Characterization of gastrointestinal inflammatory cell type in equine glandular gastric disease.

OBJECTIVE: To compare small intestinal inflammation with gastric inflammation in horses with and without equine gastric glandular disease (EGGD), we evaluated endoscopic, macroscopic, and microscopic findings of the glandular stomach and microscopic findings of the small intestine. ANIMALS: 36 horses. METHODS: Horses underwent endoscopy and were scored for EGGD. After euthanasia, stomachs were collected and macroscopically evaluated. Normal pyloric mucosa, glandular lesions, and small intestinal (duodenum, mid-jejunum, and ileum) samples were collected and processed for microscopic examination. Cellular infiltrate was scored. Immunohistochemistry (CD3, CD20, and Iba-1) was performed on the ventral pylorus and small intestine of horses with mild to moderate lymphoplasmacytic infiltrate. A Spearman's correlation coefficient was used to evaluate the relationship of EGGD grade with gastric glandular inflammation, and the relationships of cellular infiltrate type and severity among glandular stomach, duodenum, jejunum, and ileum. RESULTS: Gastrointestinal inflammation was common, with gastric inflammatory infiltrate identified in 92%, duodenal inflammatory infiltrate in 83%, jejunal inflammatory infiltrate in 92%, and ileal inflammatory infiltrate in 92% of horses. Endoscopic evidence of gastric disease (hyperemia or EGGD grade ≥ 2/4) was not associated with the presence or severity of duodenal, jejunal, or ileal inflammation. Gastric lymphoplasmacytic inflammation grade ≥ 2 was associated with duodenal lymphoplasmacytic inflammation grade ≥ 2. This was a convenience sample of horses presenting for euthanasia. Medical history (including deworming history) was unknown. CLINICAL RELEVANCE: Gastric lymphoplasmacytic inflammation is associated with duodenal lymphoplasmacytic inflammation but not more distal small intestinal inflammation. Intestinal inflammation is not associated with endoscopic findings (hyperemia or EGGD grade ≥ 2/4).

Effect of a blend of magnesium oxide on Equine Squamous Gastric Disease in young trotter horses under training.

BACKGROUND: Equine squamous gastric disease (ESGD), as part of the equine gastric ulcer syndrome (EGUS), are common in racing horses. The use of buffering feed supplements to treat and/or prevent gastric ulcers is an option to control this condition. OBJECTIVE: The purpose of this study was to evaluate the effect of a 30-day supplementation with a blend of magnesium oxide (MgO) on ESGD scores in trotters under training. METHODS: Forty-two young trotters were submitted to a gastroscopic evaluation to assess their ESGD score and were randomly assigned in a group supplemented with MgO or in a control group. After 30 days, a second evaluation by gastroscopy was performed. The effect of the MgO supplementation was assessed by comparing the evolution of the ESGD score in supplemented and control groups between day 0 and day 30. RESULTS: The results confirm the high prevalence of EGUS in young Trotters. The supplementation significantly decreased the ESGD scoring in the supplemented group whereas the control group remain unchanged. CONCLUSION: The oral MgO supplementation was efficient to control ESGD in the population studied.

Effect of diet composition on glandular gastric disease in horses.

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.

Diagnosing gastric ulcers in bottlenose dolphins (Tursiops sp.) using gastroscopy and cytology.

