Efficiency of a Combination of Polyethylene Glycol and Psyllium on the Evacuation of Sand Compared to Established Treatment Regimes in Sand Enteropathy of the Horse.

Overview

• This study evaluated the effectiveness of polyethylene glycol combined with psyllium for removing sand from the intestines of horses with sand enteropathy, comparing it to established treatments using sodium sulfate or mineral oil.
• All treatments were effective in reducing intestinal sand, but polyethylene glycol showed the best safety profile with no reported adverse effects.

Background

• Sand accumulation in the abdomen of horses, especially in the ascending colon, increases the risk of colic (severe abdominal pain).
• Sand enteropathy is a condition caused by this accumulation, requiring treatment to evacuate the sand and prevent complications.
• Psyllium, a natural fiber supplement, is used to facilitate sand evacuation, typically combined with laxatives administered via nasogastric tube.
• Common laxatives used are sodium sulfate/magnesium sulfate or mineral oil.
• Polyethylene glycol, a laxative used in humans for chronic constipation, was proposed as an alternative laxative option for horses.

Research Objective

• To compare the efficiency of polyethylene glycol combined with psyllium against traditional combinations of psyllium with sodium sulfate or mineral oil for evacuating sand in horses diagnosed with sand enteropathy.
• Evaluate the effectiveness by measuring sand evacuation using radiographic scoring and assess any adverse side effects during treatment.

Methodology

• A total of 44 horses diagnosed with sand enteropathy were randomly assigned to one of three treatment groups:
• Psyllium combined with sodium sulfate
• Psyllium combined with mineral oil
• Psyllium combined with polyethylene glycol
• Treatments were administered for four consecutive days.
• Pre- and post-treatment radiographs of the horses’ abdomens were taken and assessed using a modified sand severity scoring system derived from previous systems by Keppie et al. and Kendall et al.
• Adverse effects during the treatment period were recorded and compared among the three groups.

Results

• All three treatment groups showed a statistically significant reduction in sand severity scores following treatment (p < 0.001).
• The median score reductions were:
• Sodium sulfate group: -2 points
• Polyethylene glycol group: -3.5 points
• Mineral oil group: -2.5 points
• There was no significant difference in sand score reduction between the three groups (p = 0.428), indicating similar effectiveness.
• No adverse side effects were observed in the polyethylene glycol group during this study, nor are they commonly reported in literature.
• Some adverse effects were implied or known in the other treatment regimes but the study details about these were limited.

Conclusions

• All three treatments effectively facilitated sand evacuation in horses with sand enteropathy.
• Despite similar effectiveness, polyethylene glycol combined with psyllium may be the preferred treatment option due to the absence of adverse effects observed during the study and reported in other literature.
• Polyethylene glycol, already established in human medicine, represents a safe and efficient alternative to traditional laxatives used in horses.

Implications for Veterinary Practice

• Veterinarians treating horses with sand enteropathy might consider polyethylene glycol combined with psyllium as a first-line treatment to improve safety while maintaining efficacy.
• The findings support expanding the use of polyethylene glycol within equine medicine for gastrointestinal health.
• Future studies could further evaluate long-term outcomes, cost-effectiveness, and any rare side effects, reinforcing polyethylene glycol’s role in clinical protocols.