• 11 March 2015

"Beyond the stomach: Considerations of Equine Intestinal Pathologies"

Equine gastric ulcer syndrome has been the focus of extensive research, and diagnostic and drug developments. However, work currently being undertaken by Derek Knottenbelt, Nicola Kerbyson and Tim Parkin at the Glasgow School of Veterinary Medicine in collaboration with Freedom Health LLC is shifting the spotlight towards the large bowel and specifically colonic mucosal pathology.

Presenting at EBVM 2014, Kerbyson highlighted that pathological conditions of the intestinal tract beyond the stomach has been largely unreported and, in turn, “grossly underestimated” by the veterinary community. This is due in part to limitations on current diagnostic techniques. However, confusion and uncertainty over the clinical significance of pathological conditions of the large bowel, such as an ulcerative bowel disease, may also be partly to blame. Regardless, the incidence of this type of disease is surprising. Franklin Pellegrini , Director of Veterinary Medicine for Freedom Health, in his 2005 post-mortem study, reported a 64% incidence rate among performance horses for some form of ulcerative, proliferative or haemorrhagic pathology in the large colon (N=180). Furthermore, data collected by Pellegrini from 563 subsequent post mortems yielded an even higher incidence of 84%; rates reproduced in recent post mortem studies by Knottenbelt and Kerbyson. With incidence rates as high as these, the clinical significance of this disease is apparent.

Colonic ulceration and inflammation can elicit a range of symptoms from hindgut discomfort and recurrent colic to loss of performance and condition and even behavioural and lameness issues. Knottenbelt went on to note at AAEP 2014, that “this variable presentation and often lack of overt pathology may be why vets are too often seeing these horses at a critical stage. At this late point diagnoses may often only be achieved through histological examination during surgery or post mortem. Whilst it’s useful to know why an invasive procedure had to be carried out, an understanding of the disease process at an earlier point may allow practitioners to take proactive steps to correct it.” This gives rise to the importance of reliable diagnostic methods.

The SUCCEED® Equine Fecal Blood Test™ (FBT) is a diagnostic aid which, in conjunction with the clinician’s knowledge and expertise, facilitates differential diagnosis. This rapid field screen test, (a lateral flow ELISA) detects occult equine albumin and haemoglobin in a faecal sample stable-side, as an indication of gastrointestinal pathology. The enzymatic degradation of albumin, but not haemoglobin, cranial to the common bile duct enables conditions to be pinpointed as foregut, hindgut, or both. The test is highly sensitive but non-specific, developed to initiate the diagnostic process. The FBT has a high PPV for colonic pathology, but it is akin to a thermometer, and intended to be an indicator of disease rather than confirming a specific pathology.

The FBT is a key means for not only expanding the knowledge base of colonic mucosal pathology, but to enable the clinician to select the most appropriate and effective additional investigatory techniques and implement the best treatment options for optimal recovery.

Given the recent research, and the availability of a reliable diagnostic aid, clinicians are well-served to consider pathologies of the gut beyond the stomach in their equine patients.

 

For further information

Dr Emma Hardy

t +44 (0)7850176119

e This email address is being protected from spambots. You need JavaScript enabled to view it.

w www.succeedfbt.co.uk