Gastric ulcers have been reported in a range of cetacean species. Bottlenose dolphins (Tursiops spp.), the most common cetacean species held in captivity, are known to experience gastric ulcers in both wild and captive environments. Documented causes of gastric ulceration include bacterial infection by Helicobacter sp., parasitic infections, high dietary histamine and foreign body ingestion. Gastric ulceration without any obvious cause might be related to stress. Currently, the most accurate way to determine the presence of gastric ulcers in captive dolphins is through direct examination of the stomach mucosa using endoscopy (gastroscopy); a procedure that requires substantial animal training and specialised medical equipment. In this study, we investigate whether cytology of the gastric fluid, collected through the less intensive method of intubation, can be used as an alternative to gastroscopy to predict the presence and severity of gastric ulcers in eight captive bottlenose dolphins at uShaka Sea World, South Africa. An ulcer grading scale was developed to quantify the severity of the dolphins' gastric ulcers observed using gastroscopy. Gastric ulcer severity was then compared with the cytological data collected from gastric fluid samples taken during the gastroscopic examinations. The cytological findings were consistent with other studies, but ulcer severity was not found to be linked to the cytological parameters measured. From these results we suggest that routine cytology of the gastric fluid is not a viable alternative to gastroscopy for diagnosing gastric ulcers in bottlenose dolphins.

Effects of Transport and Feeding Strategies Before Transportation on Redox Homeostasis and Gastric Ulceration in Horses.

Transportation may lead to oxidative stress (OS) and gastric ulceration in horses, and optimal feed management before, or during, transportation is unclear. This study aimed to evaluate the effects of transportation after three different feeding strategies on OS and to explore possible associations between OS and equine gastric ulcer syndrome (EGUS). Twenty-six mares were transported by truck for 12 hours without food or water. Horses were randomly divided into 3 groups; (1) fed 1 hour before departure (BD), (2) fed 6 hours BD, (3) fed 12 hours BD. Clinical examinations and blood collections were performed at approximately 4 hours BD (T0), at unloading (T1), 8 hours (T2) and 60 hours (T3) after unloading. Gastroscopy was conducted prior to departure, and at T1 and T3. Although OS parameters remained in the normal range, transportation was associated with increased reactive oxygen metabolites (ROMS) at unloading (P=0.004), with differences between horses fed 1 hour and 12 hours BD (P < .05). The level of total antioxidant (PTAS) was affected by both transportation and feeding strategy (P = 0.019), with horses fed 1 hour BD demonstrating greater PTAS at T = 0, and a different response in comparison with the other groups and the literature. Nine horses demonstrated clinically significant ulceration of the squamous mucosa at T1 but, although weak correlations were evident between OS parameters and ulcer scores, univariate logistic regression showed no associations. This study suggests that feed management prior to a long journey (12 hours) may affect oxidative balance. Further studies are needed to understand the nexus between feed management before and during transport, transport-related OS and EGUS.

Effect of moving from being extensively managed out in pasture into training on the incidence of equine gastric ulcer syndrome in Icelandic horses.

OBJECTIVE: To investigate equine squamous gastric disease (ESGD) and equine glandular gastric disease (EGGD) in Icelandic horses moving from pasture into training. ANIMALS: 81 horses (median age, 3 years; interquartile range, 1 year) from 10 farms representing 4 different Icelandic regions. PROCEDURES: Initial gastroscopy was undertaken within 2 weeks of moving from pasture into a training establishment. A total of 71 horses underwent endoscopic examination again 8 weeks later. Various management and behavioral factors were assessed through face-to-face questionnaires with the owners or trainers. Multivariable logistic regression was used to determine factors contributing to any change in ESGD and EGGD severity score during the 8-week training period. RESULTS: Incidence of EGGD and ESGD in this feral population was similar to that found in domesticated horses. ESGD incidence (severity score, ≥ 2; score range, 0 to 4) reduced from an initial 71.6% (58/81) to 25.4% (18/71). On multivariable analysis, sex (ie, being a stallion or a female vs gelding) increased the likelihood of ulcer grade reduction. Being fed preserved forage 3 or more times a day also improved the likelihood of ESGD reduction (odds ratio, 17.95; 95% CI, 1.67 to 193.40; P = .017). Overall, the farm explained 35% of the variance, confirming the importance of management factors. Incidence of EGGD (severity score, ≥ 1; score range, 0 to 2) reduced from 47% (38/81) to 40.8% (29/71) during the same period. No measured variables were associated significantly with EGGD incidence or reduction. CLINICAL RELEVANCE: Pasture provision (without supplementary feed or forage) does not result automatically in a low incidence of gastric ulcers. Regular provision of preserved forage is a key factor in reducing ESGD incidence.

