Prevalence of gastric and duodenal ulceration in 691 nonsurviving foals (1995-2006)

Macroscopic and histopathological description of gastric lesions in horse, donkey, and mule fetuses in the last trimester of gestation

BACKGROUND

Limited information is available on gastric diseases in neonatal foals as compared with extensive studies in young, adult, and geriatric horses. Reports on fetuses are scarce.

OBJECTIVES

Assess at necropsy stomachs of horse, donkey and mule fetuses in the third trimester of gestation to characterize lesions present during intrauterine life.

ANIMALS

Forty-six fetal stomachs from both sexes (21 horses, 21 donkeys, and 4 mules) in the third trimester of gestation were collected from a processing plant immediately after slaughter.

METHODS

Measurements of longitudinal and transverse axes, weight and volume and gastric fluid pH were taken, and glandular and squamous mucosae were inspected. All findings of the gastric mucosa and measurements of the stomachs were presented descriptively. Groups were compared statistically, with significance level set at P < .05 for all evaluations.

RESULTS

All gastric contents had pH >5.8, and mules had larger stomachs and higher weights compared with horses (P < .05). Macroscopic lesions were classified as hyperemic, punctate, and erosive. Histopathologically, lesions were consistent with a chronic inflammatory process.

CONCLUSIONS AND CLINICAL IMPORTANCE

Our study provides evidence of macroscopic and histopathological lesions in the gastric mucosae of equid fetuses in the last trimester of gestation. Relevant information for perinatology and neonatology is provided regarding the prevalence and classification of preulcerous lesions in equids before birth.

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.

Equine Squamous Gastric Disease: Prevalence, Impact and Management

This narrative review explores the etiopathogenesis, clinical signs, diagnosis and treatment of ESGD (equine squamous gastric disease) and discusses the impact of this commonly encountered condition on the equine industry. ESGD refers specifically to peptic injury of the squamous mucosa of the stomach. Prevalence is highest in performance horses, but the disease has been documented across many breeds and ages, including in feral horses and foals. The pathogenesis of ESGD is well understood. Intensive management and exercise are important factors that contribute to a disruption of the normal stratification of gastric pH. This results in exposure of the vulnerable squamous mucosa to acid, leading to ulceration. Clinical signs are variable and there is little evidence to support a direct association between reported signs and the presence or absence of lesions seen on gastroscopy. Management is aimed at acid suppression and mitigation of known risk factors.

Intragastric pH of foals admitted to the intensive care unit

Background

Intragastric pH profiles of neonatal foals admitted to the intensive care unit (ICU) remain poorly characterized.

Hypothesis/Objectives

To determine intragastric pH profiles and clinical parameters associated with intragastric pH in foals admitted to the ICU.

Animals

Forty‐two neonatal foals admitted to the ICU and requiring placement of an indwelling nasogastric tube for nutritional management were included.

Methods

Intragastric pH was measured for 24 hours from the time of admission. Mean pH, % time pH <4, and % time pH >4 were determined for each foal. History, clinical findings, and clinicopathological data recorded at the time of presentation were collected.

Results

The mean pH of included foals was 5.5 ± 1.8. The median % time pH <4 was 6.3% (range: 0‐99). A history of placentitis was associated with greater mean pH (median 5.3 (range: 0.9‐7.8) versus median 7.2 (5.9‐11.3); P = .002) and less % time pH <4 (median 13 (0‐99.6) versus median 0.1 (0‐7.2); P = .01). Foals with diarrhea had a greater % time pH <4 (median 4.6% (0‐99) versus median 28.8% (1.4‐57.48); P = .02). Foals with a pH >4 for >50% recording time had a lower PaO₂ (mean difference 25.0 mm Hg; 95% confidence interval [CI], 14.4‐35.6; P = .03) and higher PaCO₂ (mean difference 14.9 mm Hg; 95% CI, 4.7‐25.2; P = .02). Surviving foals had a lower mean median hourly pH (P = .02).

Conclusions and Clinical Importance

Intragastric pH profiles were unpredictable and mostly >4 for >80% of the recording time. This study does not support the indiscriminate administration of acid suppressive treatment.

Growth Rates of Thoroughbred Foals and In Vitro Gut Health Parameters When Fed a Cereal or an All-Fiber Creep Feed

Traditions and the economic advantage when producing big athletic Thoroughbred (TB) yearlings for sale encourage owners to feed high levels of cereals. Such diets can predispose gastric ulceration and developmental orthopedic diseases, impacting negatively on future careers. This study aimed to (1) determine if an all-fiber creep feed (total mixed fiber ration [TMFR] would sustain equal growth rates in TB foals versus a cereal-based stud cube (SC) and (2) compare pH and lactate produced by SC and TMFR in in vitro foregut and hindgut conditions. Eight TB foals in matched-pairs were fed SC or TMFR for 18 weeks. Weight gain (average daily gain [ADG]), height at wither and hip, heart girth, and body length were recorded weekly. Similar growth rates were recorded for all measurements. The ADG of TMFR and SC were 1 and 1.1 kg per head per day, respectively. In vitro foregut incubation of SC and TMFR at 37°C in pepsin HCl solution for 6 hours produced higher pH 5.84 (TMFR) compared with 5.33 (SC) (P < .05). Gas production measured fermentation rate, acidity, and lactate from TMFR and SC, incubated with fecal inoculum from the foals on the same diet. Fermentation rates and lag times were equal for both feeds; total gas produced at t50 and y50 were greater (P < .05) for SC. Lactate and pH levels were lower and higher, respectively, for the TMFR. This study showed that similar growth in TB foals was achieved on the TMFR feed and that potentially better gut health, denoted by higher pH and lower lactate levels, could be maintained by fiber compared with cereal feed.

