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Topic:Colitis

Colitis in horses refers to inflammation of the colon, which can result from various causes including infections, toxins, and dietary changes. This condition affects the gastrointestinal system and can lead to symptoms such as diarrhea, abdominal pain, and dehydration. Colitis may be acute or chronic, with varying severity and potential complications. Diagnostic approaches often involve clinical examination, laboratory testing, and sometimes endoscopy or imaging to determine the underlying cause. Treatment strategies typically focus on addressing the primary cause, managing symptoms, and providing supportive care. This page compiles peer-reviewed research studies and scholarly articles that explore the etiology, pathophysiology, diagnosis, and management of colitis in equine patients.
Assessment of the impact of age and of blood-derived inflammatory markers in horses with colitis.
Journal of veterinary emergency and critical care (San Antonio, Tex. : 2001)    August 25, 2021   Volume 31, Issue 6 779-787 doi: 10.1111/vec.13099
Sage SE, Bedenice D, McKinney CA, Long AE, Pacheco A, Wagner B, Mazan MR, Paradis MR.To determine the impact of age on survival in horses with colitis and to elucidate whether a lower type-1/type-2 cytokine ratio or an exaggerated inflammatory state contribute to reduced survival in aged horses. Methods: Part 1: Retrospective cohort analysis. Part 2: Analytic observational study. Methods: Part 1: One hundred twenty-four adult horses with colitis. Part 2: Twenty-nine adult horses with new diarrhea onset while hospitalized. Results: Part 1: Patient signalment, select clinicopathological data, diagnoses, treatment, hospitalization length, and invoice were compared between survivo...
Detection of pathogens in blood or feces of adult horses with enteric disease and association with outcome of colitis.
Journal of veterinary internal medicine    August 12, 2021   Volume 35, Issue 5 2465-2472 doi: 10.1111/jvim.16238
Kopper JJ, Willette JA, Kogan CJ, Seguin A, Bolin SR, Schott HC.Rates of detecting ≥1 potential enteric pathogens (PEP) or toxins (PEP-T) in feces, blood, or both of horses ≥6 months of age with enteric disease and impact of multiple detections on outcome of horses with colitis has not been reported. Objective: To determine detection rates of PEP/PEP-T in feces, blood, or both of horses with enteric disease and effect of detecting multiple agents on outcome of horses with colitis. Methods: Thirty-seven hundred fifty-three fecal samples submitted to IDEXX Laboratories and 239 fecal and blood samples submitted to Michigan State University's Veterinary D...
The effects of signalment, diet, geographic location, season, and colitis associated with antimicrobial use or Salmonella infection on the fecal microbiome of horses.
Journal of veterinary internal medicine    July 16, 2021   Volume 35, Issue 5 2437-2448 doi: 10.1111/jvim.16206
Arnold CE, Pilla R, Chaffin MK, Leatherwood JL, Wickersham TA, Callaway TR, Lawhon SD, Lidbury JA, Steiner JM, Suchodolski JS.The fecal microbiome of healthy horses may be influenced by signalment, diet, environmental factors, and disease. Objective: To assess the effects of age, breed, sex, geographic location, season, diet, and colitis caused by antibiotic use (antimicrobial-associated diarrhea [AAD]) and Salmonella infection on fecal microbiota. Methods: Healthy horses (n = 80) were sampled from nonhospital environments across multiple geographical locations in the United States. Horses with AAD (n = 14) were defined as those that developed diarrhea secondary to antimicrobial use. Horses with Salmonella infect...
Clostridium piliforme infection (Tyzzer disease) in horses: retrospective study of 25 cases and literature review. García JA, Navarro MA, Fresneda K, Uzal FA.Tyzzer disease (TD) is caused by Clostridium piliforme, a gram-negative and obligate intracellular bacterium. The disease occurs in multiple species. A triad of lesions, namely colitis, hepatitis, and myocarditis, is described in cases of TD in some species, such as rats and mice. We carried out a retrospective analysis of 25 equine cases with a diagnosis of TD; 24 of 25 cases occurred in foals <45 d old; the remaining foal was 90 d old. There were 12 males and 12 females; no sex information was available for one foal. The affected breeds were Quarter Horse, Thoroughbred, Arabian, Paint, and...
Risk factors for laminitis and nonsurvival in acute colitis: Retrospective study of 85 hospitalized horses (2011-2019).
