Equine choke refers to an obstruction of the horse’s esophagus and is a medical condition necessitating urgent attention. The condition most frequently occurs due to rapid feed consumption and the subsequent lodging of feed or other matter in the esophagus.

Choke can occur in horses of any age or breed. Risk factors for choke include poor teeth, feeding unsoaked food pellets or large pieces of vegetables, and growths in or deformities of the esophagus.

A veterinarian will diagnose choke based on multiple clinical symptoms, including saliva and feed discharge from the nostrils and mouth. Endoscopy is useful for observing the esophagus and any blockages in the organ.

Treatment of equine choke may require veterinary care, including flushing the esophagus and administering medications that relax the musculature of the esophageal structure. In rare cases, surgery may be necessary.

For horses with a history of choke, modifying the diet to slow down their consumption and soaking the feed can help prevent future incidences.

What is Choke in Horses?

A relatively common condition, equine choke occurs when the esophagus becomes partially or fully blocked by food or a foreign body. [1]

The esophagus is a muscular tube that enables the transfer of food from the mouth to the stomach.

Choke in horses is different than choking in humans, which occurs when something becomes lodged in the airway (trachea) and prevents normal breathing.

Horses can breathe when choke occurs because their airway is not obstructed. However, choke is still a medical emergency because it can result in life-threatening complications including pneumonia and esophageal rupture.

Choke commonly occurs when horses eat concentrated feeds (such as grains) too quickly without chewing properly. If a feed hasn’t been adequately hydrated with saliva, it can form a bolus that becomes trapped in the esophagus.

Non-food materials such as fecal matter and hairballs can also cause choke.

While choke can occur in any horse, ponies and senior horses may be more prone to the condition. [12]

Primary Choke

Primary choke results when food blocks the esophagus. Anything a horse eats can potentially become stuck in the esophagus.

Aggressive eaters and horses with poor teeth may be at increased risk of choke if they consume large amounts of feed too quickly.

Secondary Choke

Secondary choke occurs due to a structural deformity in the esophagus. It can also occur due to a neurological dysfunction that interferes with peristalsis (the transport of food) through the organ.

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Signs and Complications

The signs of choke are usually obvious, although some cases of the condition may go unnoticed. Signs of choke typically occur soon after the esophagus has become blocked.

Common signs of choke include:

  • Panicked eyes: Affected horses may exhibit an alarmed or confused look in their eyes.
  • Discharge: Saliva and feed may discharge from the nostrils and or mouth during choke.
  • Attempts to clear the throat: Horses with choke may cough, gag, and make repeated efforts to swallow.
  • Dehydration: Because horses with choke are unable to drink, horses will eventually become dehydrated if the condition is not addressed.
  • Elongating the neck: Stretching the neck to attempt to relieve the blockage in the esophagus
  • Discomfort: Showing signs of sweating or pain
  • Twitching neck muscles: Cramps and tremors in the muscle of the neck
  • Lump on the neck: A lump may be present on the left side of the horse’s neck where the blockage has occurred along the esophageal pathway
  • Opening the mouth: Yawning and opening the mouth wide
  • Drooling: Saliva and feed material may drool from the mouth as the horse cannot swallow effectively.
  • Grinding the teeth

Complications of Choke

If choke is not resolved promptly, complications can result and lead to long-term health problems.

Esophageal Rupture: A life-threatening complication of choke, esophageal rupture may result from the obstruction itself or attempts to dislodge the obstruction. If the esophagus ruptures, death may occur due to septic shock.

Aspiration Pneumonia: While experiencing choke, some horses may breathe in (aspirate) fluid or food into their trachea. If the fluid or food particles move into the lungs, an infection can occur. Signs of aspiration pneumonia typically occur within 24-48 hours of choke.

A study of 34 horses found that the duration of esophageal obstruction before admission to a veterinary clinic was significantly longer in horses that developed aspiration pneumonia compared to those that did not. [2]

Upon evaluation of 109 horses with esophageal obstruction, those with an increased respiratory rate and moderate to severe tracheal contamination had an increased risk of developing aspiration pneumonia. [3]

Esophageal Scarring: Scar tissue can develop if the esophagus becomes damaged to the extent of ulceration during an episode of choke. If enough scar tissue forms, it can reduce the internal diameter of the esophagus and increase the risk of future episodes of choke.

