Does lesion type or severity predict outcome of therapy for horses with equine glandular gastric disease? – A retrospective study.
Abstract: Equine glandular gastric disease (EGGD) is a common condition of the horse. Misoprostol is reported to be superior to oral omeprazole and sucralfate for treatment. Long-acting intramuscular injectable omeprazole (LAIOMEP) is a novel treatment shown to be effective in a small population. This study aimed to determine LAIOMEP efficacy compared to misoprostol and oral omeprazole and identify characteristics that predict treatment outcome. All horses that underwent gastroscopy between 2012 and 2019 were reviewed. Lesions were characterised by 4 blinded observers, all of whom are diplomates in equine internal medicine, using established descriptors from the ECEIM consensus statement and subjective severity. Treatment outcome was ranked as worsened, improved or healed. Consensus lesion type, lesion severity and treatment choice were compared to outcome and data screened using univariate analysis (chi-squared) to determine whether each predicted outcome. Lesion types where univariate analysis predicted a trend (p<0.2) were included in a multiple-regression analysis to identify predictors of outcome irrespective of treatment. Only severity significantly predicted final outcome (p = 0.025) with severe lesions being more likely to improve. Treatment choice did not significantly predict outcome. Overall healing rate was 29% (24 horses), and 43% (44 horses) improved. Treatment healing rates were 23% (10), 12% (7) and 27% (7) for LAIOMEP, misoprostol and oral omeprazole, respectively, with improvement in 69% (14), 76% (21) and 61% (9). 64% of the latter group received sucralfate. Worsening occurred in 7% (6). Treatment length varied with a median of 4 weeks (range 4-20 weeks). This study showed poorer therapy outcome compared to previous studies. The only initial lesion descriptor to predict outcome was severity and treatment choice did not affect outcome.
© 2022 The Authors. Veterinary Medicine and Science published by John Wiley & Sons Ltd.
Publication Date: 2022-12-10 PubMed ID: 36495212PubMed Central: PMC9857143DOI: 10.1002/vms3.1034Google Scholar: Lookup
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Summary
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This research investigates whether the type or severity of lesions in horses with equine glandular gastric disease (EGGD) impacts the success of different treatments. The results show that only the severity of the lesions significantly predicts the outcome of the treatment, while the type of treatment used does not significantly affect the outcome.
Research Objectives and Methodology
- The goal of the investigation was to measure the efficacy of a novel treatment, long-acting intramuscular injectable omeprazole (LAIOMEP), compared with misoprostol and oral omeprazole, which are common treatments for EGGD. The researchers also sought to identify specific characteristics that might predict the success of the different treatments.
- The subjects of the study were horses that underwent gastroscopy procedures between 2012 and 2019. Four observers who specialize in equine internal medicine characterized the lesions and ranked the treatment outcomes as: worsened, improved, or healed.
- The researchers conducted a univariate analysis to compare lesion types, severity, and treatment choices to the treatment outcomes. They identified lesion types predicted to trend using a multiple-regression analysis, but this data was found to be irrelevant to the treatment outcome.
Research Findings
- With a significance level of p = 0.025 (indicating that the result is very likely true), the research found that only lesion severity significantly predicted the outcome of the treatment. Severe lesions were more likely to improve.
- The choice of treatment did not significantly influence the outcome. The healing rates for LAIOMEP, misoprostol, and oral omeprazole were 23%, 12%, and 27% respectively, showing no significant difference in healing rates between the treatments.
- Most horses (43%) improved, while a smaller number (29%) completely healed. A minimal number (7%) worsened. The median length of treatment was 4 weeks, but the range was quite wide (4 to 20 weeks).
Conclusion
- The researchers found that the severity of the lesion was a significant factor in predicting treatment outcome, while the type of treatment administered to the horse did not show a significant effect on the outcome.
- The findings differ from previous studies, which showed superior treatment outcomes. The authors suggest that the variability could be due to different definitions of ‘healing’ and ‘improvement,’ different protocols for assigning severity levels to lesions, or the potentially flawed assumption that ulcer scoring systems are linear.
Cite This Article
APA
Pratt SL, Bowen M, Hallowell GH, Shipman E, Bailey J, Redpath A.
(2022).
Does lesion type or severity predict outcome of therapy for horses with equine glandular gastric disease? – A retrospective study.
Vet Med Sci, 9(1), 150-157.
https://doi.org/10.1002/vms3.1034 Publication
Researcher Affiliations
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonnington, UK.
- Medicine.vet, Upper Broughton, UK.
- IVC Evidensia, Keynsham, UK.
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonnington, UK.
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonnington, UK.
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonnington, UK.
MeSH Terms
- Horses
- Animals
- Stomach Ulcer / veterinary
- Retrospective Studies
- Sucralfate
- Misoprostol
- Omeprazole / therapeutic use
- Horse Diseases / drug therapy
Conflict of Interest Statement
The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.
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