Journal of veterinary internal medicine    May 3, 2021   Volume 35, Issue 4 2019-2025 doi: 10.1111/jvim.16147
Luethy D, Feldman R, Stefanovski D, Aitken MR.Acute colitis is a serious cause of morbidity and death in horses. Recent studies have compared clinical features of coronavirus and salmonellosis, but no study has compared clinical features of enteric salmonellosis, coronavirus, and neorickettsiosis. Objective: To identify risk factors for laminitis and nonsurvival to discharge in horses with enteric salmonellosis, coronavirus, or neorickettsiosis. Methods: Eighty-five horses hospitalized for acute colitis from 2011 to 2019. Methods: Retrospective case series. Medical record review (2011-2019) of adult (≥2 years) horses with colitis. Pri...
Colonic Health in Hospitalized Horses Treated with Non-Steroidal Anti-Inflammatory Drugs – A Preliminary Study.
Journal of equine veterinary science    March 26, 2021   Volume 101 103451 doi: 10.1016/j.jevs.2021.103451
van Galen G, Saegerman C, Hyldahl Laursen S, Jacobsen S, Andersson Munk M, Sjöström H, Holm Lindmark S, Verwilghen D.Non-steroidal anti-inflammatory drugs (NSAIDs) can cause right dorsal colitis, but longitudinal clinical studies are lacking. This study investigates whether NSAID treated horses develop right dorsal colonic pathology in a clinical setting. Non-gastrointestinal hospitalized horses treated with NSAIDs >4 days, and untreated hospital-owned teaching horses and non-gastrointestinal client-owned hospitalized horses were included. All horses were monitored over time with clinical examinations (focusing on presence of colic, depression, reduced appetite, unstructured feces), ultrasonographic intestin...
Assessment of clinical and microbiota responses to fecal microbial transplantation in adult horses with diarrhea.
PloS one    January 14, 2021   Volume 16, Issue 1 e0244381 doi: 10.1371/journal.pone.0244381
McKinney CA, Bedenice D, Pacheco AP, Oliveira BCM, Paradis MR, Mazan M, Widmer G.Fecal microbial transplantation (FMT) is empirically implemented in horses with colitis to facilitate resolution of diarrhea. The purpose of this study was to assess FMT as a clinical treatment and modulator of fecal microbiota in hospitalized horses with colitis. A total of 22 horses with moderate to severe diarrhea, consistent with a diagnosis of colitis, were enrolled at two referral hospitals (L1: n = 12; L2: n = 10). FMT was performed in all 12 patients on 3 consecutive days at L1, while treatment at L2 consisted of standard care without FMT. Manure was collected once daily for 4 days fro...
Adverse Effect of Antibiotics Administration on Horse Health: An Overview.
Journal of equine veterinary science    December 2, 2020   Volume 97 103339 doi: 10.1016/j.jevs.2020.103339
Khusro A, Aarti C, Buendía-Rodriguez G, Arasu MV, Al-Dhabi NA, Barbabosa-Pliego A.Antibiotics-based therapy plays a paramount role in equine medicine because of their potential pharmacokinetics and pharmacodynamics properties. Conventional antibiotics show bacteriostatic and bactericidal properties by interfering bacterial cell wall and protein synthesis as well as inhibiting RNA polymerase, DNase 1, and DNA gyrase. Antibiotics are extensively used not only for the treatment of varied bacterial infections but also the prevention of postoperative and secondary infections. Surprisingly, antibiotics such as sulfonamides or trimethoprim/sulfonamide combinations, benzylpenicilli...
Washed Equine Platelet Extract as an Anti-Inflammatory Biologic Pharmaceutical.
Tissue engineering. Part A    September 30, 2020   Volume 27, Issue 9-10 582-592 doi: 10.1089/ten.TEA.2020.0160
Pennati A, Apfelbeck T, Brounts S, Galipeau J.Mammalian platelets participate in the immediate tissue injury response by initiating coagulation and further promoting tissue injury mitigation and repair. The latter properties are deployed following platelet release of presynthetized morphogens, cytokines, and growth and chemotactic factors, which launch a tissue regenerative, angiogenic, and anti-inflammatory program. Several blood-derived biologic products, like platelet-rich plasma (PRP) and platelet lysate (PL), are currently on the market to allow proper healing and tissue regeneration. However, not all growth factors are released from...