Diagnostic accuracy of blood sucrose as a screening test for equine gastric ulcer syndrome (EGUS) in weanling foals

Background

Equine gastric ulcer syndrome is an important cause of morbidity in weanling foals. Many foals are asymptomatic, and the development of an inexpensive screening test to ensure an early diagnosis is desirable. The objective of this study was to determine the diagnostic accuracy of blood sucrose for diagnosis of EGUS in weanling foals.

Results

45 foals were studied 7 days before and 14 days after weaning. The diagnostic accuracy of blood sucrose for diagnosis of gastric lesions (GL); glandular lesions (GDL); squamous lesions (SQL) and clinically significant gastric lesions (CSL) at 45 and 90 min after administration of 1 g/kg of sucrose via nasogastric intubation was assessed using ROC curves and calculating the AUC. For each lesion type, sucrose concentration in blood was compared to gastroscopy; and sensitivities (Se) and specificities (Sp) were calculated across a range of sucrose concentrations. Cut-off values were selected manually to optimize Se. Because of concerns over the validity of the gold standard, additional Se, Sp, and lesion prevalence data were subsequently estimated and compared using Bayesian latent class analysis. Using the frequentist approach, the prevalence of GL; GDL; SQL and CSL before weaning was 21; 9; 7 and 8% respectively; and increased to 98; 59; 97 and 82% respectively after weaning. At the selected cut-off, Se ranged from 84 to 95% and Sp ranged from 47 to 71%, depending upon the lesion type and time of sampling. In comparison, estimates of Se and Sp were consistently higher when using a Bayesian approach, with Se ranging from 81 to 97%; and Sp ranging from 77 to 97%, depending upon the lesion type and time of sampling.

Conclusions

Blood sucrose is a sensitive test for detecting EGUS in weanling foals. Due to its poor specificity, it is not expected that the sucrose blood test will replace gastroscopy, however it may represent a clinically useful screening test to identify foals that may benefit from gastroscopy. Bayesian latent class analysis represents an alternative method to evaluate the diagnostic accuracy of the blood sucrose test in an attempt to avoid bias associated with the assumption that gastroscopy is a perfect test.

A review of equine sepsis

Sepsis is defined as an exaggerated, systemic inflammatory response to infection and is a common condition in horses. Systemic inflammatory response syndrome (SIRS) associated with bacterial infection is a hallmark of sepsis. Sepsis in neonatal foals is a common sequela of failure of passive transfer and, in addition to development of SIRS, may be characterised by bacteraemia, pneumonia, enterocolitis, omphalophlebitis, meningoencephalitis or arthritis. Sepsis in mature horses is most commonly observed secondary to gastrointestinal lesions that result in disrupted mucosa and bacterial translocation into circulation (endotoxaemia). Pleuropneumonia and metritis may also cause sepsis in mature horses. Diagnosis of sepsis is based on SIRS criteria as well as suspected or confirmed infection. Due to the relatively low sensitivity of microbial culture and the subjectivity of sepsis scoring, many sepsis biomarkers are being studied for their usefulness in diagnosis and prognostication of sepsis in horses. Treatment of sepsis requires an intensive care approach that includes antimicrobial drug administration, fluid resuscitation and pressure support, and treatment for inflammation, endotoxaemia and coagulopathy. Early recognition of sepsis and prompt antimicrobial drug treatment are critical for a successful outcome. Multiple organ dysfunction syndrome may occur in severe cases of sepsis, with common manifestations including laminitis and coagulopathies. Although prognosis for septic mature horses depends highly on the primary disease process, the overall survival rate in septic neonatal foals ranges from 26 to 86%, with most studies indicating a survival rate of 45-60%.

Development and validation of a gas chromatography-flame ionization detection method for quantifying sucrose in equine serum

A simple and accurate method for quantifying sucrose in equine serum that can be applied to sucrose permeability testing in the horse was developed and validated using gas chromatography with flame ionization detection. The assay provided an acceptable degree of linearity, accuracy, and precision at concentrations of sucrose as low as 2.34 μmol/l and as high as 20.45 μmol/l. Percentage recovery of sucrose from serum ranged from 89% to 102%; repeatability and intermediate precision (relative standard deviation) ranged from 3.6% to 6.7% and 4.1% to 9.3%, respectively. The limit of detection was 0.73 μmol/l. No interfering peaks were observed except lactose, which gave 2 peaks, one of which overlapped partially with sucrose. To evaluate the suitability of the method for quantifying sucrose in serum samples from horses with naturally occurring gastric ulceration, 10 horses with and without naturally occurring gastric ulceration were subjected to sucrose permeability testing. All horses demonstrated an increase in serum sucrose concentration over time following oral administration of sucrose; however, the increase from baseline was significant for horses with gastric ulceration at 45 min (P = 0.0082) and 90 min (P = 0.0082) when compared with healthy horses. It was concluded that gas chromatography with flame ionization detection is a valid method for quantifying sucrose in equine serum and can be applied directly to the analysis of sucrose in equine serum as part of a larger validation study aimed at developing a blood test for the diagnosis of gastric ulcers in horses.