A comparison between omeprazole and a dietary supplement for the management of squamous gastric ulceration in horses

Although several studies have assessed the short-term effect of dietary supplements on the treatment and prevention of gastric ulceration in horses, few have assessed the response over a duration of more than 30 days. A blinded randomized noninferiority clinical trial was conducted using 42 Thoroughbred horses in race training with squamous ulceration of ≥ grade 2/4, randomly assigned to one of two treatment groups for a period of 90 days: omeprazole at the full label dose of 4 mg/kg or the Succeed digestive conditioning supplement. Noninferiority analyses and Wilcoxon sign rank tests were used to analyze the data. At day 90, Succeed was noninferior to 4 mg/kg omeprazole administered daily in terms of the proportion of horses with complete resolution of squamous ulceration. At day 30, Succeed was found to be inferior to omeprazole in terms of the proportion of horses with grade ≤1/4 squamous ulceration. The proportion of horses with reducing squamous ulcer score (compared with day 0) was statistically significant for both treatments at days 30 and 60. At day 90 of the 17 horses on Succeed, nine had a reducing squamous ulcer score (P value = .049), and of the 19 horses on omeprazole, 10 had a reducing squamous ulcer score at day 90 (P value = .091). The noninferiority of Succeed compared to omeprazole at 90 days for the complete resolution of squamous ulceration and the reduced efficacy of omeprazole following 90 days of treatment are likely to be of interest to practitioners managing gastric ulceration in performance horses

Equine metabolic syndrome in UK native ponies and cobs is highly prevalent with modifiable risk factors

BACKGROUND: The epidemiology of equine metabolic syndrome (EMS) is poorly described. OBJECTIVES: To estimate the prevalence of EMS in native UK ponies and cobs in England and Wales and identify associated risk factors. STUDY DESIGN: Cross‐sectional study. METHODS: Breeders registered with UK native pony breed societies and registered riding schools and livery yards within a set radius were invited to participate. All native UK ponies and cobs aged 3‐14 years and not diagnosed or being treated for conditions likely to affect insulin regulation at participating premises were eligible. Animals underwent a clinical examination and an oral glucose test while their owner or keeper completed a questionnaire by face‐to‐face interview. Data were analysed by multilevel uni‐ and multivariable modelling using insulin concentration and EMS diagnosis as outcomes. RESULTS: A total of 354 animals were examined at 64 properties (19 studs, 19 livery yards, 26 riding schools). The overall prevalence of EMS adjusted for clustering within yard was 23.3% (95%CI 17.9%–29.8%). Risk factors associated with a diagnosis of EMS included age, being female, more sedentary main activity, obesity, and shorter periods on pasture during the summer. Compared to the Welsh section A, the other Welsh, Connemara and cob breeds all had decreased odds of EMS. Clinical manifestations of hoof growth ring and supraorbital fat scores of 3/3 were more frequent in EMS ponies and animals with a history of laminitis within the last 5 years (9.7%) were 14.4 (95% CI 5.9–35.3) times more likely to be positive for EMS than those without. MAIN LIMITATIONS: Results may not be transferable to other breeds or age groups. CONCLUSIONS: Equine metabolic syndrome is highly prevalent in UK native ponies and cobs with modifiable risk factors including obesity and sedentary activities. Modifying risk factors could help reduce the risk of laminitis in susceptible animals

Development of a Web App to Convert Blood Insulin Concentrations among Various Immunoassays Used in Horses

The measurement of the blood insulin concentration, and comparison to cut-offs, is essential in diagnosing insulin dysregulation, a common equine endocrinopathy. However, different insulin assays provide disparate results. We aimed to ease comparison between assays by compiling original and published data into a web app to convert insulin measurements from one assay to another. Data were available for ADVIA Centaur insulin chemiluminescent immunoassay (CLIA), Beckman Coulter insulin radioimmunoassay (RIA), Immulite 1000 CLIA, Immulite 2000 CLIA, Immulite 2000 XPi CLIA, Mercodia equine insulin enzyme-linked immunosorbent assay (ELISA), and Millipore porcine insulin RIA. Linear models were fitted for 13 assay pairs using non-decreasing splines, and integrated into this app. Assay comparisons including data from several studies showed a lower performance. This indicates technical variation between laboratories, which has not been described before, but is relevant when diagnostic measurements and cut-offs are provided by different laboratories. Nevertheless, the models’ overall high performance (median r2 = 0.94; range 0.57–1.00) supports their use to interpret results from diagnostic insulin measurements when the reference assay is unavailable, and to compare values obtained from different assays.</jats:p

Diagnosis and treatment of confirmed and suspected primary hyperparathyroidism in equids: 17 cases (1999-2016