Equine Gastric Squamous Cell Carcinoma in a Friesian Stallion.

A 7-year-old Friesian stallion with a history of oesophageal stenosis, weight loss, inappetence, and recurrent hyperthermia was referred for gastroscopy. The stomach mucosa surrounding the oesophageal opening showed a large, necrotic, and ulcerated mass. On post-mortem examination, a very large, cauliflower-like neoplasm was seen, affecting non-glandular gastric mucosa. Nodular lesions were observed, scattered on the omentum, the spleen, and the liver. Microscopic findings allowed the diagnosis of gastric squamous cell carcinoma with abdominal metastasis. Biomolecular investigations demonstrated the presence of EcPV-2 genes in neoplastic lesions, thus supporting the role of EcPV-2 in the ethiology of equine gastric cancer.

Equine gastric ulcer syndrome in adult horses.

Many domesticated horses have gastric ulcers which can be diagnosed and graded during gastroscopy. A distinction should be made between equine squamous gastric disease (ESGD), which is caused by exposure of the mucosa to acid, and equine glandular gastric disease (EGGD), thought to occur when mucosal defence mechanisms are compromised. Horses with gastric ulcers may, but do not always, show clinical signs such as poor appetite, mild colic, discomfort during girthing, behavioural changes and reduced performance. The mainstay of treatment is blocking acid production using the proton pump inhibitor omeprazole. Treatment is usually successful in cases of ESGD, but less so for EGGD, where treatment duration is longer and for which sucralfate may be added or alternatives necessary, such as misoprostol, a prostaglandin analogue. To prevent recurrence of ulcers known risk factors, such as high concentrate diets, intense exercise and stress should be avoided or minimized.

Assessment of agreement using the equine glandular gastric disease grading system in 84 cases.

INTRODUCTION: Equine glandular gastric disease (EGGD) is a common condition causing signs of gastric pain although lesions are highly variable in their appearance. The only definitive method to diagnose EGGD ante-mortem is gastroscopy. The current recommended method for describing these lesions is the European College of Equine Internal Medicine (ECEIM) guidelines; however, repeatability between users is variable. This study aimed to validate the reliability of lesion descriptions using ECEIM consensus guidelines, using four blinded equine internal medicine diplomates. METHODS: Ninety-two horses with EGGD with pre- and post-treatment gastroscopy images were identified using the electronic record at a UK equine hospital between 2012 and 2019. Eight horses were excluded due to non-diagnostic images. Four blinded observers used the recommended grading system to describe images and outcomes. Intraclass correlation coefficients and Krippendorff's alpha were used to determine reliability and agreement, respectively. RESULTS: Intraclass correlation coefficient for severity was 0.782 (95% confidence interval [CI] 0.722-0.832), for distribution was 0.671 (95% CI 0.540-0.763), for the descriptor raised was 0.635 (95% CI 0.479-0.741), fibrinosuppurative was 0.745 (95% CI 0.651-0.812), haemorrhagic was 0.648 (95% CI 0.513-0.744), hyperaemic was 0.389 (95% CI 0.232-0.522) and for outcome was 0.677 (95% CI 0.559-0.770). Krippendorff's alpha for severity was 0.466 (95% CI 0.466-0.418), for distribution was 0.304 (95% CI 0.234-0.374), for the descriptor raised was 0.268 (95% CI 0.207-0.329), fibrinosuppurative was 0.406 (95% CI 0.347-0.463), haemorrhagic was 0.287 (95% CI 0.229-0.344), hyperaemic was 0.112 (95% CI 0.034-0.188) and for outcome was 0.315 (95% CI 0.218-0.408). There was moderate reliability determined between observers using intra-class correlation coefficients and unacceptable agreement determined between observers using Krippendorff's alpha. DISCUSSION: These results suggest that the current grading system is not comparable between observers, indicating the need to review the grading system or define more robust criteria.

