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Julliand S, Buttet M, Hermange T, Hillon P, Julliand V. Effect of diet composition on glandular gastric disease in horses. J Vet Intern Med 2023; 37:1528-1536. [PMID: 37264707 PMCID: PMC10365063 DOI: 10.1111/jvim.16747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 05/07/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Nutritional factors are suggested to influence the incidence and severity of glandular gastric disease (GGD) in horses. OBJECTIVES To retrospectively assess whether dietary fermentable carbohydrates increase the severity of GGD and to prospectively evaluate whether the partial substitution of concentrates by dehydrated alfalfa would decrease GGD severity scores. ANIMALS In total, 82 trotters from 4 training centers exercised ≥5 days/week. METHODS Multicenter retrospective observational study, and prospective 2-arm randomized trial. Glandular mucosae were observed by gastroscopy and scored (0-4 severity scale) at day 0 (D0). Biochemical composition of the diet fed was compared between ulcerated and nonulcerated groups. After D0, horses either received the same diet (control, n = 41) or pelleted dehydrated alfalfa substituting 50% concentrates (alfalfa, n = 41). Glandular scores were recorded in both groups after 21 (D21) and 42 days (D42). The first end point was a successful outcome, defined as a horse with a glandular score of 2 to 4 on D0, decreasing to a score of 0 to 1 on days 21 or 42. RESULTS Horses scored 0 to 1 at D0 ingested more (P = .01) soluble sugars from concentrates than those scored 2 to 4 before D0 (77.5 g/kg BW; 95% confidence interval [CI]: 71.1-84.0, vs 59.1 g/kg BW; 95% CI: 48.0-70.3), whereas starch intake did not differ between groups (P = .24). Among horses scored 2 to 4 at D0, fewer were scored 2 to 4 in the alfalfa group (1 out of 6) compared with the control group (6 out of 6) at D42 (P = .02). Clinical success was 47.7 times more likely in horses fed alfalfa compared with horses in the control group (95% CI: 1.6-1422.8). CONCLUSION AND CLINICAL IMPORTANCE Relationships were found between diet composition and integrity of the glandular mucosa. Feeding pelleted dehydrated alfalfa could help to reduce the incidence and severity of GGD.
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Affiliation(s)
| | | | - Tanguy Hermange
- Centre Hospitalier Vétérinaire Equin de LivetLivarot‐Pays‐d'AugeFrance
| | - Patrick Hillon
- University of Bourgogne‐Franche ComtéDijonFrance
- INSERM U1231, Lipids, Nutrition, CancerDijonFrance
- Department of HepatogastroenterologyUniversity HospitalDijonFrance
| | - Véronique Julliand
- UMR PAM A 02.102DijonFrance
- University of Bourgogne‐Franche ComtéDijonFrance
- Agrosup DijonDijonFrance
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2
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Mair T, Sherlock C. Recurrent Colic: Diagnosis, Management, and Expectations. Vet Clin North Am Equine Pract 2023:S0749-0739(23)00026-3. [PMID: 37121784 DOI: 10.1016/j.cveq.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Most recurrent episodes of non-specific colic are self-limiting, and the results of clinical examinations are unremarkable. Differentiating these cases from serious diseases can be difficult, but repeated evaluations are warranted. Horses presenting with very frequent bouts of colic are more likely to have serious diseases and a higher mortality rate compared to horses presenting with less frequent bouts of transient colic. Horses with recurrent bouts of prolonged colic are more likely to have motility issues or partial intestinal obstruction. Non-gastrointestinal diseases can also cause recurrent bouts of pain ("false colic"). Adhesions are common causes of colic following abdominal surgery.
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Affiliation(s)
- Tim Mair
- CVS Ltd, Bell Equine Veterinary Clinic, Mereworth, Maidstone, Kent, ME18 5GS, UK.
