gradual decline
Chronic severe pyloric lesions in horses: 47 cases
-Chronic severe pyloric lesions predominantly presented in younger horses (median age 3 years) with nonspecific signs such as: Poor body condition (87%) Slow eating (83%) Recurrent colic (74%) Selective appetite (64%) Other signs included frequent recumbency (57%), reflux oesophagitis (19%), and grade 4 squamous ulceration in 85% of cases.
-Reduced or absent pyloric motility was noted in most cases.
-Gastric dilation and delayed gastric emptying were identified in over half of the evaluated cases.
-Medical management with omeprazole was the most common approach.
-Gastrojejunostomy was performed in 4 cases to address gastric outflow obstruction, with 2 long-term survivors.
-Overall, long-term survival (>6 months) was 41%, with younger horses (<3 years) showing significantly lower survival rates compared to older horses (27.8% vs. 72.2%).
Myenteric networks of interstitial cells of Cajal are reduced in horses with inflammatory bowel disease
-ileal samples only
-all IBD cases, irrespective of diaginosis, were characterised by villous atrophy and lymphoid hyperplasia of the mucosa and submucosa.
-The EG cases were further characterised by submucosal and sometimes granulomatous eosinophilic infiltrate, which would extend to a varying degree into the muscularis externa.
-The GE cases would frequently have granulomatous epithelioid macrophage clusters of the mucosa and/or submucosa and the lymphoid hyperplasia was often nodular.
-The percentage of immunolabelling in IBD horses was reduced for both markers of ICC in the MP region but not in the inner circular muscle layer compared with the control horses. No significant reductions in immunolabelling for nerve cell and glial cell markers were detected in the MP region or inner circular muscle layer. Did not differe between EE and GE
-ICC markers= CD117 and TMEM16. Neuronal (PGP9.5) and glial cell (GFAP)
-Horses with granulomatous enteritis (GE) exhibited greater variability in ICC reduction compared to those with eosinophilic gastroenteritis (EG).
Higher body mass index may increase the risk for the development of incisional complications in horses following emergency ventral midline celiotomy
-Not significant when counfounding taken into account (p=0.07) in multivariable analysis. (sex, breed, metabolic disease)
- Incisional complication prevalence was 23.7%.
-Horses with incisional complications had a higher BMI (median 203.6 kg/m2 IQR = 191.5-217.4) compared with those without (median 199.1 kg/m2 , IQR = 184.7-210.2) (P = .03).
- does not appear to be associated with surgical time.
Effect of feed deprivation on daily water consumption in healthy horses
-The mean values for bodyweights decreased by 7.2% from baseline in unfed horses by the end of the 4-day period of feed deprivation and remained constant in fed horses
-Feed deprivation immediately and persistently reduced water consumption to ~16% of fed values, During feed deprivation, horses drank 10.3 mL/kg/d over the 4 days, compared with 63.4 mL/kg/d during fed conditions. Constant throughout the 4 days
- laboratory evidence of mild dehydration on day 4; TPP was significantly elevated by feed deprivation on day 4, BUN on days 2-4 and creatinine on days 1-4 (but all remained within rr). No physical evidence of dehydration
Survival rates and factors associated with survival and laminitis of horses with acute diarrhoea admitted to referral institutions
-1438 horses from 26 participating institutions from 4 continents were included;
- An enteropathogen was identified in 16%: Salmonella spp. 13%. ECoV 9%, C. difficile in 5%, 8.3% AAD. 5% sand enterocolitis.
- 76% survived to discharge with no differences identified between geographic regions.
- Associated with non survival: SIRS, SIRS and creatinine concentrations > 159 μmol/L, SIRS that had an L-lactate concentration > 2.8 mmol/L , laminitis, increases in PCV, L-lactate and creatinine and TPP at admission, presence of altered mentation and a toxic line in the oral mucus membranes on admission,
-66% met SIRS criteria– ROC curve analysis revealed that a creatinine concentration > 159 μmol/L and an L-lactate concentration > 2.9 mmol/L had the highest sensitivity and specificity to predict the outcome of non-survival when combined with meeting SIRS criteria
- Total 7% developed laminitis
-The proportion of horses that developed laminitis was lower in Europe.
-More horses developed laminitis in the summer (46%, 39/85)
Concentrations of neutrophil gelatinase-associated lipocalin are increased in serum and peritoneal fluid from horses with inflammatory abdominal disease and non-strangulating intestinal infarctions
-Horses with NSII and inflammatory abdominal diseasehad higher serum and peritoneal fluid concentrations of NGAL than the other groups (p < 0.001).
- Peritoneal fluid NGAL concentrations in horses with NSII were higher than in horses with inflammatory abdominal disease (p = 0.03).
- Serum NGAL increased with duration of colic (peritoneal trended but no specific interval differences)
-seruma and peritoneal NGAL moderately correlated (r=.5). serum NGAL corrleated with inflammatory markers, and peritoneal NGAL correlated with peritoneal WCC (r=.6)
- differential expression in peritoneal fluid may differentiate NSII that may need Sx
-Rapid rise and fall pattern
A multicenter retrospective case–cohort study on the prevalence of incisional morbidities in late pregnant mares following exploratory celiotomy (2014–2019): 579 cases
-Morbidity rates were not different between mare groups with 56% of pregnant mares and 51% of control mares reporting at least 1 morbidity.
