Behaviour and stress responses in horses with gastric ulceration

Improvement of gastric disease and ridden horse pain ethogram scores with diet adaptation in sport horses

BACKGROUND

Gastric disease is highly prevalent in sport horses and may lead to poor performance, cause behavioral changes and impact welfare.

HYPOTHESIS

Assess whether diet affects gastric disease and pain expression during riding, and whether it has an impact on physiological and locomotor variables during an exercise test, including jumps.

ANIMALS

Nine healthy show-jumping Warmbloods trained at the same stable.

METHODS

Prospective observational cohort study. The horses receiving a pelleted diet, high in sugar and starch (>30%), were examined at T0 and after 12 weeks (T12) of changing to a cooked, muesli-type low-starch (11%) diet. Each time, the horses underwent a standardized exercise test (SET) and a ridden pain score (Ridden Horse Pain Ethogram [RHpE]) was calculated by 2 blinded observers. The next day, horses underwent gastroscopy and gastric lesions were scored blindly. Results were analyzed using Wilcoxon and Spearman tests.

RESULTS

After 12 weeks of a low starch diet, the Equine Gastric Disease (EGD; 4 [3-5] at T0 vs 1 [0-1] at T12, P < .01) and RHpE scores (6 [3-13] at T0 vs 3 [0-6] at T12, P < .01) improved significantly. Squamous, glandular, and EGD scores were positively correlated with RHpE scores (respectively, r = .747, P < .01; r = .743, P < .01 and r = .867, P < .01).

CONCLUSION AND CLINICAL IMPORTANCE

Gastric disease and pain scores correlated positively in ridden horses. A low starch diet significantly decreases the severity of gastric disease and associated pain score during riding in horses. Gastric ulcers may be mitigated and the comfort of equines athletes improved by dietary adjustments.

Living the good life? A systematic review of behavioural signs of affective state in the domestic horse (Equus caballus) and factors relating to quality of life. Part 2: Horse-human interactions

Quality of life is dependent upon the extent to which behavioural needs are met, and the balance between pleasant and unpleasant lifetime experiences. In Part II of this systematic review, articles (n = 109) relating to horse-human interactions were reviewed to identify behavioural evidence of their positive or negative impact on the horse. The number of articles (n = 22) relating to the recognition of pain in horses, indicated the importance of identifying health issues, which are also likely to increase the aversiveness of interactions. These and articles relating to emotional reactivity testing in horses (n = 19), the behaviour of horses during handling and management procedures (n = 17), behaviour of the horse when ridden (n = 17), non-procedural horse-human interactions (n = 13), horse behaviour during transportation (n = 12) and behaviour during training other than when ridden (n = 9) were reviewed. During most interactions, horse behaviour is controlled and/or restricted by the human, masking negative or positive signs, and may be confounded by factors including fear and individual differences. In situations involving freedom of movement, positive experiences of horses with humans were associated with approach behaviour, negative ones with avoidance, but training could affect both. Undoubtedly, change is needed to reduce the extent to which interactions with humans are unpleasant for the horse. Only when the needs of the horse are fulfilled and interactions with humans are predominantly pleasurable will their quality of life improve.

Prevalence of squamous gastric disease in Colombian equids at slaughter: A postmortem comparative study among horses, donkeys and mules

Equine Gastric Ulcer Syndrome (EGUS) occurs with variable prevalence in horses, donkeys, and mules. Due to the particularities of the mucous membranes, the syndrome is made up of Squamous Gastric Disease (ESGD) and Glandular Gastric Disease (EGGD). Given the multifactorial nature and multiple classification systems of the syndrome, significant differences have been reported between prevalence studies performed ante mortem, which are even more remarkable when compared with postmortem evaluations. This study aimed to determine the presence and grade of squamous gastric disease in horses, donkeys and mules immediately after slaughter. The postmortem examination considered the inspection of the squamous region (cardia, dorsal fundus, and margo plicatus) and the classification of the observed lesions. The general prevalence of ESGD in the entire population of study was 83.3 % (78 %, 89 %, and 83 % for horses, donkeys, and mules, respectively), compromising the margo plicatus in all cases. 75 % had more than 5 lesions and 50 % had deep lesions, lesions of varying severity and/or evidence of recent/active bleeding. The prevalence of ESGD was similar in horses, donkeys, and mules subjected to similar handling conditions prior to slaughter, including long-distance traveling, fasting, and stress factors.