| | - Ceri Sherlock
- CVS Ltd, Bell Equine Veterinary Clinic, Mereworth, Maidstone, Kent, ME18 5GS, UK
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3
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Pratt SL, Bowen M, Hallowell GH, Shipman E, Bailey J, Redpath A. Does lesion type or severity predict outcome of therapy for horses with equine glandular gastric disease? - A retrospective study. Vet Med Sci 2022; 9:150-157. [PMID: 36495212 PMCID: PMC9857143 DOI: 10.1002/vms3.1034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Equine glandular gastric disease (EGGD) is a common condition of the horse. Misoprostol is reported to be superior to oral omeprazole and sucralfate for treatment. Long-acting intramuscular injectable omeprazole (LAIOMEP) is a novel treatment shown to be effective in a small population. OBJECTIVES This study aimed to determine LAIOMEP efficacy compared to misoprostol and oral omeprazole and identify characteristics that predict treatment outcome. METHODS All horses that underwent gastroscopy between 2012 and 2019 were reviewed. Lesions were characterised by 4 blinded observers, all of whom are diplomates in equine internal medicine, using established descriptors from the ECEIM consensus statement and subjective severity. Treatment outcome was ranked as worsened, improved or healed. Consensus lesion type, lesion severity and treatment choice were compared to outcome and data screened using univariate analysis (chi-squared) to determine whether each predicted outcome. Lesion types where univariate analysis predicted a trend (p<0.2) were included in a multiple-regression analysis to identify predictors of outcome irrespective of treatment. RESULTS Only severity significantly predicted final outcome (p = 0.025) with severe lesions being more likely to improve. Treatment choice did not significantly predict outcome. Overall healing rate was 29% (24 horses), and 43% (44 horses) improved. Treatment healing rates were 23% (10), 12% (7) and 27% (7) for LAIOMEP, misoprostol and oral omeprazole, respectively, with improvement in 69% (14), 76% (21) and 61% (9). 64% of the latter group received sucralfate. Worsening occurred in 7% (6). Treatment length varied with a median of 4 weeks (range 4-20 weeks). CONCLUSIONS This study showed poorer therapy outcome compared to previous studies. The only initial lesion descriptor to predict outcome was severity and treatment choice did not affect outcome.
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Affiliation(s)
- S. L. Pratt
- School of Veterinary Medicine and ScienceUniversity of NottinghamSutton BonningtonUK
| | | | | | - E. Shipman
- School of Veterinary Medicine and ScienceUniversity of NottinghamSutton BonningtonUK
| | - J. Bailey
- School of Veterinary Medicine and ScienceUniversity of NottinghamSutton BonningtonUK
| | - A. Redpath
- School of Veterinary Medicine and ScienceUniversity of NottinghamSutton BonningtonUK
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4
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Wise JC, Hughes KJ, Edwards S, Jacobson GA, Narkowicz CK, Raidal SL. Pharmacokinetic and pharmacodynamic effects of 2 registered omeprazole preparations and varying dose rates in horses. J Vet Intern Med 2020; 35:620-631. [PMID: 33340169 PMCID: PMC7848319 DOI: 10.1111/jvim.15971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/02/2020] [Accepted: 11/10/2020] [Indexed: 12/02/2022] Open
Abstract
Background Omeprazole preparations vary in bioavailability in horses. Hypothesis/Objectives To characterize the pharmacokinetics and pharmacodynamics of an existing enteric‐coated oral omeprazole paste (REF) and a novel, in‐feed, enteric‐coated dry granule preparation (NOV). Animals Twelve Standardbred/Thoroughbred mares free from clinical disease. Methods A prospective, blinded randomized interventional study was trial, conducted in 3 parts: (a) bioavailability study, (b) dose titration study, and (c) comparative clinical pharmacodynamic study, each using a blocked crossover design. Results Consistent with the larger dose administered, Cmax (median, 1032 ng/mL; range, 576‐1766) and AUC0‐24 (median, 63.9 μg/mL*min; range, 42.4‐152.4) were greater after single oral administration of NOV than REF (282.7 ng/mL; range, 94.8‐390.2, and 319 23.8 μg/mL*min; range, 8.2‐42.3, respectively; both P = .004). No differences were observed between products for absolute oral bioavailability (NOV 55% range, 15‐88; REF 17% range, 10‐77; P = .25). Treatment with both preparations was associated with reduced gastric squamous ulcer scores and increased pH of gastric fluid. Bioequivalence was demonstrated for pharmacodynamic measures with the exception of % time pH <4, despite differences in dose rate and subsequent plasma omeprazole concentrations. Conclusions and Clinical Importance The findings of this study indicate that the NOV product would be a suitable alternative to the reference product, and confirm that plasma concentrations of omeprazole and omeprazole dose do not predict drug pharmacodynamics in horses.
