BEVA primary care clinical guidelines: Analgesia.

Primary care guidelines provide a reference point to guide clinicians based on a systematic review of the literature, contextualised by expert clinical opinion. These guidelines develop a modification of the GRADE framework for assessment of research evidence (vetGRADE) and applied this to a range of clinical scenarios regarding use of analgesic agents. Key guidelines produced by the panel included recommendations that horses undergoing routine castration should receive intratesticular local anaesthesia irrespective of methods adopted and that horses should receive NSAIDs prior to surgery (overall certainty levels high). Butorphanol and buprenorphine should not be considered appropriate as sole analgesic for such procedures (high certainty). The panel recommend the continuation of analgesia for 3 days following castration (moderate certainty) and conclude that phenylbutazone provided superior analgesia to meloxicam and firocoxib for hoof pain/laminitis (moderate certainty), but that enhanced efficacy has not been demonstrated for joint pain. In horses with colic, flunixin and firocoxib are considered to provide more effective analgesia than meloxicam or phenylbutazone (moderate certainty). Given the risk of adverse events of all classes of analgesic, these agents should be used only under the control of a veterinary surgeon who has fully evaluated a horse and developed a therapeutic, analgesic plan that includes ongoing monitoring for such adverse events such as the development of right dorsal colitis with all classes of NSAID and spontaneous locomotor activity and potentially ileus with opiates. Finally, the panel call for the development of a single properly validated composite pain score for horses to allow accurate comparisons between medications in a robust manner.

Misoprostol is superior to combined omeprazole-sucralfate for the treatment of equine gastric glandular disease.

BACKGROUND: Previous studies have demonstrated a poor response to healing of gastric glandular lesions with oral omeprazole and other medications. OBJECTIVES: To evaluate the efficacy of two novel treatments (misoprostol [M] and combined omeprazole-sucralfate [OS]) in horses for gastric glandular disease. STUDY DESIGN: Prospective, clinical study. METHODS: Sixty-three sports horses with grade >1/4 glandular disease were identified by gastroscopy. Horses received either 5 µg/kg of misoprostol per os BID 1 h prior to feeding or a combination of 4 mg/kg enteric coated omeprazole per os SID and 12 mg/kg sucralfate per os BID where drugs were given 1 h prior to feeding and sucralfate given 60 min after omeprazole; allocation was dependent upon centre. Gastroscopy was repeated at 28-35 days. Evaluators of the gastroscopy images were blinded to the treatments the horses received and images were reviewed independently. RESULTS: The most common presenting sign in both treatment groups was poor performance (Overall - 65.1%; M - 60.5% and OS - 75%). Overall healing (P<0.001; OR = 11 [2.8-45]) and improvement (P = 0.006; OR = 11 [1.9-59]) of lesions were associated with resolution of clinical signs. Misoprostol was shown to be superior to combined omeprazole-sucralfate both for healing (M - 72% [95% CI 43-67] and OS - 20% [95% CI 7-41]; P<0.001) and improvement (M - 98% [95% CI 90-100] and OS - 65% [95% CI 43-83]; P<0.001). MAIN LIMITATIONS: Relatively small, clinical study, reliance on client questionnaire data, clients not blinded to the treatments the horse received, diet could have affected drug pharmacodynamics although mimics clinical practice and no validated scoring system available for glandular lesions. CONCLUSIONS: These results suggest that gastric glandular disease does indeed result in clinical signs. In this population of horses, misoprostol was superior to omeprazole and sucralfate and warrants further evaluation in a large scale, multi-centre trial.

Continuous fluid infusion per rectum compared with intravenous and nasogastric fluid administration in horses.

BACKGROUND: Rectal fluid administration may offer a simple, safe and inexpensive alternative to intravenous or nasogastric fluid therapy in equine clinical cases. OBJECTIVES: To evaluate the tolerance and effects of rectally administered fluid and compare the measurements of haemodilution and intravascular volume with those during nasogastric and intravenous fluid administration. STUDY DESIGN: Randomised controlled experimental trial. METHODS: Six clinically normal Standardbred geldings were used in a 4-way crossover study: each received three different fluid treatments (intravenous, nasogastric and rectal) at 5 mL/kg/h for 6 h and underwent a control (no treatment) with water and feed withheld. Bodyweight was measured at baseline and 6 h. Packed cell volume (PCV), total solids (TS), albumin, electrolytes, lactate, urine specific gravity, vital parameters, gastrointestinal borborygmi and central venous pressure were measured every 2 h. RESULTS: Rectal fluid administration with plain water was well tolerated and caused clinical chemistry changes consistent with haemodilution, indicating absorption. Mean (95% confidence interval) PCV decreased from 40% [40-42] at 0 h to 35% [34-36] at 6 h during rectal fluid treatment (P<0.001), similar to decreases in PCV occurring also with i.v. and nasogastric (NGT) treatment (P<0.001). The TS also decreased with i.v. and rectal fluid (P<0.001). There was a decrease in bodyweight in the control (P<0.001) but not with any of the fluid treatments. MAIN LIMITATIONS: A small sample size of healthy, euhydrated horses and a relatively short duration of fluid administration was used. CONCLUSIONS: Rectal fluid administration requires clinical evaluation, but may offer an inexpensive, safe alternative or adjunct to i.v. fluid administration, particularly when administration via NGT is not possible or contraindicated. The Summary is available in Portuguese - see Supporting Information.