Horse Grimace Scale Does Not Detect Pain in Horses with Equine Gastric Ulcer Syndrome

Equine gastric ulcer syndrome (EGUS) is a highly prevalent and presumptively painful condition, although the amount of pain horses might experience is currently unknown. The aims of this study were to determine if the Horse Grimace Scale (HGS) could identify pain behaviours in horses with and without EGUS and if severity would be positively associated with the HGS score. Horse grimace scale scores were assessed blindly using facial photographs by seven observers and involved evaluation of 6 facial action units as 0 (not present), 1 (moderately present) and 2 (obviously present). Lameness examination, serum amyloid A (SAA) measurement and gastroscopy evaluation were performed on all horses. Horses (n = 61) were divided into two and three groups based on the presence (yes, no) and severity (none, mild, moderate-severe) of EGUS, respectively. Presence of lameness and elevated SAA (≥50 µg/mL) were used as exclusion criteria. Inter-observer reliability was analyzed by intra-class correlation coefficients (ICC). HGS scores between groups were compared using Welch's and Brown Forsythe tests (p < 0.05). Overall, HGS ICC was "excellent" (0.75). No significant differences (p = 0.566) were observed in HGS scores between horses with and without gastric lesions (mean, 95% CI; 3.36, 2.76-3.95 and 3, 1.79-4.20, respectively). HGS was not influenced by the presence or severity of EGUS in this current study. Further studies investigating the use of different pain scales in horses with EGUS are needed.

Current Topics in Medical Colic

The list of medical causes of acute or chronic colic in horses is extensive. The purpose of this article is to review 4 medical causes of equine colic with a focus on newer trends in treatment. The 4 topics selected include gastric impaction, gastric glandular disease, colon displacement, and inflammatory bowel disease.

Changes in Management Lead to Improvement and Healing of Equine Squamous Gastric Disease

Equine squamous gastric disease (ESGD) is common in horses and poses a serious welfare problem. Several risk factors have been identified and ESGD is routinely treated with omeprazole. Fourteen mares, previously used as embryo recipients and diagnosed with ESGD, were selected. Horses were confined to individual stalls, exercised once daily, and fed ad libitum hay, 1 kg of a low starch compound complementary feed and a mineral supplement. Half of the horses received a compound containing hydrolysed collagen (supplement) and the other half did not (control). At the start of the study, ESGD scores were 3.57 and 3.36 for the supplement and control group, respectively. After 4 weeks, the ESGD grades were significantly reduced in both groups (1.89 and 1.43, respectively, p < 0.01), and healing (ESGD < 2) occurred in 7 out of 14 horses. No treatment effect was observed (p = 0.75), and it was concluded that the change in husbandry overshadowed any potential effect of the compound. Severe ESGD can improve, and even heal, with the provision of a diet of ad libitum forage and a small amount of a compound complementary feed, without the use of omeprazole. A predictable daily routine, with a limited number of dedicated caretakers, may have contributed to the improvement of gastric health.

Equine Gastric Ulcer Syndrome: An Update on Current Knowledge

Equine Gastric Ulcer Syndrome (EGUS) is a term that has been used since 1999, initially being used to describe all gastric mucosal disease in horses. Since this time, the identification of two distinct main disease entities of the equine gastric mucosa have been described under the umbrella of EGUS; these are Equine Squamous Gastric Disease (ESGD) and Equine Glandular Gastric Disease (EGGD). In 2015 the European College of Equine Internal Medicine (ECEIM) released a consensus statement defining these disease entities. This document highlighted the lack of evidence surrounding EGGD compared to ESGD, and identified knowledge gaps for further research to be directed. Subsequently, many studies on EGGD have been published, especially on pathophysiology, diagnosis, and treatment. This article updates current knowledge on both ESGD and EGGD as understanding has evolved since the last large-scale review.