Luminal and Mucosal Microbiota of the Cecum and Large Colon of Healthy and Diarrheic Horses.
Animals : an open access journal from MDPI    August 12, 2020   Volume 10, Issue 8 doi: 10.3390/ani10081403
Arroyo LG, Rossi L, Santos BP, Gomez DE, Surette MG, Costa MC.The aim of this study was to compare the mucosal and luminal content microbiota of the cecum and colon of healthy and diarrheic horses. Marked differences in the richness and in the community composition between the mucosal and luminal microbiota of the cecum and large colon of horses with colitis were observed. Microbial dysbiosis occurs in horses with colitis at different levels of the intestinal tract, and microbiota composition is different between the mucosa and luminal content of diarrheic horses. The changes in some key taxa associated with dysbiosis in the equine intestinal microbiota,...
Mortality, clinical findings, predisposing factors and treatment of Clostridioides difficile colitis in Japanese thoroughbred racehorses.
The Veterinary record    March 22, 2020   Volume 187, Issue 2 e14 doi: 10.1136/vr.105605
Nomura M, Kuroda T, Tamura N, Muranaka M, Niwa H.Although Clostridioides difficile-associated diseases (CDAD) is considered to be associated with colitis in horses, few studies have been performed with a focus on the characteristics of CDAD in thoroughbred racehorses. Between 2010 and 2018, a test for C. difficile was performed using faecal samples from 137 thoroughbred racehorses with colitis presenting with diarrhoea and fever. The mortality rate, clinical findings, predisposing factors and the selected treatments were investigated in a retrospective manner. Twenty-four cases were diagnosed as CDAD and 113 as non-CDAD. The mortality rate w...
Science-in-brief: Report on the Havemeyer Foundation workshop on acute colitis of the adult horse.
Equine veterinary journal    February 9, 2020   Volume 52, Issue 2 163-164 doi: 10.1111/evj.13223
No abstract available
Equine Coronavirus-Associated Colitis in Horses: A Retrospective Study.
Journal of equine veterinary science    January 3, 2020   Volume 87 102906 doi: 10.1016/j.jevs.2019.102906
Mattei DN, Kopper JJ, Sanz MG.Equine coronavirus (ECoV) is a known cause of fever, anorexia, and lethargy in adult horses. Although there are multiple reports of ECoV outbreaks, less is known about the clinical presentation of individual horses during a nonoutbreak situation. The purpose of this study was to describe the clinical presentation of horses diagnosed with ECoV infection that were not associated with an outbreak. Medical records of all horses admitted to Washington State University, Veterinary Teaching Hospital, during an 8-year period were reviewed (2010-2018). The five horses included in this study were older ...
Fatal parasite-induced enteritis and typhlocolitis in horses in Southern Brazil. Bianchi MV, Mello LS, Wentz MF, Panziera W, Soares JF, Sonne L, Driemeier D, Pavarini SP.Diseases related to the alimentary system are the main cause of death in horses. This retrospective study aimed to describe the pathological findings of fatal parasite-induced enteritis and typhlocolitis caused by cyathostominae, Eimeria leuckarti, Balantidium coli, and Strongyloides westeri in horses. The records of parasite-induced intestinal lesions in horses necropsied in Southern Brazil between 2005 and 2017 were reviewed. Ten horses had fatal parasitic enteritis and/or typhlocolitis, and the main causes were: cyathostominae typhlocolitis (6/10), E. leuckarti enteritis (1/10), S. westeri ...
Plasma transfusions in horses with typhlocolitis/colitis.
The Canadian veterinary journal = La revue veterinaire canadienne    February 2, 2019   Volume 60, Issue 2 193-196 
Arroyo LG, Sears W, Gomez DE.The outcome of treatment of horses with plasma for typhlocolitis/colitis at the Ontario Veterinary College-Health Sciences Centre was evaluated. Horses with typhlocolitis/colitis that received a plasma transfusion had higher odds of dying than did non-transfused horses. The clinical usefulness of transfusing plasma to hospitalized hypoproteinemic horses is questioned. . Les résultats du traitement des chevaux à l’aide de plasma pour la typhlocolite/colite au Health Sciences Centre de l’Ontario Veterinary College ont été évalués. Les chevaux atteints de typhlocolite/colite qui avaient...