Risk Factors

Choke can occur in any horse, but is more likely in horses consuming certain types of dry commercial feeds and in horses with dental issues. Certain medical conditions can also increase the risk of developing equine choke.

Rapid Feed Consumption

The most common cause of equine choke is rapid feed consumption without adequate chewing. Course and dry foods can cause choke because they are more likely to lodge in the esophagus than softened and moist foods.

Dry feeds such as beet pulp, pellets, and hay cubes can swell quickly once they are chewed, causing them to lodge in the esophagus. Large pieces of carrots or apples can also occlude the esophagus.

Undeveloped or Poor Teeth

Foals with undeveloped teeth may be at risk of choke if given dry, coarse hay or straw.

Older horses with dental pain and fractured or missing teeth may be unable to properly move their jaw to chew their feed adequately, increasing their risk of choke.

Sedation

Drugs used to sedate your horse reduce the normal muscle movement within the esophagus, leading to an increased risk of choke. These medications should only be used under veterinarian supervision.

Medical Conditions

Choke can occur due to any medical condition that interferes with the ability to swallow.

  • Esophageal Stricture: A narrowing of the esophagus, strictures can occur in older horses due to a prior episode of choke. Some foals have esophageal strictures due to unknown causes. [1]
  • Esophageal Injury: Damage to the muscles and nerves of the esophagus that impede their normal function may increase the risk of choke.
  • Botulism: The bacterium Clostridium botulinum toxin that causes botulism blocks nerve signals that facilitate muscle contractions. This illness can cause difficulty with chewing and swallowing.
  • Esophageal Growths: Tumors and cysts can obstruct the equine esophagus. [4][5]
  • Megaesophagus: This condition involves an enlargement of the esophagus and is associated with decreased motility (movement of food) in this digestive organ. More frequently reported in Friesians, megaesophagus is a hereditary disease.[6][7]

Emergency Procedure

If you think your horse is experiencing choke, contact your veterinarian immediately. While you are waiting for your veterinarian to arrive, consider taking the following steps:

  1. Do not allow your horse to eat or drink. Remove access to all food and water as eating or drinking could increase the risk of esophageal rupture and aspiration pneumonia.
  2. Remove any feed that is present in the mouth to prevent your horse from swallowing it.
  3. Keep your horse calm. Place your horse in a familiar stall or enclosed area where she is comfortable to reduce stress while you wait for the veterinarian.
  4. Gently massage your horse’s neck in the jugular furrow using a downwards motion towards the heart to promote movement of the blockage.

Diagnosis

Prompt diagnosis and treatment of equine choke reduce the risk of complications.

A veterinarian can make a diagnosis of choke by physically examining the horse. This helps determine where the blockage has occurred and how dense it is.

It may be necessary for the vet to conduct an endoscopy to evaluate the obstruction by inserting a tube into the nostril and passing it into the esophagus. Failure to pass all the way to the stomach indicates there is an obstruction in the esophagus.

The veterinarian may also use x-rays to determine the location of the obstruction within the esophagus.

Although some cases of choke resolve on their own, you should always consult a veterinarian to confirm the diagnosis and ensure the condition has fully resolved.

Treatment

Choke can sometimes resolve on its own without treatment. Affected horses continue to produce saliva that lubricates the esophagus. Eventually, the obstruction may pass into the stomach without further intervention.

However, some obstructions can last for several hours or even days, increasing the risk of complications and dehydration. [11] Your veterinarian will decide which treatment is most appropriate for your horse.

Medication

Your veterinarian may decide to administer a sedative or an antispasmodic injection to encourage the esophagus muscles to relax.

The antispasmodic medication N-butylscopolammonium bromide (Buscopan) is considered an effective treatment for simple choke. It works by relaxing smooth muscles found in the lower third of the esophagus. [11]

The analgesic and antispasmodic medication metamizol can also be given. This acts as a pain killer, muscle relaxant and antipyretic (fever relief).