-Nonsurvival was higher in pregnant mares (13%) compared to control mares (5%; P = 0.02)
-Swelling was the most common complication in both groups (54% in pregnant mares and 50% in controls), followed by drainage, infection, hernia, and dehiscence.
-Longer surgical and anesthesia times were significantly associated with increased risks of swelling and drainage.
-Abdominal bandage use was strongly linked to the presence of drainage, infection, and hernia, though this may reflect its application as a response to existing complications.
–Nonsurvival was higher in pregnant mares (13%) compared to control mares (5%; P = 0.02)
- high rate of caesarean (14/42) in pregnant mares. 12 had caesarean at the time of colic surgery (7 foals survived to discharge)
Standing gustatory papillae biopsy procedure for antemortem diagnosis of equine grass sickness
The procedure was well tolerated in all horses. Minor complications observed were a transient facial paralysis, some incisional fluid collection, and abscesses. Ten samples (10/12) were suitable for assessment of neuronal perikarya, thougn only 8 were from the correct location. Only looked at 2 chronic EGS cases (absence of neurones). Targeted foliate papillae
Ponies, miniatures, and younger equids are at higher risk of fecalith obstruction compared to a general colic population
–Miniature horses and ponies were overrepresented and equids ≤ 1 year of age were overrepresented in the fecalith population compared to the colic population.
-92% survived to discharge, 6% were euthanized intraoperatively, and 2% were euthanized during hospitalization.
-Nonsurvivors showed more severe colic signs on admission, tachycardia on admission, and hyperlipemia.
-Equids with postoperative colic (P = .01) and complications (P = .002) were less likely to survive.
- As a group, equids with fecalith obstruction presented with a moderately elevated heart rate, elevated respiratory rate, and normal rectal temperature 37.9 ± 0.6 °C. Hematocrit and TP were normal to elevated with hyperlactatemia and hypertriglyceridemia. Peritoneal fluid
TNCC were elevated with an elevated TP
-Age (greater), heart rate (lower), and peritoneal TNCC (lower) were significantly different (P < .04) between large colon fecalith obstructions and small colon
Equine duodenal motility, assessed by ultrasonography, as a predictor of reflux and survival following colic surgery
-Reduced duodenal contractility at Day 1 postoperatively (6–36 hours) was significantly associated with the development of postoperative reflux (POR; p = 0.013).
-Horses with increased duodenal contractility had better odds of survival, with an odds ratio of 1.88 per additional contraction per 2 minutes (p = 0.039).
-No clear contraction rate cutoff was identified to definitively distinguish between refluxing and non-refluxing horses, or survivors and nonsurvivors.
-Contractility measured after Day 1 did not show significant differences between groups.
-Excellent agreement between observers (weighted kappa coefficient = 0.871), indicating that ultrasonographic assessment of duodenal contractility is a reliable technique.
Monitoring equine ascarid and cyathostomin parasites: Evaluating health parameters under different treatment regimens
-Foals in Group FA (dewormed at 2 and 5 months) had significantly higher strongylid and ascarid egg counts than foals in Group FB (dewormed monthly with alternating anthelmintics).
-No significant differences in strongylid egg counts were observed between the mare groups, regardless of treatment frequency.
- significant differences in bodyweight between foal groups were detected, suggesting that reduced deworming in Group FA did not adversely affect growth.
-Mares in Group MA (treated twice yearly) had slightly lower bodyweights compared to other groups, but this finding lacked a clear explanation.
-Overall, very few health abnormalities were noted across all groups, indicating that the reduced deworming regimens did not negatively impact general health within the study period.
-long term effects not investigated, 1 season on 1 farm only. SB and TB
Limited strongyle parasite occurrence in horses kept in an arid environment
-Strongyle eggs were detected in only 9% of 851 fecal samples from 79 horses across a 7-year study period in an arid environment.
-By the study’s conclusion, 97% of fecal samples were negative for strongylid parasites, reflecting effective parasite management.
-The arid climate, characterized by low moisture and limited pasture, likely contributed to reduced parasite burden, as strongylid eggs and larvae depend on moisture and moderate temperatures for survival.
-Frequent manure removal from stables minimized environmental contamination, further reducing infection risks.
-Used a qualitative faecal float and gave moxidectin to all positive
Effects of transportation on gastric pH and gastric ulceration in mares
-Transportation significantly increased gastric squamous ulcer scores but not glandular
-Ulceration developed rapidly within 12 hours, particularly in horses fasted for 12 hours before transport.
-Median gastric fluid (GF) pH during transportation increased significantly (median 6.8-7.2, p < 0.001), suggesting reflux of alkaline small intestinal content as a potential cause.
-Confinement without transport (12 hours) did not lead to significant changes in gastric ulcer scores or median GF pH (median pH 1.7-2.5).
-Horses fasted for 12 hours before transportation exhibited more severe gastric squamous ulceration.
-Feeding closer to the time of departure (within 1-6 hours) was associated with higher retained gastric content and less severe ulceration, possibly providing protective effects.
-Gastric ulceration appeared associated with contact between the squamous mucosa and alkaline reflux, rather than prolonged acid exposure.
-Alkaline reflux may involve duodenal bile salts and short-chain fatty acids, known to impair mucosal integrity.
-? effect of pre movement PPIs