Evaluating continuous blood coagulopathy in assessing the severity of acute colitis in Thoroughbred racehorses.
Journal of equine science    September 19, 2018   Volume 29, Issue 3 79-85 doi: 10.1294/jes.29.79
Nomura M, Mizobe F, Kato T, Kuroda T, Urayama S, Muranaka M.Although severe blood coagulopathy in horses with acute colitis causes multiple organ failure, which may be fatal, few studies have focused on the correlation between the fluctuations of coagulation parameters and severity of colitis. In this study, we evaluated the fluctuations of coagulation parameters in 14 Thoroughbred racehorses with acute colitis for 5 days from the day of hospitalization and compared them between 5 survivors and 9 non-survivors. Noteworthy features in the non-survivors were that antithrombin activity and fibrin degradation products continuously decreased and increased, ...
Clinical features and outcome in horses with severe large intestinal thickening diagnosed with transabdominal ultrasonography: 25 cases (2003-2010).
Journal of the American Veterinary Medical Association    June 19, 2018   Volume 253, Issue 1 108-116 doi: 10.2460/javma.253.1.108
Biscoe EW, Whitcomb MB, Vaughan B, Dechant JE, Magdesian KG.OBJECTIVE To describe clinical features and outcome of horses with severe large intestinal thickening diagnosed with transabdominal ultrasonography. Methods: Retrospective case series. ANIMALS 25 horses. PROCEDURES Medical records of horses that underwent transabdominal ultrasonography between 2003 and 2010 were reviewed. Horses were included if the wall of the large intestine was ≥ 9 mm thick in any of 6 abdominal zones. RESULTS Median age was 13 years (range, 3 to 28 years). Horses were initially examined because of colic, diarrhea, inappetence, weight loss, lethargy, fever, or hematuria. ...
Hypertrophic cardiomyopathy in a Clydesdale gelding.
Australian veterinary journal    April 29, 2018   Volume 96, Issue 6 212-215 doi: 10.1111/avj.12701
Cullimore AM, Lester GD, Secombe CJ, Campbell K.A 7-year-old Clydesdale gelding was referred with a history of progressive lethargy and ventral oedema. The horse developed diarrhoea after treatment with antibiotics by the referring veterinarian. History, clinical signs, imaging and laboratory findings were consistent with hypertrophic cardiomyopathy complicated by antibiotic-associated colitis. Progression of clinical signs prompted euthanasia and the antemortem diagnosis of hypertrophic cardiomyopathy was confirmed at postmortem examination. Conclusions: Primary HCM is reported as rare in horses, but specific descriptions are lacking. The ...
Blood glucose is unlikely to be a prognostic biomarker in acute colitis with systemic inflammatory response syndrome in Thoroughbred racehorses.
Journal of equine science    March 23, 2018   Volume 29, Issue 1 15-19 doi: 10.1294/jes.29.15
Urayama S, Arima D, Mizobe F, Shinzaki Y, Nomura M, Minamijima Y, Kusano K.Although hyperglycemia at admission with colic has been reported to have a poor prognosis, there is no report specifically about acute colitis with systemic inflammatory response syndrome (SIRS) in horses. In this study, we measured blood glucose (Glu), insulin (Ins), and cortisol (Cor) levels in 17 Thoroughbred racehorses diagnosed as having acute colitis with SIRS, and examined the relationship between time-dependent changes in Glu, Ins, and Cor and prognosis. Glu levels were high in 3 horses at admission, but thereafter no horses had persistently high Glu levels. There was no significant di...
Neutrophil apoptosis is delayed in an equine model of colitis: Implications for the development of systemic inflammatory response syndrome.
Equine veterinary journal    May 27, 2016   Volume 49, Issue 3 383-388 doi: 10.1111/evj.12576
Anderson SL, Singh B.Horses that develop colitis invariably exhibit signs of a systemic inflammatory response syndrome (SIRS). A significant contributor to the development of SIRS in human subjects is delayed neutrophil apoptosis, but this has not been specifically studied in horses. Objective: To determine the occurrence of ex vivo neutrophil apoptosis and its contribution to the development of SIRS in an equine colitis model. Methods: Experiment using a colitis model. Methods: Neutrophils were isolated before and after the induction of colitis using an oligofructose overdose model, placed into culture for 12 h o...
