Naturally occurring large colon sand accumulations and their medical treatment in horses

Problems related to equine large colon sand accumulations have been known for at least a century, but evidence-based medicine on the subject remains scarce. The current medical treatments are largely based on case reports and small studies on research horses with artificial sand accumulation or without confirmed accumulation. Therefore, clinical studies on naturally acquired sand accumulation are needed. The main objectives of the present studies were to define clinical signs related to the presence and size of large colon sand accumulations and to determine the optimal way to medically treat horses with these accumulations. A questionnaire study was performed to determine whether certain clinical signs are linked to the amount of sand in the colon and to clarify associations between equine large colon sand accumulations and individual traits and management-related factors. Owners or caretakers of 447 horses that had been radiographed for suspected large colon sand accumulation, responded to an internet based survey on clinical signs and management of their horses. The most common clinical signs of large colon sand accumulation noted by the owner were colic, poor performance and changes in faecal consistency (diarrhoea, increased faecal water). Colic (odds ratio (OR) 2.03, confidence interval (CI) 1.42-2.91) and poor performance (OR 1.89, CI 1.33-2.68) alone were associated with the size of sand accumulation. Horses with combinations of clinical signs, such as diarrhoea and poor performance or colic and diarrhoea also had a higher probability of a large sand accumulation; OR 2.12, CI 1.42-3.44 for diarrhoea and poor performance, and OR 2.64, CI 1.69-4.13 for colic and diarrhoea. Dominant position in the herd was protective for large colon sand accumulation (Spearman rho 0.170, P=0.002), while greediness predisposed the horse to the condition (Spearman rho 0.184, P<0.001). No significant association was detected between the studied management-related factors and large colon sand accumulation. A retrospective clinical study compared the effectiveness of medical treatment of large colon sand accumulation with nasogastric intubation of psyllium and/or magnesium sulphate (MgSO4) (both 1 g/kg bodyweight (BW) once a day for 4 to 7 days, N=170 horses) with feeding psyllium (1 g/kg BW for 2 to 5 weeks, N=57 horses). The daily administration of psyllium and MgSO4 in hospital via a nasogastric tube removed the sand accumulation more efficiently than multiple weeks of feeding with psyllium alone (P<0.05). This finding raised the need to examine the effect of psyllium and MgSO4 further, using a comparative approach in a randomised prospective study. Based on the results of the aforementioned retrospective study, it was hypothesized that the combination treatment with psyllium and MgSO4 would remove more sand than either treatment alone, or no treatment. The effect of psyllium (1 g/kg BW, N=12) or MgSO4 (1 g/kg BW, N=10) alone or combined (1 g/kg BW each, N=12) was evaluated prospectively in hospitalized horses with naturally acquired sand accumulation treated utilising nasogastric intubation once a day for four days. There were significant differences between treatments. The combination of psyllium and MgSO4 removed accumulations over a four-day period more effectively than either medication alone (number of resolved horses: P=0.012 for psyllium, and P=0.03 for MgSO4, respectively). Of 12 horses treated with a combination of psyllium and MgSO4, nine fulfilled the pre-determined criteria for clearance of sand from the ventral colon within four days. In contrast, only 3/12 horses treated with psyllium and 2/10 horses treated with MgSO4 cleared the sand