Influence of weaning management on gastritis incidence in foals

This study evaluated the incidence of gastritis in foals subjected to different weaning management methods. Sixteen crossbreed foals [230±35 kg], were enrolled in an experiment with a randomized block design. After weaning, foals were housed in either individual pens or a group pen. Gastritis in the foals was evaluated through gastroscopy. Data were submitted to analysis of variance by the non-parametric Friedman test at 0.05 significance level. Before weaning, gastritis was observed in 87.5% of the foals, and the scores for the number of gastric lesions were 2.10 and 1.56 for foals housed in group and individual pens, respectively. After weaning, the scores for the number of gastric lesions were 1.75 and 1.25 for foals housed in group and individual pens, respectively. For the intensity of gastric lesions, the average scores observed before weaning were 3.31 and 1.37 for foals housed in groups and individual pens, respectively. After weaning, the scores for the intensity of gastric lesions were 1.93 and 1.00 for foals housed in group and individual pens, respectively. The intensity of the gastric lesions decreased when comparing foals prior to weaning and after weaning, regardless of the management system (P<0.05). The number of lesions was not significantly different but tended to decrease after weaning. Differences in plasma cortisol concentrations were observed between samples collected on the weaning date and after weaning (P<0.05). No differences were detected in plasma gastrin concentration. In conclusion, gastritis in foals can be observed before weaning, which contributes to a decreased gastric lesion incidence.

A new approach to horse welfare based on systems thinking

Globally, calls for change in the horse industry to prioritise the health and well-being of domestic horses (Equus caballus) are reaching a critical threshold. Horse behaviour deemed undesirable or inconvenient by owners (henceforth referred to as undesirable behaviour) is reported across all aspects of a horse's life and may indicate a welfare issue. This study proposes a reconceptualisation of undesirable horse behaviour as a complex challenge based on systems thinking. Emerging from the natural sciences, systems thinking is an interdisciplinary approach to complex challenges (such as undesirable behaviour) as dynamic, highly interconnected networks of components and feedback relationships. This critical literature review examined the undesirable behaviours studied, the disciplines conducting research and their underpinning assumptions to identify opportunities for approaching research differently. Four themes emerged from the literature: undesirable behaviour is typically studied with unarticulated assumptions and in individual disciplines; behaviours are typically studied in isolation with the complexity of horse-human interactions generally not considered; management of behaviour typically has an anthropocentric linear 'cause and effect' focus; and solutions to undesirable behaviour are often short-term 'fixes' resulting in poor horse outcomes. From these, we outline the opportunities that each provide the next generation of horse research in terms of interdisciplinarity, systems thinking and management. Undesirable horse behaviour in a horse-human system is conceptually mapped in terms of factors associated with the behaviour (eg housing, stress, diet), and the relationships between them. Systems thinking offers a way to integrate multiple disciplines and identify and navigate new solutions to promote horse welfare.

Effect of omeprazole and sucralfate on gastrointestinal injury in a fasting/NSAID model

BACKGROUND

Equine gastric ulcer syndrome (EGUS) is a common and significant cause of morbidity in horses, with a range of clinical signs, including inappetence, colic and poor performance. Hospitalised horses are exposed to factors that may induce EGUS, including fasting and nonsteroidal anti-inflammatory drug (NSAID) administration, and may be at risk for development of squamous (ESGD) and glandular gastric disease (EGGD). Prophylactic anti-ulcer medication is often prescribed for these patients, but drug selection is complicated by different aetiology and response to treatment of ESGD and EGGD.

OBJECTIVES

To establish the efficacy of sucralfate or omeprazole used prophylactically in horses exposed to a combined feed-fast and NSAID administration EGUS induction protocol. We hypothesised that these drugs would be equally effective for prevention of gastric lesions in the experimental cohort.

STUDY DESIGN

Randomised crossover experimental design.

