Assessment of agreement using the equine glandular gastric disease grading system in 84 cases

Pratt, Stefanie; Bowen, Mark; Hallowell, Gayle; Shipman, Emma; Redpath, Adam

doi:10.1002/vms3.807

Cited by 5 publications

(1 citation statement)

References 28 publications

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“…However, there are growing concerns regarding the significance of gross glandular lesions to their presenting complaints [ 63 ] and histological findings [ 88 ]. Gastroscopy has been shown to have moderate inter- and intra-individual agreement for ESGD [ 116 ], but considerable variability for descriptors of EGGD [ 116 , 117 , 118 ]. Further, there is also increasing evidence of the lack of association between gross glandular lesions and histological evidence of inflammation [ 67 , 88 ].…”

Section: Diagnosismentioning

confidence: 99%

Equine Gastric Ulcer Syndrome: An Update on Current Knowledge

Vokes

Lovett

Sykes

2023

Animals

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Equine Gastric Ulcer Syndrome (EGUS) is a term that has been used since 1999, initially being used to describe all gastric mucosal disease in horses. Since this time, the identification of two distinct main disease entities of the equine gastric mucosa have been described under the umbrella of EGUS; these are Equine Squamous Gastric Disease (ESGD) and Equine Glandular Gastric Disease (EGGD). In 2015 the European College of Equine Internal Medicine (ECEIM) released a consensus statement defining these disease entities. This document highlighted the lack of evidence surrounding EGGD compared to ESGD, and identified knowledge gaps for further research to be directed. Subsequently, many studies on EGGD have been published, especially on pathophysiology, diagnosis, and treatment. This article updates current knowledge on both ESGD and EGGD as understanding has evolved since the last large-scale review.

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Section: Diagnosismentioning

confidence: 99%

Equine Gastric Ulcer Syndrome: An Update on Current Knowledge

Vokes

Lovett

Sykes

2023

Animals

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Does lesion type or severity predict outcome of therapy for horses with equine glandular gastric disease? – A retrospective study

Pratt

Bowen²,

Hallowell³

et al. 2022

Veterinary Medicine & Sci

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Background Equine glandular gastric disease (EGGD) is a common condition of the horse. Misoprostol is reported to be superior to oral omeprazole and sucralfate for treatment. Long‐acting intramuscular injectable omeprazole (LAIOMEP) is a novel treatment shown to be effective in a small population. Objectives This study aimed to determine LAIOMEP efficacy compared to misoprostol and oral omeprazole and identify characteristics that predict treatment outcome. Methods All horses that underwent gastroscopy between 2012 and 2019 were reviewed. Lesions were characterised by 4 blinded observers, all of whom are diplomates in equine internal medicine, using established descriptors from the ECEIM consensus statement and subjective severity. Treatment outcome was ranked as worsened, improved or healed. Consensus lesion type, lesion severity and treatment choice were compared to outcome and data screened using univariate analysis (chi‐squared) to determine whether each predicted outcome. Lesion types where univariate analysis predicted a trend ( p <0.2) were included in a multiple‐regression analysis to identify predictors of outcome irrespective of treatment. Results Only severity significantly predicted final outcome ( p = 0.025) with severe lesions being more likely to improve. Treatment choice did not significantly predict outcome. Overall healing rate was 29% (24 horses), and 43% (44 horses) improved. Treatment healing rates were 23% (10), 12% (7) and 27% (7) for LAIOMEP, misoprostol and oral omeprazole, respectively, with improvement in 69% (14), 76% (21) and 61% (9). 64% of the latter group received sucralfate. Worsening occurred in 7% (6). Treatment length varied with a median of 4 weeks (range 4–20 weeks). Conclusions This study showed poorer therapy outcome compared to previous studies. The only initial lesion descriptor to predict outcome was severity and treatment choice did not affect outcome.

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Assessment of agreement using the equine glandular gastric disease grading system in 84 cases

Pratt

Bowen

Hallowell

et al. 2022

Veterinary Medicine & Sci

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Introduction Equine glandular gastric disease (EGGD) is a common condition causing signs of gastric pain although lesions are highly variable in their appearance. The only definitive method to diagnose EGGD ante‐mortem is gastroscopy. The current recommended method for describing these lesions is the European College of Equine Internal Medicine (ECEIM) guidelines; however, repeatability between users is variable. This study aimed to validate the reliability of lesion descriptions using ECEIM consensus guidelines, using four blinded equine internal medicine diplomates. Methods Ninety‐two horses with EGGD with pre‐ and post‐treatment gastroscopy images were identified using the electronic record at a UK equine hospital between 2012 and 2019. Eight horses were excluded due to non‐diagnostic images. Four blinded observers used the recommended grading system to describe images and outcomes. Intraclass correlation coefficients and Krippendorff's alpha were used to determine reliability and agreement, respectively. Results Intraclass correlation coefficient for severity was 0.782 (95% confidence interval [CI] 0.722–0.832), for distribution was 0.671 (95% CI 0.540–0.763), for the descriptor raised was 0.635 (95% CI 0.479–0.741), fibrinosuppurative was 0.745 (95% CI 0.651–0.812), haemorrhagic was 0.648 (95% CI 0.513–0.744), hyperaemic was 0.389 (95% CI 0.232–0.522) and for outcome was 0.677 (95% CI 0.559–0.770). Krippendorff's alpha for severity was 0.466 (95% CI 0.466–0.418), for distribution was 0.304 (95% CI 0.234–0.374), for the descriptor raised was 0.268 (95% CI 0.207–0.329), fibrinosuppurative was 0.406 (95% CI 0.347–0.463), haemorrhagic was 0.287 (95% CI 0.229–0.344), hyperaemic was 0.112 (95% CI 0.034–0.188) and for outcome was 0.315 (95% CI 0.218–0.408). There was moderate reliability determined between observers using intra‐class correlation coefficients and unacceptable agreement determined between observers using Krippendorff's alpha. Discussion These results suggest that the current grading system is not comparable between observers, indicating the need to review the grading system or define more robust criteria.

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Assessment of agreement using the equine glandular gastric disease grading system in 84 cases

Cited by 5 publications

References 28 publications

Equine Gastric Ulcer Syndrome: An Update on Current Knowledge

Equine Gastric Ulcer Syndrome: An Update on Current Knowledge

Does lesion type or severity predict outcome of therapy for horses with equine glandular gastric disease? – A retrospective study

Assessment of agreement using the equine glandular gastric disease grading system in 84 cases

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