accumulation. Furthermore, the effects of combination of 1 g/kg BW psyllium and 1 g/kg BW MgSO4 in 20 horses were compared with 20 untreated, hospitalized control horses that were solely removed from the sand source. After four days, the treated horses had cleared their accumulation (median area of sand decreased from 250 cm2 to 0 cm2) significantly more (P<0.001) than the control horses (median area of sand decreased from 285 cm2 to 176 cm2). In conclusion, large colon sand accumulations should be considered a differential diagnosis not only when colic, poor performance or changes in faecal consistency are seen, but also when the horse presents with combinations of various clinical signs. The most effective treatment to remove sand accumulations that had developed naturally in the population studied was repeated nasogastric intubation of psyllium and MgSO4.Hevosen paksusuolen hiekkakertymistä ja niiden aiheuttamista ongelmista on tiedetty jo yli sata vuotta, mutta tutkittu tieto niistä on melko vähäistä. Tarkkaa syytä hevosten hiekansyöntiin ei tiedetä, mutta mm. erilaisia puutostiloja on epäilty. Tahallisen maan syönnin lisäksi hiekkaa voi kertyä suolistoon ruoan mukana vahingossa. Osalla hevosista syöty hiekka kertyy paksusuoleen. Hiekkakertymä voi aiheuttaa oireina mm. ähkyä, ripulia ja laihtumista. Kertymä voidaan todeta parhaiten röntgenkuvalla, mutta myös ultraäänitutkimuksella. Nykyiset hoidot perustuvat pitkälti yksittäisiin tapausselostuksiin, muilla eläinlajeilla tehtyihin tutkimuksiin tai tutkimuksiin hevosilla, joille on tarkoituksella annettu hiekkaa. Kirjallisuudesta ei löydy aikaisempia tutkimuksia, joissa lääkehoitojen tehoa olisi verrattu potilashevosilla. Väitöskirjan tavoite oli selvittää paksusuolen hiekkakertymään liittyviä kliinisiä oireita ja ongelman taustatekijöitä, sekä löytää tehokas lääkehoito hiekkakertymän poistoon. Väitöskirja koostui neljästä osatutkimuksesta, joista ensimmäisessä kysyttiin hevosten omistajilta hiekkakertymiin liittyviä kliinisiä oireita sekä hiekkakertymille altistavia tekijöitä. Toisessa osatyössä verrattiin takautuvasti hevosten saamia hoitoja. Kolmas ja neljäs osatyö olivat satunnaistettuja kliinisiä hoitokokeita, joissa verrattiin eri lääkitysten tehoa hiekkakertymän poistossa. Kyselytutkimuksen perusteella todettiin, että suuri hiekkakertymä lisäsi ähkyn sekä suorituskyvyn alenemisen riskiä, mutta ripuli tai vesi ulosteen seassa ei ainoana oireena liittynyt kertymän kokoon. Sen sijaan ulostemuutokset yhdistettynä ähkyyn tai suorituskykyongelmiin olivat yhteydessä suurempaan kertymään. Määräävä asema laumassa oli suojaava tekijä, kun taas ahneus altisti hevosen kertymälle. Takautuvassa tutkimuksessa verrattiin kotona syötetyn psylliumin (1 g/kg, 2-5 viikkoa) tehoa hevossairaalassa nenänieluletkulla annosteltuun psylliumin ja magnesiumsulfaatin (MgSO4) yhdistelmään (molempia 1 g/kg, 3-8 päivää). Yhdistelmälääkitys nenänieluletkutuksella poisti hiekkakertymän tehokkaammin kuin psylliumin syöttö. Satunnaistetuissa tutkimuksissa verrattiin psylliumin ja MgSO4:n yhdistelmää (kumpaakin 1 g/kg, 4 päivän ajan), sekä kumpaakin yksinään nenänieluletkun kautta annettuna hevossairaalassa olleille hevosille. Yhdistelmälääkitys poisti paksusuolen hiekkaa tehokkaammin kuin kumpikaan lääke yksinään. Tämän jälkeen verrattiin yhdistelmälääkityksen tehoa potilashevosilla lääkitsemättömiin kontrollihevosiin. Hoidettujen hevosten röntgenkuvissa paksusuolessa näkyvä hiekkamäärä oli neljän päivän hoidon jälkeen merkitsevästi pienempi kuin kontrollihevosilla. Paksusuolen hiekkakertymä on yleinen ongelma suomalaisilla hevosilla, ja sen mahdollisuus myös muiden kuin ähkyoireiden aiheuttajana on syytä tiedostaa. Väitöskirjassa tutkituista hoidoista tehokkaimmaksi todettiin nenänieluletkutus psylliumin ja MgSO4:n yhdistelmällä