METHODS

Horses (n = 14) received either omeprazole (1 mg/kg PO q24h) or sucralfate (20 mg/kg PO q8h) while undergoing the feed-fast/NSAID protocol, allowed an 8-week washout period, and then administered the alternate treatment. Serial gastroscopy, ultrasound and haematology documented treatment effects.

RESULTS

ESGD and EGGD score increased over time under both treatments. There was a significant effect of treatment on EGGD scores (P < .001), with 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).

MAIN LIMITATIONS

This study was performed in healthy horses, and response to treatment may differ in horses with clinical illness. Additional investigation in a larger population may be required to detect significant differences in other clinical parameters.

CONCLUSIONS

Omeprazole was superior to sucralfate for mitigating gastric lesion severity in healthy horses exposed to a feed-fast/NSAID model.

Effect of a novel fermented soy product on gastric ulcer scores in horses

Non-pharmaceutical methods are desirable to treat or prevent gastric ulceration in horses. This two-period, randomised, double-blinded placebo-controlled study was designed to evaluate the efficacy of dietary supplementation (25 g once daily in feed for 30 days) with Fermaid®Ease 187 (FE, Lallemand Australia Pty Ltd, Maroochydore, Australia) on gastric squamous and glandular mucosal ulcer scores in horses. Gastroscopy of 120 horses presented to the Veterinary Clinical Centre at Charles Sturt University (CSU; Bathurst, Australia) or at local training establishments identified 60 horses with spontaneous gastric ulcer disease (50%). Of horses eligible for inclusion, 29 horses were recruited and randomised to receive either the FE or placebo for 30 days. Effects were assessed by repeat gastroscopy (Day 31), at which time horses started the reciprocal treatment. Eleven horses successfully completed both treatment periods. Treatment with FE showed a significant decrease in squamous ulcer scores in period 1 (P=0.008), with a similar effect observed in period 2. No change was observed in squamous ulcer scores for horses receiving placebo treatment in period 1, but increased squamous scores were observed in horses receiving placebo treatment in period 2 (P=0.062). Squamous ulcer scores on Day 31 were significantly lower (P=0.005) following FE treatment than for horses receiving the placebo treatment. No effects were observed on glandular ulcer scores. This study supported the use of FE in horses predisposed to ulceration of the squamous gastric mucosa.

Indicators of Horse Welfare: State-of-the-Art

Animal welfare is defined as a chronic state reflecting an individual's subjective perception of its situation. Because it is possible to be in a good welfare state and nevertheless experience acute fear or pain, and conversely, short-term positive emotions can be experienced during impaired welfare states, welfare as a chronic state has to be clearly distinguished from temporary states related to emotions, pain or stress. The evaluation of non-verbal individuals' welfare state, particularly in interspecific situations, is a real challenge that necessarily implies animal-based measures and requires multidisciplinary scientifically validated measures. In the last decade, studies investigating horses' welfare flourished together with new measures that were not always scientifically tested before being used. At a time were legal decisions are made on animal welfare, it is crucial to rely on reliable welfare indicators in order to prevent false evaluation. The aim of this review is to identify the scientifically tested and reliable indicators of horses' welfare (e.g., body lesions, apathy, aggressiveness, stereotypic behaviours) from signals of temporary states related to acute pain emotions or stress and from popular beliefs, in order to give the scientific community and the horse industry accurate evaluation tools.

Effects of Transport Conditions on Behavioural and Physiological Responses of Horses

