The enigma of post operative recurrent colic: Challenges with diagnosis and management

Recurrent Colic: Diagnosis, Management, and Expectations

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.

Equine colic: clinical epidemiology and associated risk factors in and around Debre Zeit

A prospective study was conducted to describe clinical epidemiology of equine colic in the Society for Protection of Animal Abroad and Donkey Sanctuary Project Clinic, at Debre Zeit, Ethiopia, from November 2014 to April 2015. The objectives were to describe clinical epidemiology of equine colic, to characterize the main types of equine colic, and to determine the major risk factors associated with equine colic. The method which was used in the study was attending clinical case of equine and assessing physiological parameters, fecal egg count, abdominal sounds, and rectal examination as well as questioner interviewing of the owners. The data were collected and analyzed using Statistical Package for Social Science. The incidence of colic was 10.3% in the study period. Colicky were typed as unknown, flatulent, impaction, spasmodic, and enterolithiasis. The proportion of case incidence were 63.1 (41/65), 33.8 (22/65), and 3.1% (2/65), in donkey, horse, and mule, respectively. The total mean (±SD) of temperature 37.80 ± 1.003, heart rate 57.54 ± 10.098, fecal egg count 236.922 ± 67.990, respiratory rate 30.92 ± 7.315, and packed cell volume 41.40 ± 10.221 were recorded. The case fatality rate of equine colic was 15.38% (10/65). There were statistically highly significant (p < 0.01) differences in impaction colic in relation to species. Interview with 183 equine owners revealed incidence of equine colic as the sixth major disease condition affecting equine. A long-term epidemiological study of the true representative population should be carried out to determine the incidence rate and associated risk factors of equine colic in the study area.

Management and horse-level risk factors for recurrent colic in the UK general equine practice population

REASONS FOR PERFORMING STUDY

Recurrent colic occurs frequently in the general horse population but little evidence exists about what factors place horses at greater risk of recurrent colic.

OBJECTIVES

To quantify time-varying and non time-varying risk factors for recurrent colic among horses attended by first-opinion veterinary surgeons in northwest England.

STUDY DESIGN

Nested case-control study.

METHODS

A nested case-control study was conducted on data from a prospective longitudinal cohort study of 127 horses recruited subsequent to an episode of medical colic. Data were collected on management and recurrent colic episodes at 4-monthly intervals by telephone questionnaires. All recurrent colic episodes were selected as cases; controls were unmatched and randomly selected from all horse-time at risk. Data relating to the 30 days prior to the date of colic or control selection were used to determine exposure status. Multivariable logistic regression analyses were used to determine risk factors for recurrent colic.

RESULTS

In total, 59 cases and 177 controls were included. The final model showed that horses that displayed crib-biting/windsucking (odds ratio [OR] 10.1, 95% confidence interval [CI] 2.5-41.0) or weaving behaviour (OR 3.9, 95% CI 1.5-10.1) had an increased risk of recurrence of colic. Increasing time at pasture reduced the risk of recurrence (OR 0.99, 95% CI 0.99-1.0). A significant interaction was found suggesting that the risk associated with crib-biting/windsucking may be modified by feeding fruit/vegetables; however, further research is required before recommendations for feeding practices can be made.

CONCLUSIONS

This study suggests that sufficient access to pasture may be an important means of reducing recurrent colic risk. The behavioural risk factors highlight individuals who may be at increased risk of recurrent colic and whose colic prevention strategies should be carefully managed.

Recurrent colic in the horse: incidence and risk factors for recurrence in the general practice population

REASONS FOR PERFORMING STUDY

The frequency of recurrent colic in the UK equine general practice population is previously unreported. Elucidating risk factors for recurrent colic could provide a basis for clinical decision making and interventions.

OBJECTIVES

To determine the incidence rate of and risk factors for recurrent colic.

HYPOTHESES

Horse management, prophylactic health care and innate behaviour contribute to the risk of recurrent colic.

METHODS

A cohort of 127 horses was enrolled at the point of a veterinary-diagnosed medical colic episode. Participating owners completed a baseline and 3 follow-up telephone questionnaires over one year. Clinical details of each colic episode were collected with data on management, behaviour and preventive healthcare. Incidence was calculated using time at risk data; non-time varying covariates were assessed for association with recurrent colic using multivariable logistic regression.

RESULTS

The recurrence rate was 50 colic events/100 horse years at risk (HYAR). Including only veterinary attended recurrent colic episodes the incidence was 35 colic events per 100 HYAR. A multivariable logistic regression model was built to explore non-time varying risk factors for recurrence collected from baseline data. The model showed that horses that have a known dental problem (OR 5.5, 95% CI 1.3, 23.1) or crib-bite/windsuck (OR 12.1, 95% CI 1.4, 108.1) were at increased risk of recurrence during the year following a colic event.

CONCLUSIONS AND POTENTIAL RELEVANCE

The incidence of recurrence in horses following a medical episode of colic is high in this population and represents a welfare concern. The incidence rate can be used to compare intervention efficacy in similar populations. Identified risk factors could provide the basis for management interventions or highlight at risk individuals.