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Home / Equine Research Bank / J Vet Intern Med / Evaluation of Owner-Reported Clinical Signs and Fecal Occult...
Journal of veterinary internal medicine2025; 39(6); e70248; doi: 10.1111/jvim.70248

Evaluation of Owner-Reported Clinical Signs and Fecal Occult Blood Tests as Predictors of Equine Gastric Ulcer Syndrome in Competition Dressage Horses.

Abstract: Equine gastric ulcer syndrome (EGUS) adversely affects the health, welfare, and performance of sports horses, requiring gastroscopy for definitive diagnosis. Owners frequently consider girth aversion as highly suggestive of EGUS. Objective: To evaluate whether owner-reported clinical signs or fecal occult blood tests (FOBTs) can help identify horses needing gastroscopy for EGUS diagnosis or monitoring treatment, thereby reducing unnecessary procedures in unaffected horses. Methods: Eighty competition dressage horses referred by veterinarians for EGUS evaluation. Methods: Case-control study including questionnaire, clinical examination, gastroscopy, and FOBT. Based on gastroscopic findings, horses were classified as cases (presenting equine squamous gastric disease, equine glandular gastric disease, or both) or controls (no lesions). Nineteen horses underwent a follow-up examination after EGUS treatment. Predictive values of clinical signs and fecal hemoglobin were assessed using the Wilson-Brown method, and group differences were analyzed using Mann-Whitney and Fisher's exact tests. Results: Fifty-five horses (69%) had EGUS. The most commonly reported clinical signs in this cohort included girth aversion (78%), poor performance (33%), and weight loss (30%), with no differences between groups (p = 0.44-0.99). Neither clinical signs nor FOBT had sufficient sensitivity or specificity for EGUS screening. Among the 19 horses reevaluated after treatment, resolution of clinical signs did not reliably predict mucosal healing, with poor agreement between owner-reported clinical response and gastroscopic outcome. Conclusions: In competition dressage horses, owner-reported clinical signs and FOBT results are unreliable predictors of EGUS or treatment outcomes. Gastroscopy remains essential for accurately diagnosing and monitoring EGUS in sports horses.
© 2025 The Author(s). Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC on behalf of American College of Veterinary Internal Medicine.
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Publication Date: 2025-10-07 PubMed ID: 41055229PubMed Central: PMC12501954DOI: 10.1111/jvim.70248Google Scholar: Lookup
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  • 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.

Overview

  • This study investigated whether clinical signs reported by horse owners and fecal occult blood tests (FOBTs) can effectively predict equine gastric ulcer syndrome (EGUS) in competition dressage horses, aiming to reduce unnecessary gastroscopy procedures.
  • The research concluded that owner-reported symptoms and FOBT results are not reliable indicators of EGUS, and gastroscopy remains necessary for accurate diagnosis and monitoring.

Introduction and Background

  • Equine Gastric Ulcer Syndrome (EGUS): A condition that negatively affects the health, welfare, and performance of sport horses, particularly in competition settings like dressage.
  • Diagnostic Challenge: EGUS requires gastroscopy—a direct visual examination of the horse’s stomach via a scope—for definitive diagnosis.
  • Owner Observations: Owners often associate clinical signs such as girth aversion (resentment or discomfort when the girth is tightened) with EGUS, but it is unclear how predictive these signs are without gastroscopy.
  • Fecal Occult Blood Test (FOBT): A non-invasive test that detects hidden blood in feces, proposed as a potential screening tool for EGUS since ulcers may cause bleeding.

Study Objectives

  • Assess if owner-reported clinical signs and FOBT results can predict the presence of EGUS and distinguish horses requiring gastroscopy.
  • Determine whether these tools can monitor treatment success and reduce unnecessary procedures.

