Failure of psyllium mucilloid to hasten evaluation of sand from the equine large intestine

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.

Colic Prevention to Avoid Colic Surgery: A Surgeon's Perspective

Management factors associated with colic, particularly related to stall confinement and nutrition, have been linked to alterations in gastrointestinal mucosal transport, motility, and microbiome, which in turn creates conditions that induce colic. In particular, meal feeding creates large changes in water movement in and out of the colon and alters the microbiome. These conditions may in turn result in colic conditions such as large colon impaction or large colon volvulus. In addition, a range of management and nutritional factors have been found to place horses at risk of select colic conditions such as ileal impaction. Other specific colic conditions, such as strangulating lipomas, may be related to fat metabolism in geldings and ponies, although the association with nutrition and the endocrine system are less well defined. It has long been understood that parasites are associated with colic, and with the advent of highly effective anthelmintics, parasite-induced colic has been markedly reduced. Nonetheless, equine mangers and veterinarians have to be aware of changes in parasite resistance or patterns of activity, such as the resurgence of large strongyles with surveillance-based management of parasites. Overall, understanding management risk factors can lead to recommendations that prevent colic in horses. Additional study of these factors may ultimately lead to reductions in the prevalence of colic by suggesting optimal management practices.

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.

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.

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

Prospective studies documenting the efficacy and side effects of medical treatment for colonic sand accumulation in horses are limited. The purpose of the study was to compare the effect of enteral administration of magnesium sulphate (MgSO4), psyllium mucilloid (psyllium), and a combination of MgSO4 and psyllium on the evacuation of large accumulations of sand in the large colon of adult horses. Thirty-four horses with naturally acquired, large sand accumulations (>5 cm × 15 cm) identified on abdominal radiography were randomly allocated to one of three treatment groups: (1) 1 g/kg psyllium (n = 12); (2) 1 g/kg MgSO4 (n = 10), or (3) their combination (n = 12). Treatments were administered once a day via nasogastric intubation and continued for a total of 4 days. Lateral radiographs of the ventral abdomen were repeated on day 4 of treatment. If the area of sand in the radiographic image was <25 cm(2) on day 4, the sand accumulation was considered resolved. Of 12 horses treated with a combination of psyllium and MgSO4, nine evacuated the sand from the ventral colon within 4 days. In comparison, only 3/12 horses treated with psyllium and 2/10 horses treated with MgSO4 resolved (both significantly different from the combination; P <0.05). Large accumulations of sand in the large colon of horses can be treated medically. Administering a combination of psyllium and MgSO4 via nasogastric intubation once daily for a total of 4 days was a more effective treatment than either constituent alone.

A review of foal diarrhoea from birth to weaning

Diarrhoea is among the most common clinical complaints in foals. Aetiologies, diagnostic testing and recommended interventions for specific causes of enterocolitis are summarised. Many mild to moderately affected foals can be managed in an ambulatory setting, while others will benefit from more intensive care at a referral centre.

Objective radiographic assessment of abdominal sand accumulation in horses

Gastrointestinal sand accumulation is a common cause of equine colic. Subjective assessment of sand accumulation on abdominal radiographs has been used as a diagnostic aid; however, there is poor correlation between clinical, diagnostic, and surgical findings. The purpose of this study was to develop an objective method of assessing radiographic sand accumulation in order to improve the diagnostic utility of radiography for sand colic. Fifty-one equine abdominal radiographic examinations were reviewed, with approximately half of the imaged patients having a clinical diagnosis of sand colic. Initially, four observers independently reviewed these radiographic studies to subjectively decide whether or not sand accumulation was sufficient to cause colic. Subsequently, an objective scoring system was developed using various radiographic parameters that yielded a score ranging from one to 12 for quantity and apparent density of sand accumulation. Inter- and intraobserver results using the subjective scoring method had significant differences among all observers. Subjective assessment was also deemed to be inaccurate for colic prediction. Using the objective scoring system, there were no significant differences between or within the observers' results. A score of seven out of 12 was found to have an 83% likelihood of being associated with a positive diagnosis of sand colic. The designed objective scoring method creates a more uniform and accurate method to assess the sand accumulation.

Epidemiological clues to preventing colic

Colic remains a significant problem in the horse in terms of welfare and economics; in some equine populations it is the single most common cause of death. Many causes of colic are cited in the equestrian and veterinary literature but little scientific evidence exists to substantiate these theories. Recent epidemiological investigations have confirmed that colic is complex and multi-factorial in nature. Studies have identified a number of factors that are associated with increased risk of colic including parasite burden, certain feed types, recent change in feeding practices, stabling, lack of access to pasture and water, increasing exercise and transport. These findings are reviewed together with examples of management practices that may be altered to reduce the incidence of specific types of colic. This is an opinionated, not a systematic, review focusing on those areas that are considered most relevant to the practitioner.

