Comparison of the effects of enteral psyllium, magnesium sulphate and their combination for removal of sand from the large colon of horses

Diagnostic approaches, aetiological agents and their associations with short-term survival and laminitis in horses with acute diarrhoea admitted to referral institutions

BACKGROUND

An international description of the diagnostic approaches used in different institutions to diagnose acute equine diarrhoea and the pathogens detected is lacking.

OBJECTIVES

To describe the diagnostic approach, aetiological agents, outcome, and development of laminitis for diarrhoeic horses worldwide.

STUDY DESIGN

Multicentre retrospective case series.

METHODS

Information from horses with acute diarrhoea presenting to participating institutions between 2016 and 2020, including diagnostic approaches, pathogens detected and their associations with outcomes, were compared between institutions or geographic regions.

RESULTS

One thousand four hundred and thirty-eight horses from 26 participating institutions from 4 continents were included. Overall, aetiological testing was limited (44% for Salmonella spp., 42% for Neorickettsia risticii [only North America], 40% for Clostridiodes difficile, and 29% for ECoV); however, 13% (81/633) of horses tested positive for Salmonella, 13% (35/262) for N. risticii, 9% (37/422) for ECoV, and 5% (27/578) for C. difficile. C. difficile positive cases had greater odds of non-survival than horses negative for C. difficile (OR: 2.69, 95%CI: 1.23-5.91). In addition, horses that were positive for N. risticii had greater odds of developing laminitis than negative horses (OR: 2.76, 95%CI: 1.12-6.81; p = 0.029).

MAIN LIMITATIONS

Due to the study's retrospective nature, there are missing data.

CONCLUSIONS

This study highlighted limited diagnostic investigations in cases of acute equine diarrhoea. Detection rates of pathogens are similar to previous reports. Non-survival and development of laminitis are related to certain detected pathogens.

Owners' Knowledge and Approaches to Colic in Working Equids in Honduras

In Honduras, many families are reliant on working equids in their daily life. The aim of this study was to evaluate knowledge about, and approaches to colic used by owners of working equids in Choluteca, Honduras using a phenomenological approach. Semi-structured, verbal questionnaires were conducted with ninety-three owners from eleven different communities in the Choluteca region on equid horse owners' knowledge of colic and treatments. Additional context was gained through observations and verbal questionnaires with three veterinary practitioners and eight agricultural pharmacy (agrovet) store owners. Working equids were commonly used for firewood collection 31% (40/126), transportation 24% (30/126), and carrying crops 13% (17/126). Thirty-eight percent of owners (35/92) said they did not know what colic was, 27% (24/89) could not name any clinical signs, and 46% (42/92) could not name any causes. Most owners with previous experience of colic had treated it themselves 79% (53/67), typically using herbal remedies. Colic was a major concern for owners of working equids who had prior experience or knowledge of the condition. Knowledge and understanding of colic varied, and access to evidence-based treatments was very limited. The findings will be used to inform the development of educational resources on colic in working equids.

How Can Nutrition Help with Gastrointestinal Tract-Based Issues?

Many horses are fed differently than their wild ancestors. They often have limited access to pasture and are fed conserved forage and concentrates rich in starch and sugars, in only 2 meals per day. Feeding practices in contrast to natural feeding behavior can lead to gastrointestinal issues. Standard nutritional evaluation is warranted because of its important role in prevention and in treatment and management of diseases. When medical and nutritional treatments are combined, success rates are higher. New techniques to characterize equine microbiota have been used, allowing for microbiota manipulation to prevent and treat intestinal diseases.

Psyllium supplementation is associated with changes in the fecal microbiota of horses

OBJECTIVE

Prophylactic supplementation of psyllium husk is recommended to enhance passage of ingested sand from the gastrointestinal tracts of horses. We hypothesized that psyllium supplementation would increase fecal sand passage and favorably alter bacterial populations in the hindgut. Six yearlings and six mature mares were fed a psyllium supplement in the diet daily for seven days. Voluntarily-voided feces were collected over the course of 29 days, prior, during, and after treatment. Feces were analyzed for acid detergent fiber (ADF) and acid detergent insoluble ash analyses. Microbial DNA was also isolated, and the V4 region of the 16S ribosomal RNA gene was PCR-amplified and sequenced using MiSeq technology.