Investigation of the potential immunomodulatory effects of resveratrol on equine whole blood: An in vitro investigation.
Research in veterinary science    March 31, 2016   Volume 106 97-99 doi: 10.1016/j.rvsc.2016.03.015
Martin LM, Johnson PJ, Amorim JR, Honaker AR, Donaldson RS, DeClue AE.Horses affected with gastrointestinal conditions such as colic or colitis are at substantial risk for translocation of bacterial components such as lipopolysaccharide (LPS, endotoxin) from the gastrointestinal tract into circulation resulting in systemic inflammation and subsequent morbidity and mortality. Therefore, there is a need for effective preventive and treatment strategies aimed at minimizing the host's inflammatory reaction to these pathogen-associated molecular patterns (PAMPs) from gastrointestinal disease. Resveratrol (RES, trans-3,5,4'-trihydroxystilbene) is a phytoalexin commonl...
Repeated measurements of blood lactate concentration as a prognostic marker in horses with acute colitis evaluated with classification and regression trees (CART) and random forest analysis.
Veterinary journal (London, England : 1997)    March 15, 2016   Volume 213 18-23 doi: 10.1016/j.tvjl.2016.03.012
Petersen MB, Tolver A, Husted L, Tølbøll TH, Pihl TH.The objective of this study was to investigate the prognostic value of single and repeated measurements of blood l-lactate (Lac) and ionised calcium (iCa) concentrations, packed cell volume (PCV) and plasma total protein (TP) concentration in horses with acute colitis. A total of 66 adult horses admitted with acute colitis (<24 h) to a referral hospital in the 2002-2011 period were included. The prognostic value of Lac, iCa, PCV and TP recorded at admission and 6 h post admission was analysed with univariate analysis, logistic regression, classification and regression trees, as well as ran...
Detection of Neorickettsia risticii, the agent of Potomac horse fever, in a Gypsy Vanner stallion from Manitoba.
The Canadian veterinary journal = La revue veterinaire canadienne    March 5, 2016   Volume 57, Issue 3 293-295 
Durán MC, Marqués FJ.A horse with colitis from Manitoba referred to the Veterinary Medical Centre, Western College of Veterinary Medicine, was diagnosed with Potomac horse fever (PHF). Polymerase chain reaction analysis of the feces confirmed Neorickettsia risticii infection. This is the first reported case of PHF in Manitoba. Détection deNeorickettsia risticii,agent de la fièvre du Potomac, chez un étalon Gypsy Vanner du Manitoba. Un diagnostic de fièvre du Potomac a été posé pour un cheval du Manitoba atteint de colite qui avait été recommandé au Veterinary Medical Centre du Western College of Veterina...
Methicillin-resistant Staphylococcus aureus ulcerative keratitis in a Thoroughbred racehorse.
Journal of equine science    September 30, 2015   Volume 26, Issue 3 95-98 doi: 10.1294/jes.26.95
Kuroda T, Kinoshita Y, Niwa H, Mizobe F, Ueno T, Kuwano A, Hatazoe T, Hobo S.We report the first case of methicillin-resistant Staphylococcus aureus (MRSA) keratitis in a racehorse. A 5-year-old mare developed punctate keratitis after racing. The corneal ulcer continued to expand despite ophthalmic antimicrobial therapy. On day 6, a conjunctival graft surgery was performed. The mare was euthanized, following colitis and laminitis development on day 10. MRSA was isolated from the corneal swab taken at the time of euthanasia. Immunohistochemical analysis demonstrated gram-positive and anti-S. aureus monoclonal antibody-positive cocci infiltration of the corneal stroma; a...
Gastritis, Enteritis, and Colitis in Horses.
The Veterinary clinics of North America. Equine practice    June 2, 2015   Volume 31, Issue 2 337-358 doi: 10.1016/j.cveq.2015.04.006
Uzal FA, Diab SS.The gastrointestinal system of horses is affected by a large variety of inflammatory infectious and noninfectious conditions. The most prevalent form of gastritis is associated with ulceration of the pars esophagea. Although the diagnostic techniques for alimentary diseases of horses have improved significantly over the past few years, difficulties still exist in establishing the causes of a significant number of enteric diseases in this species. This problem is compounded by several agents of enteric disease also being found in the intestine of clinically normal horses, which questions the va...
