Chronic severe pyloric lesions in horses: 47 cases

Abstract

Summary Background The clinical findings and outcome associated with chronic severe equine pyloric lesions have not been well described previously. Objectives To describe the history, clinical signs, endoscopic and ultrasound results, laboratory data, treatment, pathological findings and survival of horses with chronic severe pyloric lesions. Study design Retrospective case series. Methods Medical records from horses treated at clinics in Czech Republic and Germany in which chronic severe pyloric lesions were confirmed endoscopically and/or on post‐mortem examination were reviewed. Results Forty‐seven horses were identified, median age 3 years (range 0.8–16 years). There were 3 geldings, 23 mares and 19 stallions and the majority were Warmbloods (60%). The most common presenting signs were poor body condition (40; 87%), slow eating (39; 83%), recurrent colic (35; 74%) and selective appetite (30; 64%). The most consistent laboratory abnormality was hypoalbuminaemia (10; 36%). Slow gastric emptying was confirmed in 29 individuals during gastroscopy and/or ultrasonography. Endoscopy revealed distal oesophagitis in 9 of 47 horses, and severe equine squamous gastric disease in all cases. Pyloric lesions were depressed, flat or raised fibrinosuppurative pyloric ulcers and were seen in 45 (2 pylori were not seen endoscopically). Thirty‐two cases were treated, with 28 responding well initially. All treated cases received anti‐ulcer medication and four underwent gastrojejunostomy. Clinical signs recurred after medical treatment in at least 11 cases. Only 18 of 44 cases (41%) survived long term (3 were lost to follow‐up). Horses diagnosed at 3 years of age or younger were significantly less likely to survive more than 6 months than older horses (27.8% vs. 72.2%, P<0.001). Main limitations The study is retrospective, some records were incomplete and case identification was subjective. Conclusions Chronic severe pyloric lesions can be associated with delayed gastric emptying identified with ultrasonography and/or endoscopy. The prognosis is poor in young horses.

Managing glandular gastric disease in horses

“…Delayed gastric emptying has been reported in horses with chronic severe pyloric ulceration and is associated with a poor prognosis in young horses (Bezdekova and others 2020).…”

“…This is often found in conjunction with a mononuclear cell infiltrate of the lamina propria. Submucosal and muscular fibrosis may be evident in horses with deep ulceration (Bezdekova and others 2020). The raised hypertrophic rugal folds seen in some cases are characterised by hyperplasia of the gastric foveolae, and bear similarities with the hypertrophic folds seen in people with hypertrophic lymphocytic gastritis (Husted and others 2010).…”

“…In severe cases, the pylorus will be permanently disfigured despite mucosal healing. This is likely due to submucosal and muscular fibrosis, and may result in pyloric dysfunction and delayed gastric emptying (Bezdekova and others 2020).…”

Squamous gastric ulceration complicated by gastric stenosis in a foal

“…The term equine gastric ulcer syndrome (EGUS) has been in use since 1999 to describe stomach ulcers in horses, but more recently it has become clear that it encompasses two very different disease entities, now termed equine squamous gastric disease (ESGD) and equine glandular gastric disease (EGGD), with differing risk factors, epidemiology, clinical signs and prognosis (Sykes et al., 2015). Equine squamous gastric disease is the result of increased exposure of the squamous mucosa to acid and may be primary or secondary to duodenal outflow obstruction (Bezdekova & Hanak, 2009; Bezdekova et al., 2020; Sprayberry, 2015; Sykes et al., 2015; Zedler et al., 2009). Stress is often thought to play a role in the development of both ESGD and EGGD, both in foals and adult horses, although proof of the role of stress in ESGD is scarce and often indirect (Scheidegger et al., 2017; Sprayberry, 2015).…”

“…(2013) reported a developmental abnormality in the stomach of a 9‐month‐old Warmblood filly that caused delayed gastric emptying. Most commonly, impaired gastric emptying is seen in foals with ulcers at the gastroduodenal junction (Bezdekova et al., 2020; Sprayberry, 2015; Zedler et al., 2009).…”