Background Primary hyperparathyroidism is uncommon in equids. Objectives To describe the diagnostic findings and efficacy of treatment in equids with primary hyperparathyroidism. Study design Retrospective case series describing 16 horses and one mule. Methods Cases were identified by retrospective review of records at Cornell University and via an ACVIM listserv query. Inclusion criteria were an equid with hypercalcemia, normal renal function and high parathyroid hormone (PTH) or histopathological diagnosis of a parathyroid adenoma. Equids with normal PTH and PTH‐related protein (PTHrP) in the face of hypercalcemia were included as suspect cases. Results The most common presenting complaints were weight loss (12/17) and hypercalcemia (10/17). PTH was above reference range in 12/17 cases. Suspected parathyroid tumours were localised in 12/14 equids imaged using ultrasonography alone (2/3), technetium 99m Tc sestamibi scintigraphy alone (1/1) or both modalities (9/10). Three horses did not have imaging performed. Surgical exploration successfully excised tumours in six of 10 cases. Five were located at the thoracic inlet, and surgery resulted in complete cure. One tumour was excised from the thyroid lobe, and the horse remained hypercalcemic. Four other cases explored surgically, four treated medically and three that were not treated also remained hypercalcemic. Main limitations The small study size prohibited statistical analysis. Conclusions Parathyroid adenomas in equids can be successfully localised with ultrasonography and scintigraphy. Surgical excision appears more likely to be successful for single gland disease at the thoracic inlet

Carbohydrate pellets to assess insulin dysregulation in horses

Background: A glycemic challenge test is used for the diagnosis of insulin dysregulation (ID) in horses and ponies. Different forms of the test exist where the administrative route and dose of glucose vary, which makes interpretation of results challenging. Hypothesis/Objectives: To evaluate the palatability of, and blood glucose and insulin responses to, carbohydrate pellets fed as an oral glucose test (OGT), and to establish the diagnostic threshold for ID when using the pellets. Animals: University and privately-owned horses and ponies (n = 157) comprised of 31 breeds and both sexes. Methods: Multicenter cohort study. A custom-produced glycemic pellet was offered for free intake at 0.5 g/kg BW soluble carbohydrate and serum insulin and blood glucose concentrations measured before and after (60, 120, and 180 minutes) the pellets were offered. Pellet acceptance and intake time (those that finished within 10 minutes) were determined to assess palatability. Results: The pellets were palatable to 132/157 animals, and ponies found the pellets more (P =.004) palatable than horses. The median intake time (4 [3-6] minutes) was positively correlated with acceptance grade (r =.51; P <.0001). Consumption of the pellets elicited peak blood glucose (6.6 [5.8-7.8] mmol/L) and serum insulin (40.5 [19-99.8] μIU/mL) responses at 120 minutes. At 120 minutes the optimal cut-off was 83 μIU/mL (95% CI: 70-99 μIU/mL) for the IMMULITE 2000XPi assay. Conclusions and Clinical Importance: The pellets were palatable and a suitable, novel carbohydrate source for the OGT.</p

Diagnosis and treatment of confirmed and suspected primary hyperparathyroidism in equids: 17 cases (1999-2016

Background Primary hyperparathyroidism is uncommon in equids. Objectives To describe the diagnostic findings and efficacy of treatment in equids with primary hyperparathyroidism. Study design Retrospective case series describing 16 horses and one mule. Methods Cases were identified by retrospective review of records at Cornell University and via an ACVIM listserv query. Inclusion criteria were an equid with hypercalcemia, normal renal function and high parathyroid hormone (PTH) or histopathological diagnosis of a parathyroid adenoma. Equids with normal PTH and PTH‐related protein (PTHrP) in the face of hypercalcemia were included as suspect cases. Results The most common presenting complaints were weight loss (12/17) and hypercalcemia (10/17). PTH was above reference range in 12/17 cases. Suspected parathyroid tumours were localised in 12/14 equids imaged using ultrasonography alone (2/3), technetium 99m Tc sestamibi scintigraphy alone (1/1) or both modalities (9/10). Three horses did not have imaging performed. Surgical exploration successfully excised tumours in six of 10 cases. Five were located at the thoracic inlet, and surgery resulted in complete cure. One tumour was excised from the thyroid lobe, and the horse remained hypercalcemic. Four other cases explored surgically, four treated medically and three that were not treated also remained hypercalcemic. Main limitations The small study size prohibited statistical analysis. Conclusions Parathyroid adenomas in equids can be successfully localised with ultrasonography and scintigraphy. Surgical excision appears more likely to be successful for single gland disease at the thoracic inlet

Carbohydrate pellets to assess insulin dysregulation in horses.

BackgroundA glycemic challenge test is used for the diagnosis of insulin dysregulation (ID) in horses and ponies. Different forms of the test exist where the administrative route and dose of glucose vary, which makes interpretation of results challenging.Hypothesis/objectivesTo evaluate the palatability of, and blood glucose and insulin responses to, carbohydrate pellets fed as an oral glucose test (OGT), and to establish the diagnostic threshold for ID when using the pellets.AnimalsUniversity and privately-owned horses and ponies (n = 157) comprised of 31 breeds and both sexes.MethodsMulticenter cohort study. A custom-produced glycemic pellet was offered for free intake at 0.5 g/kg BW soluble carbohydrate and serum insulin and blood glucose concentrations measured before and after (60, 120, and 180 minutes) the pellets were offered. Pellet acceptance and intake time (those that finished within 10 minutes) were determined to assess palatability.ResultsThe pellets were palatable to 132/157 animals, and ponies found the pellets more (P = .004) palatable than horses. The median intake time (4 [3-6] minutes) was positively correlated with acceptance grade (r = .51; P Conclusions and clinical importanceThe pellets were palatable and a suitable, novel carbohydrate source for the OGT