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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.
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Publication Date: 2022-04-12 PubMed ID: 35412651PubMed Central: PMC9297748DOI: 10.1002/vms3.807Google Scholar: Lookup
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Summary

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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.

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Citations

This article has been cited 5 times.
  1. Vokes J, Lovett A, Sykes B. Equine Gastric Ulcer Syndrome: An Update on Current Knowledge. Animals (Basel) 2023 Apr 5;13(7).
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  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.
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  3. Sun C, Chen Q, Gao M, He S, Zhang Z, Zhang W, Xiao X. Multi-channel multiphase CT-based deep learning and radiomics fusion model for noninvasive pathological grading of clear cell renal cell carcinoma. Front Oncol 2025;15:1710329.
    doi: 10.3389/fonc.2025.1710329pubmed: 41626167google scholar: lookup
  4. Irving J, Pineau V, Shultz S, Ter Woort F, Julien F, Lambey S, van Erck-Westergren E. Impact of Low-Starch Dietary Modifications on Faecal Microbiota Composition and Gastric Disease Scores in Performance Horses. Animals (Basel) 2025 Jun 28;15(13).
    doi: 10.3390/ani15131908pubmed: 40646806google scholar: lookup
  5. Muñoz-Prieto A, Rubić I, Rešetar Maslov D, González-Sánchez JC, Mrljak V, Cerón JJ, Hansen S. Towards the Identification of New Biomarkers in Saliva and Serum for Treatment Monitoring of Equine Gastric Ulcer Syndrome: A Liquid Proteomic Approach. Animals (Basel) 2024 Oct 28;14(21).
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