Evaluation of the treatment of equine glandular gastric disease with either long-acting-injectable or oral omeprazole.

BACKGROUND: Equine glandular gastric disease (EGGD) is common in domesticated horses and can be challenging to treat. Oral omeprazole (ORLO) is used widely but the clinical response is frequently poor. OBJECTIVES: To compare rates of EGGD healing and improvement between ORLO and a long-acting injectable omeprazole preparation (LAIO). STUDY DESIGN: Retrospective clinical study. METHODS: The case records and gastroscopy images of horses presenting to masked for peer review over a 12-month period were reviewed, with images blindly assessed by one of the authors. Treatment responses to 4 mg/kg LAIO administered every 7 days for 2 and 4 weeks were compared with ORLO 4 mg/kg PO q24hrs for 4 weeks. Data were compared using a Mann-Whitney U test with post-hoc Dunn's test, Chi-squared test and a Fisher's exact test. RESULTS: Thirty-three horses that received LAIO and 12 that received ORLO were identified. Nine horses in the LAIO had received other treatments previously. The groups were comparable in signalment and EGGD lesion severity. Long-acting injectable omeprazole was found to be non-inferior to ORLO. LAIO was associated with better healing rates than ORLO at 4 weeks (LAIO-80%; ORLO-42%; p = 0.02), and reduction in lesion severity at 2 and 4 weeks in the LAIO group but not in the ORLO group at 4 weeks. Eighteen percent of horses in the LAIO group and 50% in the ORLO group did not heal at 4 weeks. There was no association between rate of healing or improvement and resolution or improvement of clinical signs. Six localised and self-limiting injection site reactions were identified in 4 horses treated with LAIO (6.7%). MAIN LIMITATIONS: Retrospective design, small numbers and the use of other treatments prior to use of LAIO. CONCLUSIONS: LAIO was found to be non-inferior to oral omeprazole for EGGD. Larger blinded randomised clinical trials are justified.

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 < .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 < .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.

Association of gastric lymphofollicular hyperplasia with Helicobacter-like organisms in dogs.

BACKGROUND: The relationships among gastric lymphoid follicular hyperplasia (GLFH), Helicobacter-like organisms (HLOs), and clinical signs have not been established in dogs. OBJECTIVES: To evaluate the epidemiologic, clinical, endoscopic, and histopathologic findings associated with GLFH in dogs, and determine the association of GLFH with HLOs and the French Bulldog (FB) breed. ANIMALS: Two hundred eighty-eight dogs that underwent gastroscopy between 2013 and 2016. METHODS: Retrospective, cross-sectional study. Gastric biopsy samples were reviewed and scored for inflammation and HLOs. Dogs were divided into 3 groups: group 1 (63 FBs), group 2 (45 non-FB brachycephalic dogs), and group 3 (180 nonbrachycephalic dogs). Variables were evaluated for their association with GLFH. RESULTS: Univariate analysis determined that intact males, young age, vomiting, gastroscopic findings (discoloration, hemorrhage, and ulcers), and histopathologic findings (gastric lamina propria lymphocytic infiltration and HLO score) were associated with GLFH (P ≤ .03). In the multivariate analysis, GLFH was associated with the HLO score (odds ratio [OR] > 5 for HLO scores 1-2 and >15 for HLO score of 3; P < .001), with vomiting (OR > 4; P = .01) but not with FB breed (P = .76) and age (P = .1). The HLO score was associated with younger age (P < .001). CONCLUSION AND CLINICAL IMPORTANCE: The HLO score was associated with a high GLFH score. Vomiting was associated with GLFH. Helicobacter-like organisms are highly prevalent in young dogs and GLFH is indirectly associated with this factor. Clinical relevance of the identification of GLFH and HLO remains to be determined.

