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.

Diagnostic and Clinical Course of Small Colon Recurrent Impaction Associated with Severe Myenteric Ganglionopathy in A Mare

A 10-year-old Koninklijk Warmbloed Paardenstamboek Nederland (KWPN, Netherlands-based organization for registration of the Dutch Warmblood horses) mare was evaluated three times over four months because of recurrent colic. At every referral, a physical examination revealed a small colon impaction, which partially responded to food deprivation and oral administration of water and magnesium sulphate. Due to the recurrent nature of the small colon impaction, several differential diagnoses were considered: inflammatory bowel disease (IBD), chronic salmonellosis and myenteric ganglionopathies. At first admission, an exploratory laparotomy was proposed, but the owner declined. On the second hospitalisation, the mare underwent a standing exploratory laparoscopy, but no abnormality related to the small colon was detected and resolved with a soap-based enema. At the third hospitalisation, the owner agreed to the exploratory laparotomy, which allowed surgical biopsies of the caecum and the large and small colon. Lymphomonocytic enteritis and mild myenteric ganglionitis were diagnosed. After laparotomy, the mare regularly fed and defecated, but a few days later, tachycardia, fever and abundant gastric reflux occurred. As the clinical condition rapidly deteriorated, the owner elected for euthanasia. A post-mortem histological examination showed severe chronic lymphocytic enterocolitis and typhlitis associated with the marked depletion of myenteric ganglion bodies. Small colon impaction is a very common disorder of the small colon in horses. In the presence of myenteric ganglionopathies, this case proposes the controversial matter of primary or secondary disorders of enteric neuromuscular function as the base of repeated small colon impactions of the horse. In this mare, recurrent small colon impaction was considered secondary to severe myenteric ganglionopathy associated with chronic intestinal pseudo-obstruction.

Effects of a nutraceutical supplement on gastrointestinal health in racing standardbreds

BACKGROUND

Feed additives that accelerate gastrointestinal transit time may help support normal gastrointestinal function in horses at risk for impaction colic. Previous research has demonstrated significant stimulatory effect of a hemp-based nutraceutical product (Gs Formula; GF) on contractility of gastric smooth muscle and gastrin production in vitro.

OBJECTIVES

To quantify effects of GF on indicators of GIT transit time and tight junction proteins.

STUDY DESIGN

Randomized placebo-controlled cross-over study.

METHODS

Eight Standardbreds were administered 200 plastic beads by nasogastric tube before (baseline; BL) and after receiving a diet containing GF (CON: 0 g/day, LO: 160 g/day or HI: 480 g/day) for 28 days. Total manure collection occurred every 2 hours for 72 hours after bead administration. Outcome measures included GIT transit time, faecal dry matter (DM), water intake, and complete biochemistry and haematology screens.

RESULTS

There was no effect of GF on GIT transit time. Faecal output was significantly lower in LO and HI horses than CON horses after 28 days on the supplement. HI horses have significantly lower rouleaux formation and lower faecal DM on Day 28 compared with BL. GF also produced changes in electrolytes associated with pH balance, which may indicate a role for GF as an alkalinizing compound in exercising horses. Clinical pathology results support the safety of GF up to 480 g/day for 28 days with no adverse effects being observed in haematology or biochemistry results.

MAIN LIMITATIONS

Future studies on GF should focus on evaluating effect of GF on gastrointestinal transit in horses with naturally or experimentally delayed gastrointestinal motility, and its effect on exercise performance and onset of fatigue.

CONCLUSIONS

GF may help support normal gastrointestinal function in horses at risk for impaction colic by reducing faecal DM and rouleaux formation.

Clinical and intestinal histologic features of horses treated for recurrent colic: 66 cases (2006-2015)

OBJECTIVE To describe gastrointestinal histologic findings for horses with recurrent colic and evaluate possible associations between initial clinical signs, biopsy method, histologic diagnosis, and outcome 1 year after hospital discharge. DESIGN Retrospective case series. ANIMALS 66 horses with a history of recurrent colic for which gastrointestinal specimens had been submitted for histologic examination. PROCEDURES Histologic diagnosis was categorized as inflammatory, neoplastic, ischemic, other, and undiagnosed. Relationships among initial clinical features, biopsy method, histologic diagnosis, and outcome 1 year after hospital discharge (ie, alive vs dead and persistent recurrent colic [yes vs no]) and between corticosteroid treatment and outcome were investigated. Odds ratios and hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated. RESULTS Inflammatory disease (36/66 [55%]) was the most common histologic diagnosis. Horses undergoing rectal biopsy alone were significantly (OR, 14.4; 95% Cl, 2.7 to 76.1) more likely to not have a histologic diagnosis than were horses in which other biopsy methods were used. In multivariable modelling, persistence of recurrent colic (HR, 15.2; 95% Cl, 1.9 to 121.2) and a history of weight loss (HR, 4.9; 95% Cl, 1.4 to 16.5) were significantly associated with outcome (alive vs dead) 1 year after surgery. Corticosteroid treatment was not significantly associated with either outcome. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that a high proportion (36/66 [55%]) of horses with recurrent colic had inflammatory gastrointestinal disease. Use of rectal biopsy alone to obtain biopsy specimens was more likely to result in no histologic diagnosis. Use of corticosteroids in horses with inflammatory gastrointestinal disease was not associated with outcome but warrants further investigation.

Myenteric ganglionitis and intestinal leiomyositis in a Jack Russell terrier

A 9-year, 6-month old spayed female Jack Russell terrier presented with a 3-week history of intermittent vomiting, diarrhoea and weight loss. Serum biochemistry demonstrated severe panhypoproteinaemia, mild hypocalcaemia and mild hypocholesterolaemia, consistent with protein-losing enteropathy. Full-thickness biopsies obtained from the stomach and different sections of small intestine demonstrated histological features of both myenteric ganglionitis and early intestinal leiomyositis. Complete resolution of clinical signs occurred within 1 week of implementing immunosuppressive therapy. At the time of writing, 9 months following diagnosis, the dog remains in remission.

Idiopathic Fibrosis of the Tunica Muscularis of the Large Intestine in Five Horses with Colic

Histological evidence of fibrosis affecting the outer layer of the large intestinal tunica muscularis was identified in five of 32 horses affected by colic. In three cases, foci of pale eosinophilia and vacuolation of myocytes were observed. These findings are suggestive of a degenerative and fibrotic abnormality in the outer layer of the tunica muscularis of the large intestinal smooth muscle of some horses with colic.