The regulations for minimal space and direction of travel for land transport in horses vary worldwide and there is currently no definitive guidance to promote equine health and welfare. This study evaluated the effects of bay size and direction of travel (forwards/backwards) in horses by comparing the behavioural, physiological, laboratory and gastroscopy parameters between transported and confined horses. A total of twenty-six mares took part in the study; 12 horses were confined for 12 h, and all mares underwent 12 hours' transportation, travelling in single (n = 18) or wide bays (n = 8), and forward (n = 10) or rear (n = 16) facing. Behaviour was recorded during confinement/transportation and analysed using a behaviour sampling ethogram. Clinical examination, blood samples and gastroscopy were conducted before and after confinement/transportation. The frequency of behaviours relating to stress and balance increased during transport, and horses transported in a rear-facing position and in a wider bay size showed fewer balance-related behaviours. Balance behaviours, particularly loss of balance, were positively associated with the severity of gastric ulceration after transportation and elevated muscle enzymes, while increased stress behaviours correlated with decreased gastrointestinal sounds. Heart rate and rectal temperature after transportation were positively associated with balance and stress behaviours, and with squamous gastric ulcer scores. Transportation was associated with expected increases in cortisol and muscle enzymes, but positioning and space allowance had minimal effects on these analytes. Findings suggest that transportation in a rear-facing position and in wider bays might reduce the impact of transport on horse health and welfare, and monitoring behaviour in transit and physiological measurements after transportation should be recommended. Behavioural and physiological parameters were more sensitive than haematological, biochemical or endocrine analytes to identify horses suffering from transport stress.

Effects of breed, management and personality on cortisol reactivity in sport horses

Sport horses need to fulfill high physical and psychological requirements during training and competition. These as well as certain conditions of modern husbandry may affect their wellbeing. Here we aimed to (1) evaluate effects of demographic and management factors as well as personality traits on stress reactivity of sport horses, (2) investigate if elite sport horses have elevated stress levels compared to amateur sport horses, and (3) assess whether different equestrian disciplines differentially influence equine adrenal cortex responsiveness. For this purpose, we visited 149 healthy elite (n = 94) and amateur (n = 54) sport horses in Switzerland and performed an adrenocorticotropic hormone (ACTH) stimulation test. Additionally, a person who was familiar with the horse completed a questionnaire about demographic and management factors and their horses' personality traits. Linear models were calculated to assess associations between the questionnaire data and salivary cortisol 60 (T60) and 90 (T90) minutes after ACTH stimulation. While the model at T90 was not significant, post-stimulatory cortisol after 60 minutes appears most informative in line with a previous study and was significantly affected by the breed and by three management factors: "number of riders", "hours spent outside" and "group housing" (adjusted r2 = 15%, p<0.001). Thoroughbred and Warmblood horses displayed an increased adrenal response compared to Franches-Montagnes horses. Horses with several riders had a less pronounced reaction than horses with one rider, and horses that spent more time outside had a decreased response compared to horses that were stabled most of the time. Horses living in groups showed higher post-stimulatory cortisol values than horses that were housed singly. However, no significant associations of cortisol responsiveness with personality traits were found, and neither the use as elite or as amateur sport horses nor the discipline had an effect on the cortisol response. This suggests that optimizing husbandry conditions may be more important for improving equine welfare than changing their use.

Dogs, but Not Wolves, Lose Their Sensitivity Toward Novelty With Age

Selection of behavioral traits holds a prominent role in the domestication of animals, and domesticated species are generally assumed to express reduced fear and reactivity toward novel stimuli compared to their ancestral species. However, very few studies have explicitly tested this proposed link between domestication and reduced fear responses. Of the limited number of studies experimentally addressing the alterations of fear during domestication, the majority has been done on canids. These studies on foxes, wolves, and dogs suggest that decreased expression of fear in domesticated animals is linked to a domestication-driven delay in the first onset of fearful behavior during early ontogeny. Thus, wolves are expected to express exaggerated fearfulness earlier during ontogeny compared to dogs. However, while adult dogs are less fearful toward novelty than adult wolves and wolf-dog hybrids, consensus is lacking on when differences in fear expression arise in wolves and dogs. Here we present the first extended examination of fear development in hand-raised dogs and European gray wolves, using repeated novel object tests from 6 to 26 weeks of age. Contrary to expectations, we found no evidence in support of an increase in fearfulness in wolves with age or a delayed onset of fear response in dogs compared to wolves. Instead, we found that dogs strongly reduced their fear response in the period between 6 and 26 weeks of age, resulting in a significant species difference in fear expression toward novelty from the age of 18 weeks. Critically, as wolves did not differ in their fear response toward novelty over time, the detected species difference was caused solely by a progressive reduced fear response in dogs. Our results thereby suggest that species differences in fear of novelty between wolves and dogs are not caused by a domestication-driven shift in the first onset of fear response. Instead, we suggest that a loss of sensitivity toward novelty with age in dogs causes the difference in fear expression toward novelty in wolves and dogs.