Risk factors for faecal sand excretion in Icelandic horses

REASONS FOR PERFORMING STUDY

Sandy soil is often mentioned as a risk factor in the development of sand-related gastrointestinal disease (SGID) in the horse. There are other variables, but few studies confirm any of these.

OBJECTIVE

To investigate soil type, pasture quality, feeding practice in the paddock, age, sex and body condition score as risk factors for sand intake in the horse.

METHODS

Faeces were collected from 211 Icelandic horses on 19 different studs in Denmark together with soil samples and other potential risk factors. Sand content in faeces determined by a sand sedimentation test was interpreted as evidence of sand intake. Soil types were identified by soil analysis and significance of the data was tested using logistic analysis.

RESULTS

Of horses included in the study, 56.4% showed sand in the faeces and 5.7% had more than 5 mm sand as quantified by the rectal sleeve sedimentation test. Soil type had no significant effect when tested as main effect, but there was interaction between soil type and pasture quality. Significant interactions were also found between paddock feeding practice and pasture quality.

CONCLUSION

To evaluate the risk of sand intake it is important to consider 3 variables: soil type, pasture quality and feeding practice. Pasture quality was identified as a risk factor of both short and long grass in combination with sandy soil, while clay soil had the lowest risk in these combinations. Feeding practice in the paddock revealed feeding directly on the ground to be a risk factor when there was short (1-5 cm) or no grass. Also, no feeding outdoors increased the risk on pastures with short grass, while this had no effect in paddocks with no grass. More than 50% of all horses investigated in this study had sand in the faeces.

POTENTIAL RELEVANCE

The identification of risk factors is an important step towards prevention of SGID. Further research is necessary to determine why some horses exhibit more than 5 mm sand in the sedimentation test and whether this is correlated with geophagic behaviour.

Gastrointestinal protectants and cathartics

The purpose of this article is to provide the reader with an overview of gastrointestinal cathartics and protectants and to point out possible applications for use in the horse with gastrointestinal disease. Most of the treatments described in this article have been used by the authors with apparent success; however, controlled studies with subsequent publication in the scientific literature with respect to these treatments in the horse are, for the most part, lacking. The authors view this emerging field of treatment as exciting and look forward to substantiating the efficacy of several of the treatments discussed.

Abdominal radiography in monitoring the resolution of sand accumulations from the large colon of horses treated medically

This retrospective study consisted of 14 horses (age 6 weeks-12 years) with radiographically evident sand accumulations cranioventrally in the abdomen and clinical signs suggestive of sand enteropathy. The horses were treated medically and resolution of sand was monitored radiographically. Routine treatment consisted of psyllium mucilloid, combined with magnesium sulphate and/or mineral oilif needed. Initially, the number, size and shape of the sand accumulations showed large variation and the response to therapy was not predictable based on the initial appearance of the accumulation. In 2 foals, some of the sand was passed and the rest was mixed with other intestinal contents within 2-4 days. Even large accumulations disappeared in 2-4 days with psyllium alone or combined with mineral oil in 4 horses. In another 4 horses, the size of the accumulations decreased but varying amounts remained approximately at the same site, despite treatment for 1-4 weeks, and all these horses also had either gastric or large colon impaction. Three horses had a limited response to psyllium treatment, but the accumulation resolved with repeated doses of magnesium sulphate, with or without mineral oil. One horse did not respond to prolonged laxative treatment but the accumulation resolved on pasture. Clinical improvement was not necessarily related to the resolution of sand. Radiography of the cranioventral abdomen was found to be a useful means for monitoring the resolution of sand and confirming the effect of medical treatment in removing sand from the large colon in the horse.

Gastrointestinal pharmacology

Diseases of the gastrointestinal tract that require pharmacologic management, usually in combination with other treatments, are gastric ulcers (omeprazole and others), colic (laxatives, analgesics), diarrhea (antibiotics, protectants and absorbents, glucocorticoids, motility inhibitors), reperfusion injury, postoperative ileus (prokinetic drugs), and adhesions. There is growing evidence that nonsteroidal anti-inflammatory drugs can alter important physiologic properties of the intestine; however, these drugs are valuable analgesics for horses and their use should be tempered with an awareness of their harmful effects. The role of antibiotics in treating gastrointestinal disease is controversial, but their ability to induce life-threatening diarrhea is well known and invites caution and defensible use of these drugs in horses.