RESULTS

Fecal ADF concentration was greater in adults while silica concentration was greater in yearlings. Mature mare fecal ADF decreased during and just after supplementation but thereafter increased. No changes in silica levels were noted in either group over time. Fecal microbial population phylogenetic diversity was greatest mid-supplementation and lowest at 11 days post-supplementation. Functional profiles of the microbial communities presented some benefits for psyllium supplementation. These findings provide compelling evidence for further detailed studies of prophylactic psyllium supplementation.

Carboxymethylcellulose and psyllium effects in sand output of horses with asymptomatic sand accumulation

ABSTRACT The aim of this study was to evaluate the effects of Psyllium (PSY) and Carboxymethylcellulose (CMC) administration on fecal elimination of sand in horses with asymptomatic sand accumulations. Eight horses were selected from sandy areas and randomly divided into 2 groups of four animals. The subjects were treated either with CMC or PSY. The presence of intestinal sand was confirmed through radiography and glove sedimentation test. The study was performed in two phases, with a 7-day interval. In phase I, all the animals received 8 liters of warm water; in phase II, the CMC group received 8 liters of water + 1g/kg of CMC, whereas the PSY group received 8 liters of water + 1g/kg of PSY. All administrations were performed through nasogastric intubation and fractionated in 2 equal volume administrations with an interval of two hours. General and specific physical examination of the digestive system were performed in conjunction with abdominal ultrasonography before the administrations and after 6, 12, 24, 36 and 48 hours, aiming to evaluate intestinal motility and presence of sand. All the feces eliminated by the animals within the 72 hours following the administrations were quantified, diluted and sedimented in order to calculate the sand output (g/kg of feces). All the animals were also subjected to radiographic examination to quantify sand accumulation prior to phase I and after 72 hours of phases I and II. No adverse effects were observed after the treatments. It was possible to notice higher sand elimination in both groups during the phase I, whereas no difference was observed in sand elimination rates between the groups in phase II. The radiographic scores presented differences between the initial timepoint and 72h in phases I and II for both groups. Based on the sand elimination rates and radiographic score, this study demonstrated that sand output was greater after administration of water alone, compared to CMC and Psyllium, leading to the inference that removal of the sandy environment and prevention of sand re-ingestion are effective measures for the elimination of sand from the colon of horses with asymptomatic sand accumulations.

Evaluation of Fecal Sand Clearance in Horses With Naturally Acquired Colonic Sand Accumulation With a Product Containing Probiotics, Prebiotics, and Psyllium

Consumption of sand and dirt in horses can cause chronic diarrhea and colic because of irritation and obstruction of the gastrointestinal tract of horses. Prevention has primarily focused on changes in management to reduce the intake of sand and feeding of psyllium products. The purpose of this study was to evaluate the efficacy of a product containing probiotics, prebiotics, and psyllium in the clearance of colonic sand in horses with naturally acquired sand accumulation using a randomized, placebo-controlled, blinded clinical trial format. After identification of 10 horses with sand accumulation as determined by both auscultation and abdominal radiography, quantitative assessment of changes in colonic sand content in response to management changes combined with treatment with the probiotic/psyllium product or no treatment was assessed by blinded observers. Fecal sand output was monitored in both groups via sand sedimentation analysis of fecal samples every 3 days for 35 days and with pre- and post-treatment abdominal radiography. There was a significant reduction in sand accumulation in both treatment and control groups, but there were no significant differences between treatment and control groups in clearance of colonic sand as measured by both fecal sand sedimentation and quantitative radiography.

