Equine glandular gastric disease: prevalence, impact and management strategies

Abstract

Equine glandular gastric disease (EGGD) is an increasingly recognized disease of the glandular mucosa of the equine stomach. Diagnosis is confirmed by gastric endoscopy and scored based upon one of several different endoscopic scoring systems. Prevalence appears to be variable, depending upon breed and discipline. Primary identified risk factors include exercise frequency, and stress; therefore, management strategies are focused on reducing exercise and stress. Limiting grain intake and increasing pasture turnout may also be helpful preventative measures. Pharmacologic treatment consists primarily of an approved omeprazole product with or without misoprostol or sucralfate. Further research into the pathophysiology of EGGD may allow for identification of other targeted treatments.

Keywords: exercise; gastric ulcer; inflammation; misoprostol; omeprazole; stress.

Figure 1

(A) Normal glandular mucosa (Grade 0, all scoring systems). (B and C) Hyperemia (Grade 1, modified EGUS council, Grade 0 MacAllister). (D) Grade 2 (modified EGUS council), Grade 1 severity and number (MacAllister), moderate, focal, flat and fibrinosuppurative, antrum (ECEIM). (E) Grade 3 (modified EGUS council), Grade 2 severity and number (MacAllister); flat, hemorrhagic, and fibrinosuppurative, antrum (ECEIM). (F) Grade 4 (modified EGUS council), Grade 4 severity and number (MacAllister), raised, hemorrhagic and fibrinosuppurative, pylorus (ECEIM). Photo courtesy Ashley Whitehead. Abbreviations: EGUS, equine gastric ulcer syndrome; ECEIM, European College of Equine Internal Medicine.

Figure 2

Primary pathways contributing to gastric acid secretion of the parietal cell, and site of action of H2 antagonists and PPIs. Abbreviation: PPIs, proton pump inhibitors.