The Horse:Your Guide To Equine Health Care provides monthly equine health care information to horse owners, breeders, veterinarians, barn/farm managers, trainer/riding instructors, and others involved in the hands-on care of the horse.
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YOUR GUIDE TO THE 2017 AAEP CONVENTION SPONSORED BY A44 TheHorse.com/AAEP2017 AAEP Wrap-Up THE HORSE March 2018 Treating Tricky Gastric Glandular Disease in Horses Not all equine gastric ulcer syndrome cases are the same. In fact, in 2015 researchers split the condition into two categories—equine glandular gastric disease (EGGD) and equine squamous gastric disease (ESGD)—because of each one's distinct pathology, risk factors, diag- nostics, and treatment approaches. Heidi Banse, DVM, PhD, Dipl. ACVIM (LA), described how to manage the more problematic of these two diseases: EGGD. Equine squamous gastric disease af- fects the upper squamous region of the stomach, which is unprotected from gas- tric acid. Equine glandular gastric disease involves the lower region. Its prevalence depends on riding discipline and horse breed but ranges from 10% to 65%, said Banse, a veterinary specialist in Louisiana State University's Department of Veteri- nary Clinical Sciences, in Baton Rouge. The condition's prevalence is high among Warmbloods and sport horses (46-65%). In preliminary findings from one study, she said, exercise frequency and performance level were associated with an increased risk of EGGD in show jumping Warmbloods, while feeding and exercise appear to contribute to increased risk in Thoroughbred racehorses. After confirming EGGD via gastros- copy, Banse suggested veterinarians use the European College of Equine Internal Medicine glandular lesion description and the modified Equine Gastric Ulcer Syndrome scoring system to characterize severity and monitor improvement. When it comes to treating EGGD, omeprazole (GastroGard, not the generic or compounded types, she said) remains the gold standard; however, said Banse, glandular disease tends to be more chal- lenging to treat than squamous. While the reason for this disparity is unknown, "diet and duration of fast- ing prior to omeprazole administration may impact the drug's pharmacokinetics and pharmacodynamics," Banse said. Previous research supports the following feeding regimen: offering EGGD horses their evening meal, withholding hay and feed overnight before administering GastroGard, and continuing to withhold feed for 90 minutes post-administration. One study's authors suggested adding the protectant sucralfate to the omepra- zole dose, after observing a 65% healing rate when combining the two drugs. An- other's suggested the hormone misopro- stol alone might be more effective (73% returned to normal) than omeprazole plus sucralfate (22%). Researchers have also tried treating this condition with antimicrobials, such as trimethoprim-sulfadimidine, and dietary supplements containing polysac- charides. But Banse does not currently recommend antimicrobials because we don't know what they do to the horse's microbiome (resident GI tract micro- organisms) and suggests that dietary supplements are likely better for preven- tion than treatment. Based on the research, Banse recom- mended vets start horses with mild EGGD lesions (Grade 1 and 2) on 4 mg/ kg omeprazole daily, and if there's no im- provement after one month, add sucral- fate or misoprostol. She recommended Study: Horses With Sand Colic Have 'Excellent' Prognosis For most horse owners noth- ing about colic is good news. But one researcher has reported that when it comes to sand colic, there's some positive news. Isabelle Kilcoyne, MVB, Dipl. ACVS, of the University of Califor- nia, Davis, School of Veterinary Medicine, said horses with this condition generally have an excellent prognosis regardless of whether they undergo medical or surgical treatment. Sand accumulation in the large colon occurs relatively frequently in regions with naturally sandy soils, including California, Texas, and Florida. Affected horses, which consume sand inadvertently while grazing or eating off the ground, can develop gastrointestinal tract obstructions, intestinal tract lin- ing irritation, altered gut motility, weight loss, diarrhea, and overt colic. If a practitioner suspects sand colic, Kilcoyne recommended that, in addition to a standard colic work-up, he or she take radiographs to confirm sand in the gut and quantify how much has accumulated. This is be- cause listening to the abdomen's oceanlike sounds using a stetho- scope (a traditional method of diagnosing sand accumulation) and measuring fecal sedimenta- tion are only effective in about 20% of cases, she said. With a positive diagnosis, the veterinarian can discuss treatment options—either medical or surgical—with the owner. Kilcoyne said one of the key factors he or she should consider when selecting an approach is how much gas has built up in the abdomen, based on radiographs and transrectal palpation. "Evidence of intestinal distention (swelling) due to that gas accumulation, based on radiographs or rectal palpation, suggests that surgery should be performed," she said. Otherwise, medical therapy involves providing intravenous fluids and passing a nasogastric tube to administer enteral fluids, psyllium, and either magnesium sulfate or mineral oil. "Both medical and surgical management resulted in over 94% of treated horses surviving to discharge from our hospital, based on a review of the medical records of 153 horses with sand colic," Kilcoyne said. "One factor to consider, however, is that half of all horses treated medically suffered recurrent colic, whereas only 17% of surgically treated horses suffered sand colic again." In sum, the amount of sand in the gastrointestinal tract does not dictate management strategy. Instead, gas accumulation ap- pears to be a more important factor.—Stacey Oke, DVM, MSc The Cost of Treatment Heidi Banse, DVM, PhD, Dipl. ACVIM (LA), a veterinary specialist in Louisiana State University's (LSU) Department of Veterinary Clinical Sciences, shared current prices of ulcer medications from LSU's pharmacy: GastroGard: $30-35/day Sucralfate: $5/day for a normal dose, $13-18/day for a high dose Misoprostol: $50-80/day