FREE SHIPPING over $40
OVER 9000 FIVE-STAR REVIEWS
5% OFF ALL SUBSCRIPTIONS
100% HAPPINESS GUARANTEE
Analyze Diet
0
Home / Equine Research Bank / Vet Med Sci / Assessment of agreement using the equine glandular gastric d...
Veterinary medicine and science2022; 8(4); 1472-1477; doi: 10.1002/vms3.807

Assessment of agreement using the equine glandular gastric disease grading system in 84 cases.

Abstract: Equine glandular gastric disease (EGGD) is a common condition causing signs of gastric pain although lesions are highly variable in their appearance. The only definitive method to diagnose EGGD ante-mortem is gastroscopy. The current recommended method for describing these lesions is the European College of Equine Internal Medicine (ECEIM) guidelines; however, repeatability between users is variable. This study aimed to validate the reliability of lesion descriptions using ECEIM consensus guidelines, using four blinded equine internal medicine diplomates. Ninety-two horses with EGGD with pre- and post-treatment gastroscopy images were identified using the electronic record at a UK equine hospital between 2012 and 2019. Eight horses were excluded due to non-diagnostic images. Four blinded observers used the recommended grading system to describe images and outcomes. Intraclass correlation coefficients and Krippendorff's alpha were used to determine reliability and agreement, respectively. Intraclass correlation coefficient for severity was 0.782 (95% confidence interval [CI] 0.722-0.832), for distribution was 0.671 (95% CI 0.540-0.763), for the descriptor raised was 0.635 (95% CI 0.479-0.741), fibrinosuppurative was 0.745 (95% CI 0.651-0.812), haemorrhagic was 0.648 (95% CI 0.513-0.744), hyperaemic was 0.389 (95% CI 0.232-0.522) and for outcome was 0.677 (95% CI 0.559-0.770). Krippendorff's alpha for severity was 0.466 (95% CI 0.466-0.418), for distribution was 0.304 (95% CI 0.234-0.374), for the descriptor raised was 0.268 (95% CI 0.207-0.329), fibrinosuppurative was 0.406 (95% CI 0.347-0.463), haemorrhagic was 0.287 (95% CI 0.229-0.344), hyperaemic was 0.112 (95% CI 0.034-0.188) and for outcome was 0.315 (95% CI 0.218-0.408). There was moderate reliability determined between observers using intra-class correlation coefficients and unacceptable agreement determined between observers using Krippendorff's alpha. These results suggest that the current grading system is not comparable between observers, indicating the need to review the grading system or define more robust criteria.
© 2022 The Authors. Veterinary Medicine and Science published by John Wiley & Sons Ltd.
Get Full Text
Publication Date: 2022-04-12 PubMed ID: 35412651PubMed Central: PMC9297748DOI: 10.1002/vms3.807Google Scholar: Lookup
The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
LinkedInCopy
  • Journal Article

Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

The research article assesses the reliability of the current grading system for diagnosing and categorizing equine glandular gastric disease (EGGD). Using a sample of 92 horses and four independent observers, the study finds moderate reliability but poor agreement between observers, suggesting the system requires review.

Research Context and Aim

  • Equine glandular gastric disease (EGGD) is a common ailment in horses, usually diagnosed through gastroscopy. The disease presents in a variety of ways and diagnosis can be subjective.
  • The current accepted method for categorizing these lesions is the European College of Equine Internal Medicine (ECEIM) guidelines. However, there has been inconsistency in the application of these guidelines between users, raising questions about their reliability.
  • The goal of this research was to evaluate the ECEIM guideline’s reliability by checking the agreement of independent observers in describing EGGD lesions.

Methodology

  • A sample of 92 horses with EGGD, who were treated in a UK hospital, were chosen for this study.
  • The horses were selected based on pre- and post-treatment gastroscopy images available from the hospital record.
  • Eight horses were later excluded due to poor quality of the images, leaving 84 horses in the study.
  • Four blinded observers, all diplomates specialized in equine internal medicine, used the ECEIM guidelines to analyze and grade the EGGD lesions depicted in the images.
  • The study used statistical measures, specifically the intraclass correlation coefficients and Krippendorff’s alpha, to determine the degree of reliability and agreement among observations from the four observers.

