Chronic gastric dilatation in horses: diagnosis, treatment and feeding management – A survey of 20 clinical cases

Abstract

Chronic gastric dilatation is a rarely diagnosed disease of the horse. The objective of this report was to describe the clinical and ultrasonographic findings of 20 cases of chronic gastric dilatation in horses. Furthermore, horses' clinical history, signalment and clinical and gastroscopic findings were recorded. Medication, feeding management and outcome are presented. Inclusion criteria were: 1) Clinical signs of recurrent abdominal discomfort or resistance to the riders leg; 2a) Repeated ultrasonographic finding of an enlarged stomach (more than five intercostal spaces), or alternatively; 2b) Repeated gastroscopic finding of an impacted stomach in combination with a subsequent sonographical confirmation; 3a) No gastric emptying following 12 hours of starvation, or 3b) Emptying but repeated episodes of dilatation following normal feeding regime; 4) Exclusion of acute gastric impactions and other gastrointestinal disorders. All horses had shown one or several of the following symptoms: repeated signs of discomfort, recurrent mild or moderate acute colic, defensive reaction when fixing the girth or against the riders left leg, chronic weight loss, poor performance and more. With exception of the rectal examination, clinical and laboratory examination was not conclusive. 19 horses showed an enlarged stomach at initial sonography (range: six to eleven intercostal spaces). The initial examination in one horse referred to our clinic was merely by gastroscopy. Gastroscopy was performed in eleven cases. The horses were treated with metoclopramide hydrochloride ( 0.1-0.15 mg/kg twice daily p.o.) and feeding management was adapted according to nutritionist's or veterinarian's recommendations. The mean duration of treatment was 16 months at submission of the manuscript. No side effects were observed. Seventeen of the treated horses survived in the long term. One horse was euthanized 10 days after start of treatment with metoclopramide hydrochloride, at the request of the owner as he had noticed no clinical improvement in that period of time. Two horses were euthanized because of orthopedic problems. Fifteen horses showed complete, and four horses partial clinical improvement after treatment and feeding management was adapted. Metoclopramide hydrochloride seemed effective for the long-term treatment of chronic gastric dilatation. Long-term administration of metoclopramide hydrochloride could be an alternative to bethanechol. Further studies are needed to determine the exact pathophysiologic mechanisms of chronic gastric dilatation and to determine the exact diagnostic findings related to different disease states.

Brunner's gland hyperplasia and recurrent gastric impaction in a horse

“…Although some horses with recurrent gastric impaction have been successfully managed with long‐term dietary modification (removal of long fibre forage) and motility stimulant administration, 4 others fail to respond and require euthanasia.…”

The use of cola for the treatment of gastric impactions in equids

“…In many cases a diagnosis is only made once the impaction has reached an advanced stage (Klier et al 2017). The most commonly reported signs associated with gastric impaction are anorexia, weight loss, emaciation, (recurrent) colic signs and sometimes foul-smelling eructation (Bird et al 2012, Bäuerlein et al 2019, Sanchez 2018. Other, less common, symptoms include lethargy and pyrexia (Vainio et al 2011, Bäuerlein et al 2019.…”

“…To confidently identify delayed gastric emptying, repeated ultrasonographic examinations are recommended (Reef 1998, Klier et al 2017. In ponies and miniature horses, abdominal radiographs may allow detection of the enlarged stomach (San-chez 2018) and in rare cases a diagnosis of gastric impaction can be made by rectal examination, especially if the stomach contains more than 30-35 litres (Hutyra et al 1945, Müller 1995, Huskamp et al 2003, Klier et al 2017, Bäuerlein et al 2019. Finally, post-mortem examination may reveal gastric impaction and evidence of potential underlying causes can be investigated, although these are not always found (Klier et al 2017).…”

“…Successful treatment by gastrotomy and evacuation of the gastric contents has been reported, although access to the stomach is challenging and carries a high risk of contaminating the abdominal cavity and the subsequent development of peritonitis (Owen et al 1987, Freeman 2011. Prokinetic drugs, including metoclopramide, have also been used in the treatment of (chronic) cases of gastric dilatation (Bäuerlein et al 2019).…”

“…The prognosis of gastric impaction, especially chronic cases, is considered poor by some, with 16/17 horses being euthanized in one study (Scheidemann and Huthmann 2011) and only 5/12 cases treated successfully as reported in another paper (Bird et al 2012). Müller et al (1995), on the other hand, suggested that patients with chronic gastric dilatation could tolerate and live with limited chronic enlargement and Bäuerlein et al (2019) reported that 17/20 cases of chronic gastric dilation survived long-term when treated with metoclopramide per os, including three cases in which the stomach was never completely empty. Vainio et al (2011) found a similar survival rate (18/20 horses), while results reported by Tallon et al (2020) are slightly less favourable, with 68/113 (60 %) horses with gastric impaction surviving to discharge.…”