Owner-Reported Clinical Signs and Management-Related Factors in Horses Radiographed for Intestinal Sand Accumulation

Clinical problems related to intestinal sand accumulation in horses are common in certain geographic areas, but the clinical signs appear nonspecific and the course of the accumulation remains somewhat obscure. This study examined the association between the presence and size of intestinal sand accumulations and owner-reported clinical signs, management, and feeding practices, as well as behavioral patterns in horses with radiographic diagnosis of sand accumulation. Owners of the horses filled in an online questionnaire. A total of 447 responses met the inclusion criteria. The size of the sand accumulation detected in the radiographs was not significantly associated with the age, body condition score, sex, or use of the horses. Horses reported to have expressed colic had significantly larger sand accumulations than those without this sign, and a similar association was detected in horses with poor performance. The highest odds ratio for sand accumulation was for the combination of colic and poor performance, followed by colic combined with diarrhea/loose feces or hyperesthesia to touch of the abdominal wall. Larger sand accumulations were detected in greedy horses that eat all their roughage, whereas dominant position in group hierarchy was associated with less sand. The possibility of abdominal sand accumulation should be considered as one of the differentials in horses with multiple owner-reported clinical signs such as colic, poor performance, diarrhea, and hyperesthesia to touch of the abdomen.

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.

Occurrence, treatment protocols, and outcomes of colic in horses within Nairobi County, Kenya

Aim:

The aim of this study was to determine the treatments and their outcomes in horses with colic in Nairobi County, Kenya.

Materials and Methods:

This is a retrospective study to determine the occurrence, treatments, pain management, and outcomes of colic in horses in Nairobi County. Association between pain management protocols and the outcomes of colic with regard to recovery or death was also determined. Data collected from four equine practitioners were organized manually and given numerical codes as appropriate to facilitate entry into the computer. The coded data were entered into Microsoft Excel 2010 and exported to StatPlus pro 5.9.8 statistical package for analysis. Simple association tests were done between various factors and occurrence of colic.

Results:

The incidence of colic for the 11 years was 3.1%, which constituted 68.0% spasmodic colic, 27.8% impaction colic, and 4.2% displacement colic. Flunixin meglumine as a nonsteroidal anti-inflammatory drug (NSAID) was used as the only pain management treatment in 85.3% of the cases, flunixin meglumine and butorphanol as NSAID-OPIOD combination in 6.4% of the cases, while buscopan as an antispasmodic was recorded in 5.9% of the cases mainly in spasmodic colic. Univariate analysis revealed simple association between various factors and the type of colic a horse was having. There was an association between the type of colic and the decision-making on the pain management protocol to use, whether single analgesic protocol (χ²=22.5, p<0.001) or use of analgesic combinations (χ²=18.3, p<0.001). The type of colic strongly influenced the decision for performing nasogastric intubation (χ²=265, p<0.001), but performing nasogastric intubation was weakly (χ²=4.9, p=0.03) associated with horse recovery from colic. Type of colic also strongly influenced the need for the use of metabolic stimulants, particularly vitamin B-complex (χ²=99.3, p<0.001). Recovery or death of the horse from colic was strongly associated with the type of colic (χ²=250, p<0.001). The possibility of recurrence of colic was weakly (χ²=4.6, p=0.04) determined by the type of colic, a horse had. Multivariate logistic regression revealed that the main cause of death was intestinal displacement and the majority of the horses with intestinal displacement died (β-estimate 2.7, odds ratio=0.07, p=0.007) compared to horses that had impaction colic.

Conclusion:

The incidence of colic is 3.1%, and the most common type of colic is spasmodic followed by impaction. The most common pain management protocol for colic is NSAIDs, mainly flunixin meglumine, followed by flunixin-butorphanol combination. Surgery for horses with colic in Nairobi County is not commonly done due to impeding poor prognoses. The horse owners tend to prefer euthanasia for such cases.

Clinical findings and management of 153 horses with large colon sand accumulations

OBJECTIVE

To determine the influence of radiographic quantification of sand accumulation on the medical versus surgical management of large colon sand accumulations. To compare short- and long-term outcomes and complications associated with medical and surgical management of these horses.

STUDY DESIGN

Retrospective.

SAMPLE POPULATION

A total of 153 horses.

METHODS

Medical records and abdominal radiographs of horses presented for colic between 2004 and 2014 were reviewed. Severity of sand accumulation was quantified by tracing and measuring a region of interest with a commercial software program. Breed, weight, amount of sand, presence of diarrhea at presentation, treatment, and the development of complications were recorded.