Results

  • The intraclass correlation coefficients showed moderate reliability among the observers while grading the severity, distribution, and properties of the lesions along with the treatment outcomes.
  • However, Krippendorff’s alpha, a measure of agreement, demonstrated low agreement between the observers in their assessments.
  • The results suggest variability in the interpretations of the ECEIM guidelines, leading to inconsistencies in assessments.

Conclusions

  • The present grading criteria for EGGD lesions are not adequately precise or consistent, leading to considerable variation in diagnoses and grading.
  • This lack of consistent agreement indicates that the grading system should either be revised or more definite criterias should be developed to ensure uniformity in diagnosing and grading EGGD.

Cite This Article

APA
Pratt S, Bowen I, Hallowell G, Shipman E, Redpath A. (2022). Assessment of agreement using the equine glandular gastric disease grading system in 84 cases. Vet Med Sci, 8(4), 1472-1477. https://doi.org/10.1002/vms3.807

Publication

Veterinary medicine and science
ISSN: 2053-1095
NlmUniqueID: 101678837
Country: England
Language: English
Volume: 8
Issue: 4
Pages: 1472-1477

Researcher Affiliations

Pratt, Stefanie
  • School of Veterinary Medicine and Science, University of Nottingham, Nottingham, UK.
Bowen, Ian
  • School of Veterinary Medicine and Science, University of Nottingham, Nottingham, UK.
Hallowell, Gayle
  • School of Veterinary Medicine and Science, University of Nottingham, Nottingham, UK.
Shipman, Emma
  • School of Veterinary Medicine and Science, University of Nottingham, Nottingham, UK.
Redpath, Adam
  • School of Veterinary Medicine and Science, University of Nottingham, Nottingham, UK.

MeSH Terms

  • Animals
  • Gastroscopy / veterinary
  • Horse Diseases / pathology
  • Horses
  • Humans
  • Reproducibility of Results
  • Stomach Diseases / diagnosis
  • Stomach Diseases / veterinary

Conflict of Interest Statement

The authors declare no conflict of interest.