Characterization of Clostridium perfringens in the feces of adult horses and foals with acute enterocolitis. Gohari IM, Arroyo L, Macinnes JI, Timoney JF, Parreira VR, Prescott JF.Up to 60% of cases of equine colitis have no known cause. To improve understanding of the causes of acute colitis in horses, we hypothesized that Clostridium perfringens producing enterotoxin (CPE) and/or beta2 toxin (CPB2) are common and important causes of severe colitis in horses and/or that C. perfringens producing an as-yet-undescribed cytotoxin may also cause colitis in horses. Fecal samples from 55 horses (43 adults, 12 foals) with clinical evidence of colitis were evaluated by culture for the presence of Clostridium difficile, C. perfringens, and Salmonella. Feces were also examined by...
Postoperative Clostridium difficile infection with PCR ribotype 078 strain identified at necropsy in five Thoroughbred racehorses.
The Veterinary record    December 13, 2013   Volume 173, Issue 24 607 doi: 10.1136/vr.101960
Niwa H, Kato H, Hobo S, Kinoshita Y, Ueno T, Katayama Y, Hariu K, Oku K, Senoh M, Kuroda T, Nakai K.Clostridium difficile is an important cause of acute enterocolitis in horses. We describe five cases of C difficile infection occurring postoperatively in Thoroughbred racehorses. Following diarrhoea or colic accompanied by a marked increase in packed cell volume (to ≥60 per cent) and leucopenia (≤4000 cells/μl) within two to four days after surgery in all five horses, four of them died or were euthanased because of colitis or severe diarrhoea. In these four horses, necrotising entero-typhlo-colitis was revealed by postmortem examination, and C difficile was recovered from the contents of...
Prophylactic digital cryotherapy is associated with decreased incidence of laminitis in horses diagnosed with colitis.
Equine veterinary journal    December 5, 2013   Volume 46, Issue 5 554-559 doi: 10.1111/evj.12156
Kullmann A, Holcombe SJ, Hurcombe SD, Roessner HA, Hauptman JG, Geor RJ, Belknap J.Recent research suggested that prophylactic digital cryotherapy (ICE) improved lameness scores, diminished histological changes and early laminar inflammatory signalling in horses following oligofructose administration. In clinical practice, horses at risk for sepsis-associated laminitis receive ICE. Evidence to support this practice is lacking. Objective: To determine factors associated with development of laminitis in horses diagnosed with colitis, including ICE. Methods: Multicentre retrospective case series. Methods: Medical records for horses admitted to 2 university hospitals diagnosed w...
Lawsonia intracellularis-associated ulcerative and necro-hemorrhagic enteritis in 5 weanling foals.
The Canadian veterinary journal = La revue veterinaire canadienne    October 25, 2013   Volume 54, Issue 9 853-858 
Arroyo LG, Ter Woort F, Baird JD, Tatiersky L, Delay J, van Dreumel T.This report describes 5 cases of fatal Lawsonia intracellularis-associated ulcerative and necro-hemorrhagic enteritis in weanling Thoroughbred and Standardbred foals. The lesions are similar to those of the L. intracellularis-associated ulcerative and necro-hemorrhagic enteritis syndrome in pigs. Two foals had concurrent severe typhlo-colitis as a result of a large burden of encysted cyathostomes. The clinical, diagnostic, and therapeutic challenges, and the potential complications encountered during the management of such cases are discussed. Entérite ulcérative et nécro-hémorragique asso...
Clinical and clinicopathological factors associated with survival in 44 horses with equine neorickettsiosis (Potomac horse Fever).
Journal of veterinary internal medicine    October 1, 2013   Volume 27, Issue 6 1528-1534 doi: 10.1111/jvim.12209
Bertin FR, Reising A, Slovis NM, Constable PD, Taylor SD.The epidemiology of equine neorickettsiosis (EN) has been extensively studied but limited clinical and clinicopathological data are available concerning naturally infected horses. Objective: Factors predictive of survival will be identified in horses diagnosed with EN. Methods: Convenience sample of 44 horses with EN admitted to 2 referral institutions. Methods: A retrospective study was performed. A diagnosis of EN was based on the presence of positive blood or fecal PCR. Results: The most common clinical signs included diarrhea (66%), fever (50%), anorexia (45%), depression (39%), colic (39%...