RESULTS

Records from 153 horses were reviewed. The mean cross-sectional area of sand accumulation was 692.9 cm² (median = 658.7 cm² , 84.6-1780.7 cm² ). Increased accumulation of gas on radiographs and abnormal transrectal examination findings were associated with an increased likelihood of surgery. The most common complication was the development of diarrhea (20.3%) with only 4 (2.6%) horses positive for Salmonella spp. Horses had a favorable prognosis, with 94.8% of horses treated medically and 94.7% of those treated surgically surviving to discharge.

CONCLUSION

Increased accumulation of gas on radiographs and transrectal palpation of impaction or intestinal gas distension increase the likelihood of surgery. Both medical and surgical treatments carry a good prognosis.

CLINICAL RELEVANCE

The sheer quantity of sand is not a factor when determining surgical intervention. Attention should be paid to the presence of increased gas accumulation on rectal or radiographic examination.

Long-term follow-up on recovery, return to use and sporting activity: a retrospective study of 236 operated colic horses in Finland (2006-2012)

BACKGROUND

Surgical treatment of colic is expensive and complications may occur. Information on the prognosis and the use of the horse after surgery for colic is important for surgeons and owners. Current literature on return to athletic function after celiotomy is limited. The present study reviewed surgical cases of the Veterinary Teaching Hospital, Helsinki, Finland for 2006-2012. The aim was to follow the population of horses of different breeds for surgical findings, postsurgical complications, long-term recovery and prognosis. The findings and their influence on survival, return to previous or intended use and performance were assessed.

RESULTS

Most of the operated horses (82.6%; 195/236) recovered from anesthesia and 74.9% (146/195) were discharged. The total follow-up time was 8 years and 10 months and the median survival time 79.2 months. Age of the horse, location of the abdominal lesion (small vs. large intestine), incidence of postoperative colic, surgical site infection, incisional hernia or convalescence time after surgery, did not significantly affect the probability of performing in the previous or intended discipline after the surgery. A majority of the discharged horses (83.7%) was able to perform in the previous or intended discipline and 78.5% regained their former or higher level of performance. Operated horses had 0.18 colic episodes per horse-year during the long-term follow-up. The incidence of colic was 20.0% within the first year after surgery. Horses operated for large intestinal colic were 3.3-fold more prone to suffer postoperative colic than horses operated for small intestinal colic. The majority of the owners (96.3%) were satisfied with the veterinary care and nearly all (98.5%) evaluated the recovery after the colic surgery to be satisfactory or above.

CONCLUSIONS

If the horse survives to discharge, prognosis for long-term survival and return to previous level of sporting activity and performance was good after colic surgery in a population of horses of different breeds. None of the factors studied were found to decrease the probability of performing in the same or intended discipline after surgery. The majority of horses were able to return to their previous activity and perform satisfactorily for several years after surgery.

Comparison of psyllium feeding at home and nasogastric intubation of psyllium and magnesium sulfate in the hospital as a treatment for naturally occurring colonic sand (geosediment) accumulations in horses: a retrospective study

BACKGROUND

Ingestion of geosediment (further referred as sand) may cause weight loss, diarrhea and acute or recurrent colic in horses. Our aim was to compare the efficacy of three treatment protocols in clearing colonic sand accumulations in clinical patients. This retrospective clinical study consisted of 1097 horses and ponies, which were radiographed for the presence of colonic sand. Horses included to the study (n = 246) were displaying areas of sand in the radiographs of ≥75 cm² and were treated medically monitoring the response with radiographs. The horses were assigned into three groups based on the given treatment: Group 1 was fed psyllium [1 g/kg body weight (BW)] daily at home for a minimum of 10 days (n = 57); Group 2 was treated once with psyllium or magnesium sulfate by nasogastric tubing followed by daily feeding of psyllium (1 g/kg BW) at home for a minimum of 10 days (n = 19), and Group 3 was treated by daily nasogastric tubing for 3-7 days with psyllium and/or magnesium sulfate (1 g of each/kg BW) (n = 170).

RESULTS

The initial area of sand did not differ significantly between the treatments. Group 3 had significantly less residual sand than Groups 1 and 2, and the proportion of resolved horses was higher in Group 3 than in Groups 1 and 2.

CONCLUSIONS

Daily nasogastric tubing with psyllium and/or magnesium sulfate for 3-7 days removes large accumulations of sand from the colon in horses more effectively than feeding psyllium for at least 10 days.