Effect of Changing Diet on Gastric Ulceration in Exercising Horses and Ponies After Cessation of Omeprazole Treatment

Diet is an accepted risk factor for equine squamous gastric disease (ESGD), but there is little published evidence for the benefit of dietary change (DC). This study evaluated the effect of DC with or without initial omeprazole medication. Twelve pairs of exercising horses with ESGD Grade 2/4 (EM) and 17 pairs with ESGD Grade ≥3/4 (ES), were monitored. Paired horses had similar management, feeding times, workloads, and initially feed or forage. One of each pair was randomly assigned, postgastroscopy (Scope1), to a specified restricted starch ration; the other remained on their original diet. Omeprazole (4 mg/kg per os SID) was given to all ES pairs for 4 weeks. Gastroscopies were scored, without dietary knowledge, after 4 and 10 weeks (Scopes 2 and 3). Workloads remained similar throughout. McNemar's tests identified any changes in ESGD grade. Within the EM group, DC had no additional effect. For the ES group remaining on their original diet, there was significant improvement in ESGD grade from Scopes 1 to 2 (P < .001) but a worsening between Scopes 2 and 3 (P = .005), with Scope 3 being no different from Scope 1 (P = .08) reflecting no apparent long-term medication benefit. For the DC group, there was significant improvement in ESGD grade from Scopes 1 to 2 (P < .001) and between Scopes 1 and 3 (P = .003); In addition, there was no significant difference between Scopes 2 and 3 (P = .32). Although limited by the small number of pairs evaluated, this study provides evidence that appropriate DCs can be a beneficial management strategy for ESGD.

Management factors and clinical implications of glandular and squamous gastric disease in horses

BACKGROUND

To date, risk factors for equine glandular gastric disease (EGGD) have not been described in Thoroughbred racehorses.

OBJECTIVES

To determine management factors associated with EGGD, identify clinical signs in affected horses, and compare these to equine squamous gastric disease (ESGD).

ANIMALS

The study was carried out on 109 Thoroughbred racehorses from 8 training yards (3 in the United Kingdom and 5 in Australia).

METHODS

Gastroscopic examination alongside a questionnaire regarding management, feeding, exercise, and health.

RESULTS

Management factors and clinical signs were different for EGGD versus ESGD. Exercising ≥5 days per week was associated with a 10.4 times (95% CI [confidence interval]: 1.34-26.9) increased risk of EGGD. Horses racing below expectation were 3.7 times (95% CI: 1.1-16.7) more likely to have EGGD. Trainer was also identified as a risk factor for EGGD. Time in work ≤6 weeks was associated with a decreased risk of ESGD (odds ratio [OR] 0.3; 95% CI: 0.1-0.99). Horses aggressive to humans were less likely to have ESGD (OR 0.12; 95% CI: 0.03-0.54). Horses with stereotypies were more likely to have ESGD (OR 5.0; 95% CI: 1.6-15.9).

CONCLUSIONS AND CLINICAL IMPORTANCE

The findings of our study further support the notion that EGGD should be considered as a distinct disease entity to ESGD. Exercising ≤4 days per week could reduce the risk of EGGD. Horses with EGGD are more likely to perform below expectation and, as such, EGGD might be performance limiting in some affected individuals. Stress minimization could reduce the risk of EGGD.