Effects of a nutraceutical supplement in the management of mild equine squamous gastric disease in endurance horses.

INTRODUCTION: Equine squamous gastric disease (ESGD) may require prolonged treatments with acid suppressants; therefore, interest in nutraceutical supplements with anti-ulcerogenic properties has increased. This study aims to investigate the efficacy of Trophogast pellet for the treatment of ESGD in endurance horses. MATERIAL AND METHODS: Fifteen endurance horses were included based on their gastroscopic examination and randomly assigned to a treatment group, receiving Trophogast pellet for 30 days together with management changes, or to a control group, only subjected to management modifications. At the end of treatment, gastroscopy was repeated. Scores were assigned according to the Equine Gastric Ulcer Council scoring system. All horses were weighed at the beginning and at the end of the study. ESGD grades and weight before and after treatment were compared. RESULTS: At enrolment, median ESGD score in the treatment group was 2, while in the control group it was 1. After the treatment period, a significant decrease in ESGD grade was observed in the treatment group (median 1, p = 0.0078), while there was no change in the control group (median 2). No significant weight change was observed in either group. CONCLUSION: Trophogast pellet was effective at promoting healing of mild ESGD in endurance horses.

A comparative time-dependent study of hematology, serum gastrin concentrations, and gastroscopic assessment of meloxicam-induced gastric ulceration in dogs.

BACKGROUND: Diagnosis of gastric ulcers by methods other than gastroscopy in dogs has been problematic for many years and biomarkers such as serum gastrin (SG) concentrations have been introduced as a noninvasive way to evaluate gastric diseases. OBJECTIVES: To determine the time course changes in hematology, SG concentrations, and gastroscopic images of meloxicam-induced gastric ulceration in dogs and identify a relationship between SG and gastroscopic image analysis in a clinical setting. ANIMALS: Fifteen crossbreed dogs. METHODS: Two groups: control (n = 5) and meloxicam-treated (n = 10). The meloxicam-treated group received meloxicam 0.2 mg/kg PO for 15 days. Clinical signs, hematology, SG, and image analysis (PI, pixel intensity; ID, integrated density; RA, relative area; and UI, ulcer index) of the gastroscopic examination were evaluated across time (T5, time 5 day; T10, time 10 day; and T15, time 15 day). RESULTS: Significant changes were observed among 3 time points and between the 2 groups in terms of SG, hematology, and gastroscopic image analysis. In the meloxicam-treated group, decreases in hemoglobin concentration, red blood cell count and packed cell volume at T10 and T15 (P = .0001) were observed, whereas SG, ID, and UI increased over time (P < .0001). The PI decreased significantly (P = .0001) in the meloxicam-treated group compared to controls. Significant correlations were found between SG and PI, and ID and ulcer area (r = -0.89, 0.81, 0.64), respectively. CONCLUSION AND CLINICAL IMPORTANCE: Gastroscopy is the gold standard for early descriptive diagnosis of gastric ulcerations in dogs, and SG is a good indicator for meloxicam-induced gastric ulcers in dogs and can predict the gastroscopic score of the lesion.

Endoscopic assessment of presumed acquired pyloric narrowing in cats: A retrospective study of 27 cases.