References

This article includes 31 references
  1. Andrews F, Bernard W, Byars D, Cohen N, Divers T, Macallister C, Mcgladdery A, Merritt A, Murray M, Orsini J. Recommendations for the diagnosis and treatment of equine gastric ulcer syndrome (EGUS). Equine Veterinary Education 11, 262–272.
  2. Banse HE, Andrews FM. Equine glandular gastric disease: prevalence, impact and management strategies.. Vet Med (Auckl) 2019;10:69-76.
    pmc: PMC6642651pubmed: 31406687doi: 10.2147/vmrr.s174427google scholar: lookup
  3. Begg LM, O'Sullivan CB. The prevalence and distribution of gastric ulceration in 345 racehorses.. Aust Vet J 2003 Apr;81(4):199-201.
    pubmed: 15080440doi: 10.1111/j.1751-0813.2003.tb11469.xgoogle scholar: lookup
  4. Bell RJ, Kingston JK, Mogg TD. A comparison of two scoring systems for endoscopic grading of gastric ulceration in horses.. N Z Vet J 2007 Feb;55(1):19-22.
    pubmed: 17339912doi: 10.1080/00480169.2007.36730google scholar: lookup
  5. Bowen M. Equine glandular gastric disease recommendations. Equine Health 2018, 29–33.
  6. Crumpton SM, Baiker K, Hallowell GD, Habershon-Butcher JL, Bowen IM. Clinical Research Abstracts of the British Equine Veterinary Association Congress 2015.. Equine Vet J 2015 Sep;47 Suppl 48:9.
    pubmed: 26374956doi: 10.1111/evj.12486_18google scholar: lookup
  7. Hallowell G. Pathogenesis of equine squamous and glandular gastric disease. UK‐Vet Equine 2, 70–75.
  8. Hepburn R. Endoscopic examination of the squamous and glandular gastric mucosa in sport and leisure horses: 684 horses (2005‐2011). The Eleventh International Equine Colic Research Symposium July 7–10, 2014 in Dublin, Ireland.
  9. Hepburn R, Proudman C. Treatment of ulceration of the gastric glandular mucosa: Retrospective evaluation of omeprazole and sucralfate combination therapy in 204 sport and leisure horses. The Eleventh International Equine Colic Research Symposium July 7–10, 2014 in Dublin, Ireland.
  10. Hewetson M, Sykes BW, Hallowell GD, Tulamo RM. Diagnostic accuracy of blood sucrose as a screening test for equine gastric ulcer syndrome (EGUS) in adult horses.. Acta Vet Scand 2017 Mar 11;59(1):15.
    pmc: PMC5346197pubmed: 28284214doi: 10.1186/s13028-017-0284-1google scholar: lookup
  11. Hewetson M, Venner M, Volquardsen J, Sykes BW, Hallowell GD, Vervuert I, Fosgate GT, Tulamo RM. Diagnostic accuracy of blood sucrose as a screening test for equine gastric ulcer syndrome (EGUS) in weanling foals.. Acta Vet Scand 2018 Apr 13;60(1):24.
    pmc: PMC5899374pubmed: 29653546doi: 10.1186/s13028-018-0377-5google scholar: lookup
  12. Husted L, Jensen TK, Olsen SN, Mølbak L. Examination of equine glandular stomach lesions for bacteria, including Helicobacter spp by fluorescence in situ hybridisation.. BMC Microbiol 2010 Mar 19;10:84.
    pmc: PMC2848230pubmed: 20298612doi: 10.1186/1471-2180-10-84google scholar: lookup
  13. Koo TK, Li MY. A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research.. J Chiropr Med 2016 Jun;15(2):155-63.
    pmc: PMC4913118pubmed: 27330520doi: 10.1016/j.jcm.2016.02.012google scholar: lookup
  14. Luthersson N, Nielsen KH, Harris P, Parkin TD. The prevalence and anatomical distribution of equine gastric ulceration syndrome (EGUS) in 201 horses in Denmark.. Equine Vet J 2009 Sep;41(7):619-24.
    pubmed: 19927578doi: 10.2746/042516409x441910google scholar: lookup
  15. MacAllister CG, Andrews FM, Deegan E, Ruoff W, Olovson SG. A scoring system for gastric ulcers in the horse.. Equine Vet J 1997 Nov;29(6):430-3.
    pubmed: 9413714doi: 10.1111/j.2042-3306.1997.tb03154.xgoogle scholar: lookup
  16. Martineau H, Thompson H, Taylor D. Pathology of gastritis and gastric ulceration in the horse. Part 1: range of lesions present in 21 mature individuals.. Equine Vet J 2009 Sep;41(7):638-44.
    pubmed: 19927581doi: 10.2746/042516409x464816google scholar: lookup
  17. Pedersen SK, Cribb AE, Windeyer MC, Read EK, French D, Banse HE. Risk factors for equine glandular and squamous gastric disease in show jumping Warmbloods.. Equine Vet J 2018 Nov;50(6):747-751.
    pubmed: 29660168doi: 10.1111/evj.12949google scholar: lookup
