EQUUS - - Eq Medicalfro­nt -

It may not be the most con­ve­nient or cheap­est op­tion, but re­peated na­so­gas­tric tub­ing done in a hospi­tal set­ting is the most ef­fec­tive method for clear­ing sand from a horse’s diges­tive tract, ac­cord­ing to a new study from Fin­land.

A horse who grazes on sandy soil can de­velop ac­cu­mu­la­tions of sed­i­ment in his large colon, which can lead to re­cur­rent colic, weight loss and di­ar­rhea. In se­vere cases, surgery is nec­es­sary to man­u­ally re­move the sand, but sev­eral non­in­va­sive treat­ments are com­monly used to pre­vent and clear ac­cu­mu­la­tions.

One method is feed­ing psyl­lium mu­cil­loid, dried husks from the seed of the Plan­tago ovata plant that ex­pand in the colon to a gelati­nous con­sis­tency. As it passes out of the diges­tive tract, the psyl­lium is be­lieved to carry sand with it. In the other com­mon treat­ment, a na­so­gas­tric tube is used to ad­min­is­ter mag­ne­sium sul­fate (Ep­som salts), which acts as a lax­a­tive.

To com­pare the ef­fi­cacy of these meth­ods, re­searchers at the Uni­ver­sity of Helsinki re­viewed the records of 1,097 horses who had been x-rayed for sand in the diges­tive tract over a six-year pe­riod. They then fo­cused on 246 horses whose ra­dio­graphs showed ar­eas of sand in the colon greater than 75 square cen­time­ters and who were treated med­i­cally and were mon­i­tored ra­dio­graph­i­cally. The study horses fell into one of three treat­ment cat­e­gories:

• those treated at home and fed psyl­lium daily for at least 10 days (group 1)

• those treated once with psyl­lium or mag­ne­sium sul­fate de­liv­ered by a vet­eri­nar­ian us­ing a na­so­gas­tric tube, and then fed psyl­lium at home for 10 days (group 2)

• horses kept in a hospi­tal for three to seven days and treated there daily with psyl­lium and/or mag­ne­sium sul­fate (group 3)

“Horses in group 2 were ini­tially given psyl­lium or mag­ne­sium sul­fate or both de­pend­ing on the clin­i­cian’s judg­ment,” says Ritva Kaikko­nen, DVM. “In group 3 there were some horses who had high mag­ne­sium lev­els or very loose fe­ces so some tub­ings were done with­out mag­ne­sium sul­fate and some were given only mag­ne­sium sul­fate de­pend­ing of the clin­i­cal sta­tus of the horse.”

Fol­low-up ra­dio­graphs

were also taken for each horse. If the horse was man­aged at home, the ra­dio­graphs were taken within 40 days of treat­ment and those in the hospi­tal were ra­dio­graphed within eight days. If the sec­ond ra­dio­graph in­di­cated the sand area had de­creased to less than 25 square cen­time­ters, the ac­cu­mu­la­tion was con

sidered re­solved.

The re­sult­ing data showed that group 3, horses who were hos­pi­tal­ized and un­der­went re­peated tub­ing, had a much higher per­cent­age of re­solved cases, with 91 of 170 horses (53 per­cent) clear­ing sand. In con­trast, the suc­cess rate in group 1 was 24 per­cent and in group 2, it was 21 per­cent.

Kaikko­nen says the ef­fec­tive­ness of hos­pi­tal­iza­tion with re­peated na­so­gas­tric tub­ings could be at­trib­uted to a few fac­tors. “Horses usu­ally do not eat mag­ne­sium sul­fate [so it needs to be de­liv­ered via na­so­gas­tric tube]. With that method, you can get a large bo­lus 0 at once. Ad­min­is­tra­tion tech­nique seems to have an in­flu­ence, but based on pre­vi­ous stud­ies we know that mag­ne­sium sul­fate and psyl­lium in com­bi­na­tion seem to be most ef­fec­tive. An­other fac­tor may be also that horses in the hospi­tal did not have con­tin­ued ex­po­sure to sand.”

Own­ers of horses at risk of sand colic are wise to con­sider the pos­si­ble lim­i­ta­tions of var­i­ous treat­ments, says Kaikko­nen: “We see lots of horses who are given psyl­lium at home but with no ef­fect. So I would ad­vise the horse own­ers not to trust blindly that feed­ing psyl­lium is the so­lu­tion. At the very least, the horse’s en­vi­ron­ment should be con­trolled to pre­vent the ac­cess to sand.”

Ref­er­ence: “Com­par­i­son of psyl­lium feed­ing at home and na­so­gas­tric in­tu­ba­tion of psyl­lium and mag­ne­sium sul­fate in the hospi­tal as a treat­ment for nat­u­rally oc­cur­ring colonic sand (geosed­i­ment) ac­cu­mu­la­tions in horses: a ret­ro­spec­tive study,” Acta Ve­teri­naria Scan­di­nav­ica, Oc­to­ber 2016

Re­peated na­so­gas­tric tub­ing done in a hospi­tal set­ting is the most ef­fec­tive method for clear­ing sand from a horse’s diges­tive tract, ac­cord­ing to a new study from Fin­land.

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