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Affiliation(s)
- Jessica C Wise
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Kristopher J Hughes
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Scott Edwards
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Glenn A Jacobson
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia
| | - Christian K Narkowicz
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia
| | - Sharanne L Raidal
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
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5
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Raidal S, Hughes K. Effect of a novel fermented soy product on gastric ulcer scores in horses. JOURNAL OF APPLIED ANIMAL NUTRITION 2020. [DOI: 10.3920/jaan2020.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- S.L. Raidal
- Charles Sturt University, School of Animal and Veterinary Sciences, Boorooma St, Wagga Wagga, NSW 2650, Australia
| | - K.J. Hughes
- Charles Sturt University, School of Animal and Veterinary Sciences, Boorooma St, Wagga Wagga, NSW 2650, Australia
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6
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Padalino B, Davis GL, Raidal SL. Effects of transportation on gastric pH and gastric ulceration in mares. J Vet Intern Med 2020; 34:922-932. [PMID: 32009244 PMCID: PMC7096603 DOI: 10.1111/jvim.15698] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 12/20/2019] [Indexed: 01/05/2023] Open
Abstract
Background Transportation has been suggested as a risk factor for gastric ulceration in horses, but limited evidence supports this assumption. Animals Twenty‐six Standardbred, Thoroughbred, and Warmblood mares from a university teaching herd. Methods Twelve mares were confined for 12 hours, overnight, in reproductive stocks with indwelling nasogastric tubes (NGTs) to assess pH of gastric fluid (GF). Gastric ulceration was assessed endoscopically before and after confinement. Subsequently, 26 horses were transported for 12 hours, overnight, in 2 consignments. During transportation, GF was aspirated from indwelling NGT placed in the same 12 mares used in the confinement study, and gastric ulceration was assessed endoscopically before and after transportation in all horses. Results The median pH of GF in confined horses was 1.70‐2.49 at each sampling point, and there was no apparent effect on gastric squamous ulcer scores. The median pH of GF from the same 12 horses at corresponding sampling times during transportation was 6.82‐7.22. Transportation was associated with increased gastric squamous ulcer scores, particularly in horses fasted for gastroscopy and NGT placement immediately before departure. Gastric emptying appeared delayed after transportation in horses fed before departure. Conclusions and Clinical Importance Transportation is associated with increased gastric squamous ulceration and with increased pH of GF. These findings may be a consequence of impaired gastric emptying and reflux of alkaline small intestinal content, with factors such as duodenal bile salts and short‐chain fatty acids mediating mucosal injury.
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Affiliation(s)
- Barbara Padalino
- Department of Agricultural and Food Sciences, Division of Animal Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Georgina L Davis
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Sharanne L Raidal
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
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7
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Bruniges N, Milner P, Bardell D. The use of multimodal analgesia in the management of suspected extremity compartment syndrome in the pelvic limb of a horse. EQUINE VET EDUC 2019. [DOI: 10.1111/eve.12797] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- N. Bruniges
- Institute of Veterinary Sciences University of Liverpool Leahurst Cheshire UK
| | - P. Milner
- Institute of Veterinary Sciences University of Liverpool Leahurst Cheshire UK
| | - D. Bardell
- Institute of Veterinary Sciences University of Liverpool Leahurst Cheshire UK
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8
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Alvarenga MA, Segabinazzi LG. Application of Misoprostol as a Treatment of Unexplained Infertility in Mares. J Equine Vet Sci 2018. [DOI: 10.1016/j.jevs.2018.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Camacho-Luna P, Buchanan B, Andrews FM. Advances in Diagnostics and Treatments in Horses and Foals with Gastric and Duodenal Ulcers. Vet Clin North Am Equine Pract 2018. [DOI: 10.1016/j.cveq.2017.11.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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10
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Scheidegger M, Gerber V, Bruckmaier R, van der Kolk J, Burger D, Ramseyer A. Increased adrenocortical response to adrenocorticotropic hormone (ACTH) in sport horses with equine glandular gastric disease (EGGD). Vet J 2017; 228:7-12. [DOI: 10.1016/j.tvjl.2017.09.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 08/17/2017] [Accepted: 09/07/2017] [Indexed: 01/15/2023]
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11
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Pennington MR, Cossic BGA, Perkins GA, Duffy C, Duhamel GE, Van de Walle GR. First demonstration of equid gammaherpesviruses within the gastric mucosal epithelium of horses. Virus Res 2017; 242:30-36. [PMID: 28870469 DOI: 10.1016/j.virusres.2017.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/31/2017] [Accepted: 09/01/2017] [Indexed: 12/25/2022]
Abstract
Horses commonly develop gastric mucosal ulcers, similar to humans, a condition known as equine gastric ulcer syndrome (EGUS) that can lead to poor performance and lost training time and care expenses. Unlike humans, however, an infectious bacterial cause of ulcers has not been conclusively identified. Herpesviruses, while well-established causative agents of diseases such as cold sores, genital lesions, and certain types of cancer, have also been implicated in the development of a subset of gastric ulcers in humans. The presence of equid herpesviruses in the gastrointestinal tract and their potential contribution to EGUS has not been evaluated. Here, we provide the first evidence of equid gammaherpesviruses 2 and 5 (EHV-2 and -5) within the epithelium of the gastric mucosa of horses. These viruses were initially detected by a nested PCR screen of gastric tissue samples obtained from client- and university-owned horses with and without ulcers; however, no association with EGUS was found in this limited sample set. We then validated a highly sensitive in situ hybridization (ISH) assay and used this assay to characterize the distribution of these viruses in necropsy gastric tissue samples from five racehorses. Analyses revealed frequent EHV-2 and EHV-5 co-infections within the gastric mucosal epithelium, regardless of the ulcer status. These results are the first to demonstrate the presence of equid gammaherpesviruses in the gastric mucosa of horses and warrants further investigation to determine the contribution of these viruses to the development of EGUS and/or other gastrointestinal diseases.