Oxytocin has also been used to treat the condition by reducing the tone of the esophageal musculature. [8]

Esophageal Flushing

Esophageal flushing involves gently irrigating the esophagus with water or another lubricating substance to encourage the obstruction to move into the stomach.

Your veterinarian must complete this procedure slowly and carefully to avoid injuring or rupturing the organ.

The procedure requires inserting a stomach tube into a nostril and down the esophagus to flush water through it while the affected horse is under sedation.

Esophageal flushing is done with the head of the horse positioned below the esophagus to prevent the flushed matter from entering the lungs.

Surgery

In severe cases of choke, surgery may be used as a last resort to resolve the condition. Surgical intervention is not usually necessary but may be required if no other treatments have worked.

An esophagostomy is a surgical procedure that involves creating an incision in the esophagus to facilitate the removal of an obstruction. [6]

Recovery & Follow up Care

After the obstruction has been cleared, your horse should be carefully monitored for signs of pain, distress or infection.

Your horse’s diet should be modified to provide feed that is easy to chew and swallow. Unsoaked pelleted feeds, dry grains and rough forages should be avoided.

Feeding: After an obstruction is cleared from the esophagus, horses should be fed grass or feeds in the form of a soaked mash for several days to allow the esophagus to heal.

This will help to avoid irritation of the esophagus and prevent choke from recurring. Soft and moistened feeds are ideal for horses to eat while esophageal swelling subsides.

Antibiotics: Your veterinarian may prescribe antibiotics to help prevent infection in the throat or lungs if aspiration of food or fluid has occurred.

Monitor your horse: Monitor your horse’s temperature for at least five days following an episode of choke. If your horse’s temperature rises above 38.5°C (101°F), this could indicate an infection.

Observe your horse for depression and reduced feed intake as these signs may indicate she is ill. Have your vet examine your horse if you are unsure if she is recovering well.

How to Prevent Equine Choke

Choke can happen to any horse anytime food or other substances are consumed. Consider taking the following precautions to help prevent the condition.

  • Soak dried feeds: Thoroughly soak feeds with water before they are eaten and swallowed. This is especially important when feeding forage cubes or beet pulp, which can expand when moistened by saliva.
  • Provide regular dental care: Have your horse’s teeth checked regularly (every six months to a year) to ensure they can chew their food properly. During a dental exam, your veterinarian will check for any injuries to the insides of the cheeks caused by sharp teeth, which may interfere with adequate chewing. [10]
  • Ensure access to fresh water: Provide constant access to clean water to encourage adequate water intake. Do not rely on natural water sources such as creeks, ponds, and streams for your horse to drink from as some horses will not drink readily from them.
  • Avoid problematic feeds: If your horse is prone to choking on certain types of feeds such as grains and concentrates, avoid feeding them and work with a nutritionist to identify a more suitable alternative.
  • Slow down aggressive eaters: Place a salt block or large, smooth rocks in your horse’s feed pan to slow the rate at which they eat their food. Feed hay in a hay net to slow down hay consumption. Spread forage over a large area so your horse cannot grab large mouthfuls at one time.
  • Feed in a natural position: Place your horse’s feed horses off the ground to keep their head and neck in a natural feeding position.
  • Reduce competition for food: Offer multiple buckets of food and water for horses fed in a group setting. This will decrease stress and competition at feeding time, which can cause horses to eat too quickly. Alternatively, separate horses at feeding time to prevent competition.
  • Provide several meals per day: Offer multiple meals with smaller amounts of feed in each rather than providing large feedings less often.
  • Soak or steam hay: Soaking or steaming hay makes it easier to chew and increases water intake.
  • Cut treats into small pieces: Cut apples and carrots into small pieces to prevent them from getting stuck in the esophagus if your horse fails to chew them adequately before swallowing.

If your horse has experienced choke in the past, consult with an equine nutritionist to develop a feeding plan to help prevent future episodes of choke.

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