Diagnostic accuracy of post-ACTH challenge salivary cortisol concentrations for identifying horses with equine glandular gastric disease

The aims of this study were to better characterize the adrenal response to i.v. adrenocorticotropic hormone (ACTH) in horses with and without gastric disease and to validate and simplify the ACTH stimulation test by determining the diagnostic accuracy of six consecutive sampling time points after ACTH administration for equine glandular gastric disease (EGGD) and equine squamous gastric disease (ESGD). Twenty-six endurance and eventing horses without clinical disease [Sport Horse Population (SHP)] and an independent population of 62 horses [General Population (GP)] were grouped by gastroscopic findings (no/mild vs. moderate/severe EGGD, grade 0-1 vs. 2-4 ESGD, respectively) and underwent an ACTH stimulation test. Salivary cortisol (ng/mL) was analyzed before and 30, 60, 90, 120, and 150 min after i.v. injection of 1 µg/kg BW synthetic ACTH1-24. The association between having moderate or severe EGGD or ESGD and the amount of salivary cortisol was analyzed by means of receiver-operating characteristic (ROC) analysis. The following explanatory variables were considered: cortisol values for every time point, the area under the curve (AUC)-including all time points and corrected for the baseline-and the partial areas under the curve AUC0-90 and AUC90-150. Sampling after 60 min had highest association with moderate/severe EGGD. The diagnostic potential of the ACTH test was higher for the SHP [sensitivity 100% (95% CI 54% to 100%), specificity 75% (95% CI 51% to 91%), ROC-AUC 91% (95% CI 69% to 98%), 1-sided P-value < 0.001] than for the GP [sensitivity 75% (95% CI 48% to 93%), specificity 52% (95% CI 37% to 67%), ROC-AUC 68% (95% CI 51% to 79%), 1-sided P-value = 0.0064]. There were, however, no significant associations with ESGD. The superiority of sampling after 60 min suggests that the initial release of cortisol rather than its peak or the AUC are relevant regarding EGGD. Even though the wide confidence intervals and thus the lack of diagnostic accuracy do not presently support clinical use, characterization of the adrenal response to an ACTH stimulus improves the understanding of EGGD pathophysiology and its relation to stress.

Risk Factors for Equine Gastric Glandular Disease: A Case-Control Study in a Finnish Referral Hospital Population

Background

Equine gastric glandular disease (EGGD) is a term used to classify erosive and ulcerative diseases of the glandular mucosa of the equine stomach. Epidemiologic studies of risk factors for EGGD have not been reported.

Objective

To determine risk factors for EGGD.

Animals

Cases (n = 83) had endoscopic evidence of EGGD; controls (n = 34) included healthy horses and horses with equine squamous gastric disease (ESGD) without EGGD.

Methods

Retrospective case‐control study. The data were analyzed by multivariable logistic regression modeling. Analysis was performed on the full dataset. An additional analysis compared horses with glandular lesions (n = 43) against healthy horses (n = 22).

Results

On first analysis, Warmblood breed (OR = 13.9, 95% CI 2.2–90.9, P = .005) and an increasing number of caretakers (OR = 7.3, 95% CI 0.98–55.6, P = .053) were associated with an increased risk of EGGD. On analysis of the subset of data, Warmblood breed (OR = 28.6, 95% CI 2.96–250.0, P = .004) and increasing number of riders (OR = 12.99, 95% CI 0.94–166.7, P = .056) were risk factors. The presence of sand in the colon appeared to have a protective effect against EGGD (OR = 0.195, 95% CI 0.04–1.0, P = .051 for sand versus not having sand).

Conclusions and clinical importance

This study suggests that Warmbloods are predisposed to EGGD and multiple handlers/riders might increase the risk of EGGD. Identification of risk factors allows speculation on potential pathophysiological mechanisms of EGGD.

Therapeutics for Equine Gastric Ulcer Syndrome

Equine gastric ulcer syndrome (EGUS) is an umbrella term used to describe ulcers in the nonglandular squamous and glandular mucosa, terminal esophagus, and proximal duodenum. Gastric ulcers in the squamous and glandular regions occur more often than esophageal or duodenal ulcers and likely have a different pathogenesis. At present, omeprazole is accepted globally as the best pharmacologic therapy for both regions of the stomach; however, the addition of coating agents and synthetic prostaglandins could add to its effectiveness in treatment of EGUS. Dietary and environmental management are necessary for prevention of recurrence.