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Affiliation(s)
- Matthew R Pennington
- Baker Institute for Animal Health, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Brieuc G A Cossic
- Department of Biomedical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Gillian A Perkins
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Carol Duffy
- Department of Biological Sciences, College of Arts and Sciences, University of Alabama, Tuscaloosa, AL, USA
| | - Gerald E Duhamel
- Department of Biomedical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Gerlinde R Van de Walle
- Baker Institute for Animal Health, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA.
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12
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Bush J, van den Boom R, Franklin S. Comparison of aloe vera and omeprazole in the treatment of equine gastric ulcer syndrome. Equine Vet J 2017; 50:34-40. [DOI: 10.1111/evj.12706] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 05/16/2017] [Indexed: 11/30/2022]
Affiliation(s)
- J. Bush
- School of Animal and Veterinary Science; Adelaide South Australia Australia
| | - R. van den Boom
- School of Animal and Veterinary Science; Adelaide South Australia Australia
| | - S. Franklin
- School of Animal and Veterinary Science; Adelaide South Australia Australia
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13
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Zavoshti FR, Andrews FM. Therapeutics for Equine Gastric Ulcer Syndrome. Vet Clin North Am Equine Pract 2017; 33:141-162. [PMID: 28325176 DOI: 10.1016/j.cveq.2016.11.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
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.
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Affiliation(s)
| | - Frank M Andrews
- Equine Health Studies Program, Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Skip Bertman Drive, LA 70803, USA.
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14
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Sgorbini M, Bonelli F, Papini R, Busechian S, Briganti A, Laus F, Faillace V, Zappulla F, Rizk A, Rueca F. Equine gastric ulcer syndrome in adult donkeys: Investigation on prevalence, anatomical distribution, and severity. EQUINE VET EDUC 2017. [DOI: 10.1111/eve.12747] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- M. Sgorbini
- Department of Veterinary Sciences; Veterinary Teaching Hospital “Mario Modenato”; University of Pisa; Pisa Italy
| | - F. Bonelli
- Department of Veterinary Sciences; Veterinary Teaching Hospital “Mario Modenato”; University of Pisa; Pisa Italy
| | - R. Papini
- Department of Veterinary Sciences; University of Pisa; Pisa Italy
| | - S. Busechian
- Department of Clinical Sciences; University of Perugia; Perugia Italy
| | - A. Briganti
- Department of Veterinary Sciences; Veterinary Teaching Hospital “Mario Modenato”; University of Pisa; Pisa Italy
| | - F. Laus
- School of Biosciences and Veterinary Medicine; University of Camerino; Matelica Macerata Italy
| | - V. Faillace
- School of Biosciences and Veterinary Medicine; University of Camerino; Matelica Macerata Italy
| | - F. Zappulla
- Department of Clinical Sciences; University of Perugia; Perugia Italy
| | - A. Rizk
- Department of Surgery, Anesthesiology and Radiology; Faculty of Veterinary Medicine; Mansoura University; Mansoura Egypt
| | - F. Rueca
- Department of Clinical Sciences; University of Perugia; Perugia Italy
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15
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Bonelli F, Busechian S, Meucci V, Caporrino G, Briganti A, Rueca F, Zappulla F, Ferini E, Ghiandai L, Sgorbini M. pHyloGASTRO in the Treatment of Equine Gastric Ulcer Lesions. J Equine Vet Sci 2016. [DOI: 10.1016/j.jevs.2016.06.069] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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16
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Affiliation(s)
- F. M. Andrews
- Equine Health Studies Program; Department of Veterinary Clinical Sciences; School of Veterinary Medicine; Louisiana State University; Baton Rouge USA
| | - C. Larson
- Zinpro Corporation; Eden Prairie Minnesota USA
| | - P. Harris
- WALTHAM Centre for Pet Nutrition; Waltham-on-the-Wolds; Leicestershire UK
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