  18. Rendle D, Bowen M, Brazil T, Hallowell G, Hewetson M, Sykes B, Hepburn R, Conwell R. Recommendations for the management of equine glandular gastric disease. UK‐Vet Equine 2, 2–11.
  19. Shabankhani B, Yazdani Charati J, Shabankhani K, Kaviani Cherati S. Survey of agreement between raters for nominal data using krippendorff's Alpha. Archives of Pharmacy Practice 10, 160–164.
  20. Spanton JA, Smith L, Mair TS. Is Serum Amyloid A elevated in horses with equine gastric ulcer syndrome?. Equine Veterinary Education 32, 16–19.
  21. Sykes B, Jokisalo J. Rethinking equine gastric ulcer syndrome: Part 1–Terminology, clinical signs and diagnosis. Equine Veterinary Education 26, 543–547.
  22. Sykes B, Jokisalo J, Hallowell G. Evaluation of a commercial faecal blood test for the diagnosis of gastric ulceration in Thoroughbred racehorses: A preliminary report [abstract]. The Eleventh International Equine Colic Research Symposium July 7–10, 2014 in Dublin, Ireland.
  23. Sykes BW, Kathawala K, Song Y, Garg S, Page SW, Underwood C, Mills PC. Preliminary investigations into a novel, long-acting, injectable, intramuscular formulation of omeprazole in the horse.. Equine Vet J 2017 Nov;49(6):795-801.
    pubmed: 28397996doi: 10.1111/evj.12688google scholar: lookup
  24. Sykes BW, Sykes KM, Hallowell GD. A comparison of two doses of omeprazole in the treatment of equine gastric ulcer syndrome: a blinded, randomised, clinical trial.. Equine Vet J 2014 Jul;46(4):416-21.
    pubmed: 24102898doi: 10.1111/evj.12191google scholar: lookup
  25. Sykes BW, Bowen M, Habershon-Butcher JL, Green M, Hallowell GD. Management factors and clinical implications of glandular and squamous gastric disease in horses.. J Vet Intern Med 2019 Jan;33(1):233-240.
    pmc: PMC6335573pubmed: 30499188doi: 10.1111/jvim.15350google scholar: lookup
  26. Sykes BW, Hewetson M, Hepburn RJ, Luthersson N, Tamzali Y. European College of Equine Internal Medicine Consensus Statement--Equine Gastric Ulcer Syndrome in Adult Horses.. J Vet Intern Med 2015 Sep-Oct;29(5):1288-99.
    pmc: PMC4858038pubmed: 26340142doi: 10.1111/jvim.13578google scholar: lookup
  27. Sykes BW, Sykes KM, Hallowell GD. A comparison of three doses of omeprazole in the treatment of equine gastric ulcer syndrome: A blinded, randomised, dose-response clinical trial.. Equine Vet J 2015 May;47(3):285-90.
    pubmed: 24761780doi: 10.1111/evj.12287google scholar: lookup
  28. Tallon R, Hewetson M. Inter-observer variability of two grading systems for equine glandular gastric disease.. Equine Vet J 2021 May;53(3):495-502.
    pubmed: 32808328doi: 10.1111/evj.13334google scholar: lookup
  29. Tesena P, Yingchutrakul Y, Roytrakul S, Taylor J, Angkanaporn K, Wongtawan T. Searching for serum protein markers of equine squamous gastric disease using gel electrophoresis and mass spectrometry.. Equine Vet J 2019 Sep;51(5):581-586.
    pubmed: 30636330doi: 10.1111/evj.13068google scholar: lookup
  30. Varley G, Bowen IM, Habershon-Butcher JL, Nicholls V, Hallowell GD. Misoprostol is superior to combined omeprazole-sucralfate for the treatment of equine gastric glandular disease.. Equine Vet J 2019 Sep;51(5):575-580.
    pubmed: 30809869doi: 10.1111/evj.13087google scholar: lookup
  31. Wise JC, Wilkes EJA, Raidal SL, Xie G, Crosby DE, Hale JN, Hughes KJ. Interobserver and intraobserver reliability for 2 grading systems for gastric ulcer syndrome in horses.. J Vet Intern Med 2021 Jan;35(1):571-579.
    pmc: PMC7848314pubmed: 33284465doi: 10.1111/jvim.15987google scholar: lookup

Citations

This article has been cited 2 times.
  1. Vokes J, Lovett A, Sykes B. Equine Gastric Ulcer Syndrome: An Update on Current Knowledge.. Animals (Basel) 2023 Apr 5;13(7).
    doi: 10.3390/ani13071261pubmed: 37048517google scholar: lookup
  2. Pratt SL, Bowen M, Hallowell GH, Shipman E, Bailey J, Redpath A. Does lesion type or severity predict outcome of therapy for horses with equine glandular gastric disease? - A retrospective study.. Vet Med Sci 2023 Jan;9(1):150-157.
    doi: 10.1002/vms3.1034pubmed: 36495212google scholar: lookup
Subscribe to our newsletter
Join 99,357 horse owners like you who receive our email updates on horse health and nutrition.