Retrospective study assessing efficacy of treatment of large colonic impactions.

Cases with a history of colic due to a large colonic impaction were recruited retrospectively to assess the treatment efficacy and complications of oral and parenteral fluid therapy regimes for correction of primary large colon impactions. Oral isotonic fluids had been administered at varying intervals following initial treatment with magnesium sulphate and water. There was no significant difference in complication rates between groups. Considering complication rates with impaction clearance, hourly administration of oral fluids appears to be the most appropriate treatment regime of those investigated.

A comparison of three doses of omeprazole in the treatment of equine gastric ulcer syndrome: A blinded, randomised, dose-response clinical trial.

REASONS FOR PERFORMING THE STUDY: A previous study demonstrated that a dose effect between 1.6 and 4.0 mg/kg bwt of omeprazole per os s.i.d. is present in the treatment of equine gastric ulceration. In the same study, healing of glandular ulceration appeared inferior to healing of squamous ulceration. However, several limitations were recognised in that study and further investigation is warranted. OBJECTIVES: To further investigate the presence of a dose relationship in the treatment of gastric ulceration under conditions that may favour omeprazole efficacy such as administration prior to exercise and after a brief fast, and potential differences between the response of squamous and glandular ulceration to omeprazole therapy. STUDY DESIGN: A blinded, randomised, dose-response clinical trial. METHODS: Sixty Thoroughbred racehorses with grade ≥2/4 squamous and/or glandular ulceration were identified by gastroscopy. Horses were randomly assigned to receive either 1.0, 2.0 or 4.0 mg/kg bwt of enteric coated omeprazole per os s.i.d. 1-4 h prior to exercise. Gastroscopy was repeated at approximately 28 days. RESULTS: The lower doses studied (1.0 and 2.0 mg/kg bwt) were noninferior to the reference dose (4.0 mg/kg bwt) in the treatment of squamous ulceration. Healing was greater in squamous ulceration than glandular ulceration (86% vs. 14%; P<0.0001). Improvement in ulcer grade was more likely in squamous lesions than glandular lesions (96% vs. 34%; P<0.0001). Worsening of the glandular ulcer grade was observed in 36% of horses. CONCLUSIONS: The results of this study suggest that, under the conditions studied, where omeprazole is administered before exercise and following a brief fast, doses of omeprazole as low as 1 mg/kg bwt per os s.i.d. may be as effective as higher doses. The proportion of glandular ulceration that heals with 28 days of omeprazole therapy is less than that of squamous ulceration.

Clinical Research Abstracts of the British Equine Veterinary Association Congress 2015.

REASONS FOR PERFORMING STUDY: Equine gastric glandular disease (EGGD) is a common condition, for which the underlying pathophysiology is undetermined. Endoscopic mucosal biopsies have been proposed as a method for adapting therapy. OBJECTIVES: To evaluate diagnostic information obtained from endoscopic mucosal biopsies. STUDY DESIGN: Prospective, experimental study. METHODS: Twenty-one horses undergoing elective humane slaughter were subjected to gross examination of the glandular mucosa. Glandular pathology was graded using EGUS Council guidelines from digital camera images. Mucosal biopsies were obtained using a 'single-bite' (1.8 mm; A and 2.4 mm; B) or 'double bite' technique (2.4 mm; C) using endoscopic biopsy instruments. Tissue was formalin fixed, processed and stained using standard protocols. Inflammatory infiltrates visualised histologically were graded (mild, moderate or severe) and compared with ulcer grade. Full thickness biopsies were also obtained adjacent to the biopsy site and of other visual lesions and inflammatory cell counts were compared with mucosal biopsies using ICC. RESULTS: Full thickness samples were artefact free and allowed visualisation of all layers. Mucosal biopsy samples contained mucosa in all samples, submucosa in 55% (C), 61% (A) and 66% (B) of samples and glands in 50% (B), 66% (A) and 100% (C). Samples from A were too small for histological assessment (33%) and tissue damage was commonly seen in A and B (n = 8 and n = 10) when compared with C (n = 3). Horses with normal glandular appearance (grade 0; n = 7) mostly demonstrated mild gastritis (n = 5). Severe gastritis was identified in mild EGGD (grade 1/2), whilst mild and moderate gastritis was identified in all EGGD grades. There was no histological evidence of ulceration or erosion. There was poor agreement between cell numbers and sampling techniques (ICC<0.29). CONCLUSIONS: These data show lack of ulcerative pathology and instead inflammation in EGGD. Lesion appearance is a poor indicator of underlying severity. Mucosal biopsies offer limited value in predicting underlying disease. Ethical animal research: This study was approved by the University of Nottingham Ethics and Welfare Committee. The study was performed on material collected at an abattoir. SOURCE OF FUNDING: None. Competing interests: None declared.

