Comparison of endoscopic, necropsy and histology scoring of equine gastric ulcers.
Abstract: Equine gastric ulcer syndrome (EGUS) represents a major health problem in performance horses. Much debate exists regarding endoscopic gastric ulcer scoring systems and their ability accurately to predict severity or depth of gastric ulcers. The purpose of this study was to evaluate the ability of an endoscopist to count gastric ulcers and predict gastric ulcer severity or depth using 2 endoscopic scoring systems and compare them to the same gastric ulcers see on necropsy and histopathology. Endoscopic examination of the stomach was performed under general anaesthesia on 23 mixed breed yearling horses, after feed was withheld for 24 h. Gastric ulcers were scored using 2 systems, number/severity-scoring (N/S) and practitioner simplified (PS) systems. After endoscopy, the horses were subjected to euthanasia and the stomach mucosa examined blindly and scored again at necropsy using above scoring systems. Representative gastric ulcers were then placed in 10% formalin and processed routinely for histopathology. The gastric ulcers were scored using a histopathology system (HSS) based on ulcer depth. Number scores in the N/S scoring system and PS on endoscopic and necropsy examinations were compared using Friedman 2 way analysis of variance. Where significant differences between variables were found a post hoc analysis was conducted using a Tukey's Studentised range (HSD) test. Severity scores using the N/S (ENGS) and PS scores recorded for the stomach via endoscopy and scores from HSS were evaluated for significant association using a Mantel-Haenszel Chi-square and Pearson moment correlation coefficient analysis. Significance was P < 0.05. All horses had gastric ulcers in the nonglandular mucosa via endoscopic examination and at necropsy examination. Mean nonglandular ulcer number (ENGN) score was significantly (P = 0.0024) lower on endoscopic examination compared to the score at necropsy (NNGN); whereas PS scores were not significantly different on endoscopy when compared to necropsy examination. A significant but weak association was found between ENGS and HSS (3.89, P = 0.048; r = 0.453, P = 0.045) and no correlation was found between PS and HSS (1.2, P = 0.272; r = 0.117; P = 0.622). Only 1/23 horses had glandular ulcers observed via endoscopic examination whereas, 6/23 horses had glandular ulcers at necropsy and on histopathology. The prevalence of EGUS is high in stalled yearling horses. The endoscopist may underestimate the number of gastric ulcers and may not be able accurately to predict the severity or depth of those ulcers present in the nonglandular equine stomach. Furthermore, the endoscopist may miss glandular gastric ulcers.
Publication Date: 2002-10-03 PubMed ID: 12358050DOI: 10.2746/042516402776117827Google Scholar: Lookup
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- Comparative Study
- Evaluation Study
- Journal Article
- Research Support
- Non-U.S. Gov't
Summary
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This study aimed to evaluate the capability of endoscopists to accurately count and predict the severity of gastric ulcers in horses using two endoscopic scoring systems in comparison to direct examination during necropsy and histopathological analysis. The findings suggested that endoscopists may underestimate both the number and severity of gastric ulcers.
Research Methodology
- The study included an endoscopic examination of 23 mixed breed yearling horses, performed under general anesthesia after a 24-hour fasting period.
- Gastric ulcers were scored using two systems: number/severity-scoring (N/S) and practitioner simplified (PS) systems.
- Post-endoscopy, the horses were euthanized and the stomach mucosa was examined and scored again at necropsy using the same scoring systems. This allowed for a direct comparison between endoscopy and necropsy results.
- Representative gastric ulcers were then preserved in 10% formalin and routinely processed for histopathology, further enabling a comparison between endoscopic/necropsy results and histopathological results.
Findings and Analysis
- All horses were found to have gastric ulcers in the nonglandular mucosa both during endoscopic examination and at necropsy examination.
- The mean ulcer number score was found to be significantly lower on endoscopic examination than during necropsy, implying a potential underestimation by endoscopists.
- A weak yet significant association was observed between the severity scores from the N/S endoscopy and histopathology system scores but not between the PS and histopathology system scores. This indicates a limited ability of endoscopists to predict gastric ulcer severity.
- Only one horse was found to have glandular ulcers during endoscopic examination, as compared to six horses during necropsy and histopathology. This further reinforces the potential for endoscopists to miss signs of glandular gastric ulcers.