Methods

  • Study Design: Case-control study involving 80 competition dressage horses referred for EGUS evaluation.
  • Procedures Performed:
    • Completion of owner questionnaires documenting clinical signs.
    • Clinical examination by veterinarians.
    • Gastroscopy to visually diagnose EGUS based on gastric lesions.
    • Fecal occult blood tests conducted to detect blood in feces.
  • Classification: Horses were grouped into ‘cases’ (with EGUS lesions—equine squamous gastric disease, equine glandular gastric disease, or both) and ‘controls’ (no gastric lesions).
  • Follow-up: Nineteen horses with EGUS underwent re-evaluation after treatment to assess clinical sign resolution and mucosal healing.
  • Statistical Analysis:
    • Sensitivity, specificity, and predictive values of clinical signs and FOBT were calculated using the Wilson-Brown method.
    • Group differences tested with Mann-Whitney and Fisher’s exact tests.

Results

  • Prevalence of EGUS: 69% (55/80) of horses had gastric ulcers confirmed by gastroscopy.
  • Common Clinical Signs Reported:
    • Girth aversion (78% of horses).
    • Poor performance (33%).
    • Weight loss (30%).
  • Comparisons Between Groups: No significant differences in presence or frequency of these signs between horses with and without EGUS (p-values ranged 0.44 to 0.99), indicating low diagnostic value.
  • Fecal Occult Blood Tests: FOBT also showed poor sensitivity and specificity, failing to reliably differentiate affected horses.
  • Treatment Monitoring: Among the 19 horses reassessed after treatment:
    • Improvement or resolution of owner-reported clinical signs did not consistently match mucosal healing observed on follow-up gastroscopy.
    • There was poor agreement between clinical response and actual gastric mucosal status.

Conclusions and Implications

  • Owner-reported clinical signs such as girth aversion, poor performance, and weight loss are not reliable indicators to diagnose EGUS in competition dressage horses.
  • FOBTs do not have sufficient diagnostic accuracy to serve as standalone screening tools for EGUS.
  • Clinical signs do not reliably predict the healing of gastric lesions after treatment, so they are not effective for monitoring treatment outcomes.
  • Gastroscopy remains essential as the gold standard diagnostic and monitoring tool for EGUS in sports horses.
  • This highlights the need for veterinary professionals and owners to rely on gastroscopy rather than clinical observations or FOBT when diagnosing and managing EGUS in competitive horses.

Cite This Article

APA
Frippiat T, Bonhomme M, Dyson S, Votion DM. (2025). Evaluation of Owner-Reported Clinical Signs and Fecal Occult Blood Tests as Predictors of Equine Gastric Ulcer Syndrome in Competition Dressage Horses. J Vet Intern Med, 39(6), e70248. https://doi.org/10.1111/jvim.70248

Publication

Journal of veterinary internal medicine
ISSN: 1939-1676
NlmUniqueID: 8708660
Country: United States
Language: English
Volume: 39
Issue: 6
Pages: e70248
PII: e70248

Researcher Affiliations

Frippiat, Thibault
  • Sporthorse Medical Diagnostic Centre (SMDC), Heesch, the Netherlands.
  • Fundamental and Applied Research for Animals & Health (FARAH), Faculty of Veterinary Medicine, University of Liège, Liège, Belgium.
Bonhomme, Maëlle
  • Fundamental and Applied Research for Animals & Health (FARAH), Faculty of Veterinary Medicine, University of Liège, Liège, Belgium.
Dyson, Sue
  • The Cottage, Market Weston, UK.
Votion, Dominique-Marie
  • Fundamental and Applied Research for Animals & Health (FARAH), Faculty of Veterinary Medicine, University of Liège, Liège, Belgium.

MeSH Terms

  • Animals
  • Horses
  • Horse Diseases / diagnosis
  • Horse Diseases / pathology
  • Stomach Ulcer / veterinary
  • Stomach Ulcer / diagnosis
  • Stomach Ulcer / pathology
  • Occult Blood
  • Case-Control Studies
  • Male
  • Female
  • Gastroscopy / veterinary

Conflict of Interest Statement

Authors declare no off‐label use of antimicrobials. The authors declare no conflicts of interest.

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