Acquired pyloric narrowing is a rare and poorly-documented condition in cats, but the endoscopic appearance of pyloric narrowing has never previously been reported. The objectives of this study were to describe the clinical, endoscopic and histological features in cats with gastrointestinal signs where the pylorus could not be passed during endoscopy, and to compare these data with a control group. Medical files of cats that underwent upper GI endoscopy by the same operator between 2006 and 2015 were reviewed. Cats for which the pylorus could not be passed were assigned to the case group, whilst those with an easily-passable pylorus were assigned to the control group. The case group comprised 27 cats and control group comprised 35 cats. Median age and weight were not different between groups, but there were more Siamese cats in the case group (6/27) compared with the control group (1/35; P = 0.04). Chronic vomiting was the main clinical sign in both groups, but the vomitus was more likely to contain food in case group (23/25) than in cats in control group (17/30; P < 0.01). Endoscopic findings confirmed gastric inflammation in both groups, whilst histological findings revealed similar lymphoplasmacytic infiltration of the gastric mucosa and the duodenum in most cases, neoplastic features being infrequent. Acquired pyloric narrowing is probably an underdiagnosed condition in adult cats. A possible association between pyloric narrowing and gastrointestinal inflammatory disease requires further study but, for now, it is recommended that multiple gastric, pyloric, and duodenal biopsies be acquired during the endoscopy.

Interobserver and intraobserver reliability for 2 grading systems for gastric ulcer syndrome in horses.

BACKGROUND: Grading of equine gastric ulcer syndrome (EGUS) is undertaken in clinical and research settings, but the reliability of EGUS grading systems is poorly understood. HYPOTHESIS/OBJECTIVES: Investigate interobserver and intraobserver reliability of an established ordinal grading system and a novel visual analog scale (VAS), and assess the influence of observer experience. ANIMALS: Sixty deidentified gastroscopy videos. METHODS: Six observers (3 specialists and 3 residents) graded videos using the EGUS Council (EGUC) system and VAS. Observers graded the videos three 3 for each system, using a cross-over design with at least 1 week between each phase. The order of videos was randomized for each phase. METHODS: Interobserver and intraobserver reliability were estimated using Gwet's agreement coefficient with ordinal weights applied (AC2) for the EGUC system and the intraclass correlation coefficient (ICC) for the VAS. RESULTS: Using the EGUC system, interobserver reliability was substantial for squamous (AC2 = 0.69; 95% confidence interval [CI], 0.57-0.80) and glandular mucosa (AC2 = 0.72; 95% CI, 0.70-0.75), and intraobserver reliability was substantial for squamous (AC2 = 0.80; 95% CI, 0.71-0.90) and glandular mucosa (AC2 = 0.80; 95% CI, 0.74-0.86). Interobserver reliability using the VAS was moderate for squamous (ICC = 0.64; 95% CI, 0.31-0.96) and poor for glandular mucosa (ICC = 0.35; 95% CI, 0.06-0.64), and intraobserver reliability was moderate for squamous (ICC = 0.74; 95% CI, 0.62-0.86) and glandular mucosa (ICC = 0.56; 95% CI, 0.39-0.72). CONCLUSIONS AND CLINICAL IMPORTANCE: The EGUC system had acceptable intraobserver and interobserver reliability and performed well regardless of observer experience. Familiarity and observer experience improved reliability of the VAS.

A study investigating the treatment of equine squamous gastric disease with long-acting injectable or oral omeprazole.

BACKGROUND: Equine squamous gastric disease (ESGD) is a highly prevalent disease in horses, particularly in elite athletes. Some horses respond slowly, or fail to respond, to the licensed treatment, oral omeprazole (ORLO). OBJECTIVES: To compare rates of ESGD healing and improvement between ORLO and a long-acting injectable omeprazole preparation (LAIO). STUDY DESIGN: Retrospective clinical study. METHODS: The case records and gastroscopy images of horses presenting to Rainbow Equine Hospital over a 12-month period were reviewed, with images being reviewed blind by one of the authors (David Rendle). Treatment responses were compared between horses that received 2 or 4 injections of 4 mg/kg LAIO at weekly intervals, and horses that received ORLO at 4 mg/kg PO SID for 4 weeks. Data were compared using a Mann-Whitney test with post hoc Dunn's test, chi-squared test or Fisher's exact test. RESULTS: Fifty-six horses met the inclusion criteria: 29 received LAIO and 27 received ORLO. Treatment groups were comparable in terms of signalment and ESGD lesions. There was a difference in rate of healing when LAIO and ORLO treatment groups were compared at 28 days (LAIO-97%; ORLO-67%; p = .005; OR = 14(1.8-158)), but no difference between LAIO at 14 days and ORLO at 28 days (LAIO-86%; ORLO-67%; p = .12; OR = 3.1 (0.9-10)). Five localised and self-limiting injection site reactions were identified in 3 horses out of 98 injections (5.1%). MAIN LIMITATIONS: The study was limited by its retrospective nature, absence of randomisation and limited numbers. CONCLUSIONS: Four weeks of treatment with LAIO resulted in better rates of ESGD healing than 4 weeks of ORLO. Larger more robust studies of LAIO are warranted.