Conclusions
- The prevalence of Equine Gastric Ulcer Syndrome (EGUS) was found to be high in stalled yearling horses.
- The study revealed a potential drawback of endoscopic examination in underestimating both the count and severity of gastric ulcers in horses.
- This underscores the need for better diagnostic techniques or training in endoscopic examinations to prevent a misdiagnosis or underestimation of equine gastric ulcers.
- Additional care might be needed to detect possible glandular gastric ulcers which are harder to detect during endoscopy.
Cite This Article
APA
Andrews FM, Reinemeyer CR, McCracken MD, Blackford JT, Nadeau JA, Saabye L, Sötell M, Saxton A.
(2002).
Comparison of endoscopic, necropsy and histology scoring of equine gastric ulcers.
Equine Vet J, 34(5), 475-478.
https://doi.org/10.2746/042516402776117827 Publication
Researcher Affiliations
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville 37901-1071, USA.
MeSH Terms
- Animals
- Autopsy / veterinary
- Female
- Gastroscopy / methods
- Gastroscopy / veterinary
- Horse Diseases / pathology
- Horses
- Male
- Observer Variation
- Severity of Illness Index
- Stomach Neoplasms / pathology
- Stomach Neoplasms / veterinary
- Stomach Ulcer / pathology
- Stomach Ulcer / veterinary
Citations
This article has been cited 12 times.- Sami M, Azizi S, Kheirandish R, Ebrahimnejad H, Alizadeh S. Protective Effects of Donkey Milk on Ethanol-Induced Gastric Ulcer in Rat. Vet Med Sci 2025 Jan;11(1):e70156.
- Alamoudi JA, El-Masry TA, El-Nagar MMF, El Zahaby EI, Elmorshedy KE, Gaballa MMS, Alshawwa SZ, Alsunbul M, Alharthi S, Ibrahim HA. Chitosan/hesperidin nanoparticles formulation: a promising approach against ethanol-induced gastric ulcers via Sirt1/FOXO1/PGC-1α/HO-1 pathway. Front Pharmacol 2024;15:1433793.
- Tesena P, Vinijkumthorn R, Preuksathaporn T, Piyakul P, Chotikaprakal T, Sirireugwipas R, Wong-Aree K, Prapaiwan N. Evaluation of gastrointestinal tract lesions and serum malondialdehyde levels after repeated oral administration of phenylbutazone in horses. Vet Res Commun 2024 Aug;48(4):2343-2355.
- Asgari P, Amniattalab A. Immunohistochemical Assessment of GDNF and Chromogranin A Expression in Erosive and Granulomatous Lesions in Glandular Region of Equine Stomach. Arch Razi Inst 2023 Aug;78(4):1365-1377.
- McDaniel ZS, Hales KE, Nagaraja TG, Lawrence TE, Amachawadi RG, Carroll JA, Burdick Sanchez NC, Galyean ML, Smock TM, Ballou MA, Machado VS, Broadway PR. Short communication: evaluation of an endotoxin challenge and intraruminal bacterial inoculation model to induce liver abscesses in Holstein steers. J Anim Sci 2023 Jan 3;101.
- Hewetson M, Tallon R. Equine Squamous Gastric Disease: Prevalence, Impact and Management. Vet Med (Auckl) 2021;12:381-399.
- Sasaki N, Nishi Y, Fujiwara Y, Takeyama T, Kumagai H, Senarathna S, Ushiya S, Tokuyama T, Tokuyama T, Tokuyama T, Mii T, Ayaki S, Matsuno K, Nakagawa Y, Nishihara Y, Taura Y. Effect of a novel rice fermented extract on gastric ulcers in horses. J Equine Sci 2021 Jun;32(2):27-30.
- Conner AL, Davis AJ, Porr CA. Effects of a dietary supplement on gastric ulcer number and severity in exercising horses. Transl Anim Sci 2018 Apr;2(2):119-124.
- Munsterman AS, Dias Moreira AS, Marqués FJ. Evaluation of a Chinese herbal supplement on equine squamous gastric disease and gastric fluid pH in mares. J Vet Intern Med 2019 Sep;33(5):2280-2285.
- 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.
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