Equine herpesvirus 1 – Review

Peer reviewe

Comparison of psyllium feeding at home and nasogastric intubation of psyllium and magnesium sulfate in the hospital as a treatment for naturally occurring colonic sand (geosediment) accumulations in horses : a retrospective study

Background: Ingestion of geosediment (further referred as sand) may cause weight loss, diarrhea and acute or recurrent colic in horses. Our aim was to compare the efficacy of three treatment protocols in clearing colonic sand accumulations in clinical patients. This retrospective clinical study consisted of 1097 horses and ponies, which were radiographed for the presence of colonic sand. Horses included to the study (n = 246) were displaying areas of sand in the radiographs of >= 75 cm(2) and were treated medically monitoring the response with radiographs. The horses were assigned into three groups based on the given treatment: Group 1 was fed psyllium [1 g/kg body weight (BW)] daily at home for a minimum of 10 days (n = 57); Group 2 was treated once with psyllium or magnesium sulfate by nasogastric tubing followed by daily feeding of psyllium (1 g/kg BW) at home for a minimum of 10 days (n = 19), and Group 3 was treated by daily nasogastric tubing for 3-7 days with psyllium and/or magnesium sulfate (1 g of each/kg BW) (n = 170). Results: The initial area of sand did not differ significantly between the treatments. Group 3 had significantly less residual sand than Groups 1 and 2, and the proportion of resolved horses was higher in Group 3 than in Groups 1 and 2. Conclusions: Daily nasogastric tubing with psyllium and/or magnesium sulfate for 3-7 days removes large accumulations of sand from the colon in horses more effectively than feeding psyllium for at least 10 days.Peer reviewe

Diagnostic evaluation and short-term outcome as indicators of long-term prognosis in horses with findings suggestive of inflammatory bowel disease treated with corticosteroids and anthelmintics

Abstract Background Recurrent colic and unexplained weight loss despite good appetite and adequate feeding and management practices are common conditions in the horse. However, little information has been published on the systematic diagnostic evaluation, response to treatment, prognostic factors or outcome of either presentation. The aims of this study were to 1) identify possible prognostic indicators and 2) report the short- and long-term response to treatment with corticosteroid therapy of a variety of horses with a presumptive diagnosis of inflammatory bowel disease (IBD). Thirty-six horses with a history of recurrent colic and/or unexplained weight loss were screened with a detailed clinical, clinicopathological and diagnostic imaging examination. Twenty horses were subsequently selected that had findings consistent with inflammatory bowel disease based on the fulfilment of one or more of the following additional inclusion criteria: hypoproteinaemia, hypoalbuminaemia, malabsorption, an increased intestinal wall thickness on ultrasonographic examination or histopathological changes in rectal biopsy. These 20 horses were treated with a standardized larvicidal anthelmintic regime and a minimum of three weeks of corticosteroid therapy. Results The initial response to treatment was good in 75% (15/20) of horses, with a 3-year survival rate of 65% (13/20). The overall 3-year survival in horses that responded to initial treatment (12/15) was significantly higher (P = 0.031) than in those that did not respond to initial treatment (1/5). The peak xylose concentration was significantly (P = 0.048) higher in survivors (1.36 ± 0.44 mmol/L) than non-survivors (0.94 ± 0.36 mmol/L). Conclusions The overall prognosis for long-term survival in horses with a presumptive diagnosis of IBD appears to be fair to moderate, and the initial response to anthelmintic and corticosteroid therapy could be a useful prognostic indicator. The findings of the present study suggest that a low peak xylose concentration in absorption testing is associated with a less favourable prognosis, supporting the use of this test

Owner-Reported Clinical Signs and Management-Related Factors in Horses Radiographed for Intestinal Sand Accumulation