The Contribution of Specific and Nonspecific Biomarkers in Diagnosis of Equine Gastric Ulcer Syndrome (EGUS) Under Field Condition.

The aim of this study is to investigate the diagnostic efficiency of gastrin, pepsinogen, proinflammatory cytokines (TNF-α, IL-6), and oxidative stress biomarkers in horses with equine gastric ulcer syndrome (EGUS). Thirty horses diagnosed with gastroscopic EGUS and 15 clinically healthy horses were selected for this study. The serum levels of gastrin, pepsinogen showed nonsignificant changes in horses with EGUS when compared with healthy horses. The serum levels of TNF-α, IL-6 revealed a significant increase in horses with EGUS when compared with healthy ones. Oxidative stress is evident in horses with EGUS in comparison with healthy horses as detected by higher levels of malondialdehyde (MDA) and decreased serum levels of total antioxidant capacity (TAC), Superoxide dismutase (SOD), glutathione (GSH), and nitric oxide (NO). MDA and TNF-α showed better sensitivity and specificity than IL-6 in distinguishing horses with EGUS from control horses. Conclusively, examination of serum gastrin and pepsinogen levels had a limited value in diagnosis of EGUS in horses under investigation. Moreover, this study showed that oxidative stress is evident in horses with EGUS. Higher levels of TNF-α and IL-6 indicate their role in EGUS pathogenesis in horses. Finally, MDA, TNF-α, and IL-6 could be used as biological markers for preliminary screening of horses with EGUS. Gastroscopy still accredited as the "gold standard" for diagnosis EGUS.

Effect of Changing Diet on Gastric Ulceration in Exercising Horses and Ponies After Cessation of Omeprazole Treatment.

Diet is an accepted risk factor for equine squamous gastric disease (ESGD), but there is little published evidence for the benefit of dietary change (DC). This study evaluated the effect of DC with or without initial omeprazole medication. Twelve pairs of exercising horses with ESGD Grade 2/4 (EM) and 17 pairs with ESGD Grade ≥3/4 (ES), were monitored. Paired horses had similar management, feeding times, workloads, and initially feed or forage. One of each pair was randomly assigned, postgastroscopy (Scope1), to a specified restricted starch ration; the other remained on their original diet. Omeprazole (4 mg/kg per os SID) was given to all ES pairs for 4 weeks. Gastroscopies were scored, without dietary knowledge, after 4 and 10 weeks (Scopes 2 and 3). Workloads remained similar throughout. McNemar's tests identified any changes in ESGD grade. Within the EM group, DC had no additional effect. For the ES group remaining on their original diet, there was significant improvement in ESGD grade from Scopes 1 to 2 (P < .001) but a worsening between Scopes 2 and 3 (P = .005), with Scope 3 being no different from Scope 1 (P = .08) reflecting no apparent long-term medication benefit. For the DC group, there was significant improvement in ESGD grade from Scopes 1 to 2 (P < .001) and between Scopes 1 and 3 (P = .003); In addition, there was no significant difference between Scopes 2 and 3 (P = .32). Although limited by the small number of pairs evaluated, this study provides evidence that appropriate DCs can be a beneficial management strategy for ESGD.