Diagnostic accuracy of blood sucrose as a screening test for equine gastric ulcer syndrome (EGUS) in adult horses

Abstract

BackgroundEquine gastric ulcer syndrome (EGUS) is common in adult horses, particularly those involved in performance disciplines. Currently, detection of EGUS by gastroscopy is the only reliable ante mortem method for definitive diagnosis; however it is unsuitable as a screening test because it is expensive, time consuming, and is not readily available to most veterinarians. Sucrose permeability testing represents a simple, economical alternative to gastroscopy for screening purposes, and the feasibility of this approach in the horse has been previously reported. The aim of this study was to determine the diagnostic accuracy of blood sucrose as a screening test for EGUS in a large group of adult horses with and without naturally occurring gastric disease.ResultsOne hundred and one adult horses with or without naturally occurring gastric ulceration were studied. The diagnostic accuracy of blood sucrose for diagnosis of gastric lesions (GL), glandular lesions (GDL), squamous lesions (SQL), and clinically significant lesions (CSL) at 45 and 90 min after administration of 1 g/kg of sucrose via nasogastric intubation was assessed using receiver operator characteristics (ROC) curves and calculating the area under the curve (AUC). For each lesion type, sucrose concentration in blood was compared to gastroscopy, as the gold standard, and sensitivities (Se) and specificities (Sp) were calculated across a range of sucrose concentrations. Ulcer grading was performed blindly by one observer; and the results were validated by comparing them with that of two other observers, and calculating the level of agreement. Cut-off values were selected manually to optimize Se. The prevalence of GL, GDL, SQL, and CSL was 83, 70, 53 and 58% respectively. At the selected cut-offs, Se ranged from 51 to 79% and Sp ranged from 43 to 72%, depending upon the lesion type and time of sampling.ConclusionsBlood sucrose is neither a sensitive or specific test for detecting EGUS in this population of adult horses with naturally occurring gastric ulceration. Further studies aimed at evaluating the performance characteristics of the test in different study populations are warranted. Given the limitations of endoscopy, due consideration should also be given to alternative methods for comparison of blood sucrose with a gold standard.Electronic supplementary materialThe online version of this article (doi:10.1186/s13028-017-0284-1) contains supplementary material, which is available to authorized users.

BEVA primary care clinical guidelines: Analgesia

“…A further study using sucrose permeability as a marker of gastric damage showed that phenylbutazone caused more gastric damage compared to equipotent doses of meloxicam. However, sucrose permeability did not correlate with plasma protein concentrations, and the clinical relevance of these findings is not fully understood, nor is sucrose absorption directly related to gastric pathology . In foals, the use of NSAIDs is often associated with clinically significant adverse events, especially in relation to gastric ulceration.…”

Recommendations for the management of equine glandular gastric disease

“…Gastroscopy is currently the only reliable ante mortem means of diagnosing and monitoring EGGD; and should be considered the gold standard against which all other diagnostic tests are compared (Sykes et al, 2015a). Based on current evidence, the sucrose blood test and tests for protein or haemoglobin in faeces are unreliable and should not be used diagnostically (Sykes et al, 2014a;Hewetson et al, 2017). Biopsies are rarely indicated but if more severe pathological changes are suspected or if cases are refractory to treatment for 3 or more months then biopsies should be considered.…”

Searching for serum protein markers of equine squamous gastric disease using gel electrophoresis and mass spectrometry

“…ESGD is very common, particularly in performance horses (>80%) [5][6][7][8][9] and has potentially deleterious effects on both animal welfare and performance [3,4]. At present there are no reliable, noninvasive, rapid diagnostic tests available to detect ESGD [10][11][12], and the current consensus statement recommends gastroscopy as the most reliable diagnostic method [4,12,13]. However, gastroscopy, is unsuitable as a screening test due to it being expensive, time consuming, and not readily available to most veterinarians [11,13].…”

“…At present there are no reliable, noninvasive, rapid diagnostic tests available to detect ESGD [10][11][12], and the current consensus statement recommends gastroscopy as the most reliable diagnostic method [4,12,13]. However, gastroscopy, is unsuitable as a screening test due to it being expensive, time consuming, and not readily available to most veterinarians [11,13]. Therefore, a simple, accurate and noninvasive technique is required to determine the presence of ESGD.…”