Medical management of sand enteropathy is common in equine practice, but the clinical features and outcomes associated with medically managed sand enteropathy are not well described.
To review clinical features, therapeutic approaches and outcomes associated with primary medical management of sand enteropathy in the mature horse.
Medical record databases at 3 equine referral hospitals from January 2000 to April 2010 were reviewed for cases of sand enteropathy diagnosed via abdominal radiographs in mature horses that were initially managed medically. Data were collected and descriptive analyses compiled. Uni- and multivariate logistic regression was used to evaluate factors potentially associated with treatment failure.
The medical records of 62 horses were analysed; 90% of horses survived to discharge and 50% of horses that had repeat abdominal radiographs taken demonstrated improvement in the degree of sand accumulation after treatment. Nine horses underwent exploratory laparotomy during hospitalisation, and colonic sand impaction was found in all 9, with a concurrent gastrointestinal lesion identified in 7. Four horses were subjected to euthanasia during or after surgery because of disease severity or complications. Need for exploratory laparotomy was the factor most strongly associated with nonsurvival.
These data suggest that medical management can result in clinical and radiographic resolution of uncomplicated sand enteropathy in mature horses, and is associated with a good prognosis. Horses with sand enteropathy that exhibit persistent colic signs despite medical management are likely to have a concurrent gastrointestinal lesion, so prompt exploratory laparotomy should be considered in such cases.
Uncomplicated sand enteropathy can be managed medically in mature horses, and serial abdominal radiography can be used to monitor sand clearance. Surgery to evaluate for and correct concurrent gastrointestinal lesions should be recommended without delay in horses showing persistent colic signs.
"However, we expected it to be minor compared to the magnitude of the reduction of sand in accumulations considered to be resolved and unlikely to cause a clinically relevant bias. Landes et al. (2008) showed that a 0.5 g/kg dose of psyllium combined with pro-and prebiotics increased faecal sand excretion in horses with no colic signs, whereas Ruohoniemi et al. (2001) and Hart et al. (2013) have described radiographic monitoring of sand removal in equine clinical cases. The current study focused on the rate of evacuation of sand from the colon, rather than the absolute quantity of sand removed, as each horse had different quantities of sand in the colon at the beginning of the study. "
[Show abstract][Hide abstract] ABSTRACT: Prospective studies documenting the efficacy and side effects of medical treatment for colonic sand accumulation in horses are limited. The purpose of the study was to compare the effect of enteral administration of magnesium sulphate (MgSO4), psyllium mucilloid (psyllium), and a combination of MgSO4 and psyllium on the evacuation of large accumulations of sand in the large colon of adult horses. Thirty-four horses with naturally acquired, large sand accumulations (>5 cm × 15 cm) identified on abdominal radiography were randomly allocated to one of three treatment groups: (1) 1 g/kg psyllium (n = 12); (2) 1 g/kg MgSO4 (n = 10), or (3) their combination (n = 12). Treatments were administered once a day via nasogastric intubation and continued for a total of 4 days. Lateral radiographs of the ventral abdomen were repeated on day 4 of treatment. If the area of sand in the radiographic image was <25 cm2 on day 4, the sand accumulation was considered resolved.Of 12 horses treated with a combination of psyllium and MgSO4, nine evacuated the sand from the ventral colon within 4 days. In comparison, only 3/12 horses treated with psyllium and 2/10 horses treated with MgSO4 resolved (both significantly different from the combination; P < 0.05). Large accumulations of sand in the large colon of horses can be treated medically. Administering a combination of psyllium and MgSO4 via nasogastric intubation once daily for a total of 4 days was a more effective treatment than either constituent alone.
The Veterinary Journal 10/2014; 202(3). DOI:10.1016/j.tvjl.2014.10.017 · 1.76 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The gastrointestinal microbiota is extremely important for human and animal health. Investigations into the composition of the microbiota and its therapeutic modification have received increasing interest in human and veterinary medicine. Probiotics are a way of modifying the microbiota and have been tested to prevent and treat diseases. Probiotics are proposed to exert their beneficial effects through various pathways. Production of antimicrobial compounds targeting intestinal pathogens, general immune stimulation, and colonization resistance are among these mechanisms. Despite widespread availability and use, scientific, peer-reviewed evidence behind commercial probiotic formulations in horses is limited. Additionally, quality control of commercial over-the-counter products is not tightly regulated. Although promising in vitro results have been achieved, in vivo health benefits have been more difficult to prove. Whether the ambiguous results are caused by strain selection, dosage selection or true lack of efficacy remains to be answered. Although these limitations exist, probiotics are increasingly used because of their lack of severe adverse effects, ease of administration, and low cost. This review summarizes the current evidence for probiotic use in equine medicine. It aims to provide veterinarians with evidence-based information on when and why probiotics are indicated for prevention or treatment of gastrointestinal disease in horses. The review also outlines the current state of knowledge on the equine microbiota and the potential of fecal microbial transplantation, as they relate to the topic of probiotics.
Journal of Veterinary Internal Medicine 09/2014; 28(6). DOI:10.1111/jvim.12451 · 1.88 Impact Factor
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