A comparison of two doses of omeprazole in the treatment of equine gastric ulcer syndrome: a blinded, randomised, clinical trial.

REASONS FOR PERFORMING THE STUDY: Studies on omeprazole have reported that doses as low as 0.7 mg/kg bwt per os are potent suppressors of acid production. Yet, to date, no studies have compared treatment efficacy of different doses in clinical cases of equine gastric ulceration. Furthermore, no studies have been performed to compare the healing response of the squamous and glandular mucosa to acid suppression therapy. OBJECTIVES: To compare: 1) the efficacy of 2 doses of omeprazole in the treatment of primary squamous and glandular gastric ulceration; and 2) the healing response of primary squamous and glandular gastric ulceration to acid suppression therapy. STUDY DESIGN: A blinded, randomised, dose-response clinical trial. METHODS: Twenty Thoroughbred racehorses with grade ≥2/4 glandular ulceration were identified on gastroscopy. Seventeen horses also had grade ≥2/4 squamous ulceration. Horses were randomly assigned to one of 2 groups. Horses received either 2.0 g (high dose: 4.0 mg/kg bwt) or 0.8 g (low dose: 1.6 mg/kg bwt) of oral omeprazole per os once daily. Gastroscopy was repeated at 28-35 days. RESULTS: Time and dose significantly affected grades of squamous (P<0.0001, P = 0.02) and glandular (P = 0.006 and 0.005) ulceration. Data analysis did not support our hypothesis that the lower dose would have similar effects (i.e. be noninferior) to the higher dose when considering ulcer healing and ulcer improvement. Improvement was more likely with the high dose for the squamous (P = 0.05) but not glandular (P = 0.4) mucosa. The percentage of glandular ulcers that improved was less than squamous ulcers (P = 0.02). CONCLUSIONS: The results suggest that a dose-response exists for the treatment of both squamous and glandular ulcers. Improvement of glandular ulcers was not as complete as observed with squamous ulcers and current equine gastric ulcer syndrome treatment recommendations may not be appropriate for glandular disease.

Methods and normal values for echocardiography in adult dairy cattle.

OBJECTIVE: The objective of the study was to report normal ultrasonographic appearance and intra-cardiac dimensions in two dairy breeds and to calculate cardiac output (CO) using echocardiography. BACKGROUND: Intra-cardiac dimensions, time indices and CO estimation have not previously been reported in adult cattle. ANIMALS, MATERIALS AND METHODS: Echocardiograms were obtained from healthy adult dairy cows (10 Jersey (J) and 12 Holstein Friesians (HF)) in the body weight range of 400 to 700 kg. Standard echocardiographic images were obtained from the left and right hemithoraces. Velocity time integrals were obtained in order to calculate CO using pulsed wave Doppler of aortic flow in the J cows. Measurements obtained included pulmonary artery and aortic diameters, left and right ventricular diameters (and calculated fractional shortening and left ventricular ejection fraction), left atrial size and time indices assessing valve function. RESULTS: HF cows had significantly (p<0.05) larger pulmonary artery and aortic diameters, larger left atrial diameters and left ventricular internal diameters during diastole, but these were not different when corrected for body weight. Left and right ventricular dimensions, adjusted for body weight, were significantly larger (p=0.02 and p=0.035 respectively) in J cows when compared to HF cows. No differences were noted in the time indices between the two groups. No significant differences were noted in intra-operator variability and the only significant difference in inter-operator variability was in measurement of the pulmonary artery (p=0.03; ICC=0.63). CONCLUSIONS: It is possible to obtain repeatable, reliable echocardiograms in order that meaningful intra-cardiac dimensions can be obtained in adult dairy cattle.