Clinical problems related to intestinal sand accumulation in horses are common in certain geographic areas, but the clinical signs appear nonspecific and the course of the accumulation remains somewhat obscure. This study examined the association between the presence and size of intestinal sand accumulations and owner-reported clinical signs, management, and feeding practices, as well as behavioral patterns in horses with radiographic diagnosis of sand accumulation. Owners of the horses filled in an online questionnaire. A total of 447 responses met the inclusion criteria. The size of the sand accumulation detected in the radiographs was not significantly associated with the age, body condition score, sex, or use of the horses. Horses reported to have expressed colic had significantly larger sand accumulations than those without this sign, and a similar association was detected in horses with poor performance. The highest odds ratio for sand accumulation was for the combination of colic and poor performance, followed by colic combined with diarrhea/loose feces or hyperesthesia to touch of the abdominal wall. Larger sand accumulations were detected in greedy horses that eat all their roughage, whereas dominant position in group hierarchy was associated with less sand. The possibility of abdominal sand accumulation should be considered as one of the differentials in horses with multiple owner-reported clinical signs such as colic, poor performance, diarrhea, and hyperesthesia to touch of the abdomen. (C) 2019 The Authors. Published by Elsevier Inc.Peer reviewe

Pikkuvarsojen ojentajajänteen repeämä

Pikkuvarsoilla tavataan etujaloissa satunnaisesti ojentajajänteen repeämiä. Repeämäkohta on etupolven alueella jännetupen sisällä, ja repeämän seurauksena etupolven ulkopinnalle syntyy fluktuoiva turvotus. Varsat eivät varsinaisesti onnu, mutta heittävät jalan ulkokautta eteen ja voivat kompuroida tai raahata jalkaa. Repeämä voi olla varsan ainoa ongelma, tai se voi liittyä muihin ortopedisiin ongelmiin. Ojentajajänteen repeämä yhdessä nivelkoukistumien, luuston kehittymättömyyden ja alapurennan kanssa ovat tyypilliset oireet Pohjois-Amerikassa raportoidussa pikkuvarsan kilpirauhasen vajaatoiminta –oireyhtymässä. Syventävissä opinnoissani kartoitettiin pikkuvarsojen ojentajajänteen repeämän yleisyyttä Yliopistollisen eläinsairaalan potilasaineistossa, eri hoitovaihtoehtoja ja varsojen ennustetta. Lisäksi pyrittiin selvitettämään repeämän mahdollista yhteyttä pikkuvarsojen kilpirauhasen vajaatoiminta –oireyhtymään Suomessa. Vuosina 1986 - 1999 diagnosoitiin ojentajajänteen repeämä 14 varsalla. Kaikki varsat olivat alle kaksiviikkoisia repeämän tapahtuessa. Kahdeksalla varsalla molempien etujalkojen jänteet olivat repeytyneet, kuudella vain toisen jalan. Puolella varsoista oli myös nivelkoukistumia, useimmiten etupolvessa. Samoin puolella oli merkkejä luuston epäkypsyydestä. Yhdellä varsalla oli neljä tyypillistä kilpirauhasen vajaatoimintaan viittaavaa oiretta, viidellä oli kolme oiretta. Kaikki varsat olivat karsinalevossa 1 – 4 viikkoa, ja yhtä lukuunottamatta kaikilla pidettiin repeämäjalassa pehmustettua tukisidettä saman ajan. Osalla varsoista oli myös lasta. Rajoitettu liikunta aloitettiin oireiden vähennyttyä, ja ulkoiluaikaa lisättiin vähitellen. Varsat, joilla oli pelkkä repeämä, paranivat hyvin. Muut ongelmat kuten nivelkoukistumat heikensivät ennustetta. Varsoista neljä on lopetettu, kaikilla lopettamisen syynä oli muu kuin repeämä. Ojentajajänteen repeämästä kärsivä varsa on aina tutkittava huolellisesti, sillä vaikka repeämä on helposti hoidettava ja yksinkertainen vaiva, siihen näyttää yleisesti liittyvän muita huomattavasti hankalampia ongelmia