Comparison of different medication protocols in horses with Equine Gastric Glandular Disease (EGGD) – a retrospective study

Abstract

Erosive and ulcerative lesions of the squamous and glandular gastric mucosa are a common disease of the equine stomach. In the past, these lesions in different regions of the mucosa were summarized as one disease (Equine Gastric Ulcer Syndrome) and research focused mainly on the squamous gastric mucosa. Today, findings raised awareness of different underlying pathologies depending on the gastric region. This led to the development of a more precise terminology and the differentiation in Equine Squamous Gastric Disease (ESGD) and Equine Glandular Gastric Disease (EGGD). However, therapy especially of the glandular regions (EGGD) is challenging as treatment protocols such as omeprazole/sucralfate seem less effective as the effects are on squamous lesions. The retrospective study was performed to investigate the efficacy of a monotherapy with misoprostol in comparison to omeprazole/sucralfate and a combined therapy of omeprazole and misoprostol. Therefore, 67 horses which underwent gastroscopic examination were included in the study. The horses were either presented due to acute colic as an emergency and examined during the hospitalisation or had been referred due to behavioural abnormalities and intermittent mild colic symptoms. The horses had glandular and squamous gastric lesions and the group included 31 geldings, 35 mares and one stallion. 50 of the equine patients were Warmblood horses and 17 of them were ponies. Scoring was performed following suggestions of the Consensus statement of the European College of Equine Internal Medicine (2015) and Banse and Andrews (2019). Findings before and after treatment were evaluated retrospectively. 29 horses were treated with omeprazole (2–4mg/kg q. 24h) and sucralfate (12mg/kg q. 12h), 28 horses were treated with misoprostol (5µg/ kg q. 12h) and 10 horses were treated with omeprazole (2–4mg/kg q. 24h) and misoprostol (5µg/kg q. 12h). Mean duration of therapy was 28 days (omeprazole/sucralfate and misoprostol) and 35 days (omeprazole/misoprostol). The horses were discharged from the clinic after the first gastroscopic examination and respective treatment was done at home by their owners until the follow-up examination. A detailed medication protocol was explained and given to the owners as well as a feeding and management advice. Four horses were excluded from the study because they developed mild colic symptoms and lethargy under therapy with misoprostol. Mean EGGD scores decreased significantly under therapy with misoprostol in all examined localisations as follows: fundus p=0.005, antrum pyloricum p=0.003, pylorus p=0.001. Significant improvements after therapy with omeprazole/sucralfate in the glandular region included exclusively the pylorus (p=0,038). EGGD scores decreased non-significantly after treatment with omeprazole and misoprostol. Post-treatment ESGD scores did not show improvement after the therapy with omeprazole/sucralfate. Monotherapy with misoprostol was superior to omeprazole/sucralfate and omeprazole/misoprostol for ameliorating glandular lesions of the equine stomach. This resembles the results of Varley et al. (2019). There was no worsening of ESGD-lesions following therapy with misoprostol like it has been reported in a study of Pickles et al. (2020). Therapy with omeprazole and sucralfate had only little efficacy on lesions of the glandular mucosa and did not have positive effects on squamous lesions. To date, there is no compound containing misoprostol available for equine veterinary medicine in Germany. The authors highly request further research concerning alternative therapeutical options for horses with EGGD and the improvement of their availability for veterinary medicine in Germany.